Surgical Clips in Breast-conserving Surgery: Do they Represent the Tumour Bed Accurately?

Author(s): Ozlem Demircioglu*, Erkin Aribal, Meral Uluer, Zerrin Ozgen, Fatih Demircioglu

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 15 , Issue 6 , 2019

Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Introduction: Radiotherapy after Breast-Conserving Surgery (BCS) is a standard treatment for breast cancer. Currently, surgical clips are used to determine the tumour bed before radiotherapy planning. This study aimed to evaluate the migration of these clips on mammograms.

Methods: The study was conducted on 121 females who were treated with radiotherapy after BCS at their first radiologic control examination 6 months after the end of treatment. MLO and CC views of all cases were evaluated regarding the clips. The distance between the surgical scar centre and the centre of the area covered by the clips was measured on both MLO and CC projections and recorded separately. This distance was determined as the clip displacement. A displacement ≤10 mm was recorded as no displacement.

Results: The clips were out of the images and were not evaluated in 45 cases (37.2%) on CC and in 9 cases (7.4%) on MLO projections. There were no clip displacements in 37 (30.6%) cases on CC and in 43 (35.5%) cases on MLO views. The amount of displacement ranged from 11 to 56 mm with a mean of 24.38 mm on CC views, while on MLO projections, displacement ranged from 11 to 66 mm with a mean of 24.42 mm.

Conclusion: A clip displacement of greater than 10 mm was found in 64.5% of cases on MLO views. Therefore, we believe that the reliability of these clips for accurate delineation of the tumour bed in radiotherapy planning is controversial and other methods must be added.

Keywords: Surgical clips, breast-conserving therapy, localization, tumour bed, radiotherapy, breast cancer.

Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet 2005; 366(9503): 2087-106.
Veronesi U, Marubini E, Mariani L, et al. Radiotherapy after breast-conserving surgery in small breast carcinoma: Long-term results of a randomized trial. Ann Oncol 2001; 12(7): 997-1003.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347(16): 1233-41.
Liljegren G, Holmberg L, Bergh J, et al. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: A randomized trial. J Clin Oncol 1999; 17(8): 2326-33.
Smith TE, Lee D, Turner BC, Carter D, Haffty BG. True recurrence vs. new primary ipsilateral breast tumor relapse: An analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys 2000; 48(5): 1281-9.
Vrieling C, Collette L, Fourquet A, et al. Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following Breast-Conserving Therapy in young patients? Eur J Cancer 2003; 39(7): 932-44.
Vicini FA, Beitsch PD, Quiet CA, et al. First analysis of patient demographics, technical reproducibility, cosmesis, and early toxicity: Results of the American Society of Breast Surgeons MammoSite breast brachytherapy trial. Cancer 2005; 104(6): 1138-48.
Vaidya JS, Tobias JS, Baum M, et al. TARGeted Intraoperative radiotherapy (TARGIT): An innovative approach to partial-breast irradiation. Semin Radiat Oncol 2005; 15(2): 84-91.
Arthur DW, Vicini FA. Accelerated partial breast irradiation as a part of breast conservation therapy. J Clin Oncol 2005; 23(8): 1726-35.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347(16): 1227-32.
Arriagada R, Lê MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: Patterns of failure with 15 years of follow-up data. J Clin Oncol 1996; 14(5): 1558-64.
Kirova YM, Fournier-Bidoz N, Servois V, et al. How to boost the breast tumor bed? A multidisciplinary approach in eight steps. Int J Radiat Oncol Biol Phys 2008; 72(2): 494-500.
Orel SG, Kay N, Reynolds C, Sullivan DC. BI-RADS categorization as a predictor of malignancy. Radiology 1999; 211(3): 845-50.
Suzhen W, Jianbin LI, Wei WANG, et al. Study on the displacements of the clips in surgical cavity for external-beam partial breast irradiation after breast-conserving surgery based on 4DCTJ. Radiat Res 2012; 53: 433-8.
Ding Y, Li J, Wang W, et al. Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: A comparative study. Br J Radiol 2013; 86(1030)20130416
Park CK, Pritz J, Zhang GG, Forster KM, Harris EE. Validating fiducial markers for image-guided radiation therapy for accelerated partial breast irradiation in early-stage breast cancer. Int J Radiat Oncol Biol Phys 2012; 82(3): e425-31.
Harris E, Prtiz J, Latifi K, Zhang G, Forster K. Fiducial based image guided radiotherapy for whole breast irradiation. Radiother Oncol 2011; 99: S300.
Yang Z, Chen J, Hu W, et al. Planning the breast boost: How accurately do surgical clips represent the CT seroma? Radiother Oncol 2010; 97(3): 530-4.
Goldberg H, Prosnitz RG, Olson JA, Marks LB. Definition of postlumpectomy tumor bed for radiotherapy boost field planning: CT versus surgical clips. Int J Radiat Oncol Biol Phys 2005; 63(1): 209-13.
Chitapanarux I, Muttarak M, Na-Chiangmai W, et al. Can radiographic plain film be used to determine the depth of the tumour bed in the absence of surgical clips for breast boost planning. Biomed Imaging Interv J 2009; 5(3)e11
Landis DM, Luo W, Song J, et al. Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys 2007; 67(5): 1299-308.
Dzhugashvili M, Pichenot C, Dunant A, et al. Surgical clips assist in the visualization of the lumpectomy cavity in three-dimensional conformal accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys 2010; 76(5): 1320-4.
Esserman L, Hylton N, Yassa L, Barclay J, Frankel S, Sickles E. Utility of magnetic resonance imaging in the management of breast cancer: evidence for improved preoperative staging. J Clin Oncol 1999; 17(1): 110-9.
Charles C. Genson, Caroline E. Blane, Mark A. Helvie, Seth A. WaitsThomas L. Chenevert effects on breast MRI of artifacts caused by metallictissue marker clips. AJR 2007; 188: 372-6.
Kirova YM, Castro Pena P, Hijal T, et al. Improving the definition of tumor bed boost with the use of surgical clips and image registration in breast cancer patients. Int J Radiat Oncol Biol Phys 2010; 78(5): 1352-5.
Kader HA, Truong PT, Pai R, et al. When is CT-based postoperative seroma most useful to plan partial breast radiotherapy? Evaluation of clinical factors affecting seroma volume and clarity. Int J Radiat Oncol Biol Phys 2008; 72(4): 1064-9.
Berrang TS, Truong PT, Popescu C, et al. 3D ultrasound can contribute to planning CT to define the target for partial breast radiotherapy. Int J Radiat Oncol Biol Phys 2009; 73(2): 375-83.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 21 August, 2018
Page: [573 - 577]
Pages: 5
DOI: 10.2174/1573405614666180821121254
Price: $65

Article Metrics

PDF: 41