Ultrasound visibility of select breast biopsy markers for targeted axillary node localization following neoadjuvant treatment: simulation using animal tissue models

Purpose To compare ultrasound visibility of selected biopsy markers in animal tissue models simulating axillary echotexture. Methods Four breast biopsy markers were selected based on size, shape, and composition and compared to an institutional standard for testing in beef steak and pork loin phantoms. BD (R) UltraCor (TM) Twirl (TM); Hologic (R) Tumark (R) Professional series Q, Vision, and X; and BD (R) UltraClip (TM) Dual Trigger wing-shaped (institutional standard) biopsy markers were deployed at superficial (0-2.0 cm) and deep (2.1-4.0 cm) depths in the animal models. An animal model without a biopsy marker served as control. Four participating breast imagers blinded to marker shape and location assessed ultrasound visibility of each biopsy marker using a handheld 5-12 MHz linear array transducer with a 4-point grading system (0, not visible; 1, unsure if visible; 2, visible with difficulty; 3, definite visibility). Each breast imager was asked to select the three most easily visualized biopsy markers. Results Total visibility scores with the four-point grading system demonstrate highest score for the Twirl (TM) (48/48 points), followed by the Tumark (R) Q (42/48) and Tumark (R) Vision (41/48) biopsy markers. Overall individual accuracy scores across all biopsy marker types ranged from 83.3 to 95.8%. Visibility scores based on subjective radiologist assessment also demonstrate the highest vote for the Twirl (TM) (11), followed by the Tumark (R) Vision (7) and Tumark (R) Q (6) biopsy markers. The wing-shaped biopsy marker had the lowest visibility and voter score. Conclusion The Twirl (TM) followed by the Tumark (R) Q and Vision biopsy markers demonstrates the highest visibility scores using a four-point grading system and by radiologist vote.