DOI: 10.1148/rg.241035052
(Radiographics. 2004;24:147-156.)
© RSNA, 2004
Recognizing Pitfalls in Early and Late Migration of Clip Markers after Imaging-guided Directional Vacuum-assisted Biopsy1
Lisa E. Esserman, MD,
Marco A. Cura, MD and
Darlene DaCosta, MD
1 From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140. Recipient of a Certificate of Merit award for an education exhibit at the 2002 RSNA scientific assembly. Received March 6, 2003; revision requested April 4 and received May 23; accepted May 27. All authors have no financial relationships to disclose. Address correspondence to L.E.E. (e-mail: lesserma@salick.com).
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Abstract
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Directional vacuum-assisted biopsy has become an irreplaceable tool in the management of suspicious mammographic lesions. Often, the entire lesion is removed and clips are used to localize the biopsy site. Postbiopsy mammograms are used to determine the adequacy of clip placement and the location of the clip. Clip displacement from the site of deployment is not an uncommon finding. Clips may migrate within the same quadrant where the lesion was located or to another quadrant of the breast. Clip migration may occur immediately after biopsy or may be seen on later follow-up mammograms. Clip migration can affect interpretation of mammographic findings and localization for future surgery. It should not be assumed that the clip is correctly located at the biopsy site on subsequent mammograms. It is essential to recognize the relationship of the clip to the targeted lesion to ensure accurate localization of lesions that require surgical excision.
© RSNA, 2004
Index Terms: Biopsies, complications, 00.126, 00.458 • Biopsies, technology, 00.126 • Breast, biopsy, 00.126 • Breast neoplasms, localization, 00.125 Foreign bodies, 00.4537
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LEARNING OBJECTIVES FOR TEST 5
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After reading this article and taking the test, the reader will be able to:
- Identify patients at risk for clip migration after stereotactic breast biopsy.
- Describe the causes and mechanisms of clip migration after stereotactic breast biopsy.
- Discuss the use of prebiopsy, biopsy, postbiopsy, and follow-up mammography in detection of clip migration.
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Introduction
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Small breast lesions can be removed completely after stereotactic biopsy, and radiographic marker clips are deployed at the biopsy site to facilitate location of the target when additional surgery may be required (1). The marker clip serves as a target for future preoperative needle localization and must be deployed at the intended site and must remain close to it to mark the biopsy site accurately. However, marker clips can be deployed away from the biopsy site or may migrate immediately after biopsy or later, resulting in inappropriate location of a later target site for future needle localization (1,2).
There are many reported causes of clip migration, but additional causes that may result in migration of the clip have not yet been described, to our knowledge. This article describes different mechanisms of clip migration, which include the following: the accordion effect, clip migration in the biopsy track, a clip floating in a hematoma, clip displacement by a hematoma, change in the clip site due to resorption of air at the biopsy cavity, change in the clip site after neoadjuvant chemotherapy, change in the clip site after reduction mammaplasty, and clip displacement by another clip. Other topics discussed are measurement of clip placement and preventive measures.
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Discussion
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Stereotactic core breast biopsy is a minimally invasive procedure that does not deform the breast, causes minimal to no scarring, provides better treatment planning by means of preoperative diagnosis, can be performed quickly, and has a short recovery time (3–5). Results of biopsy of suspicious microcalcifications show in situ or infiltrative cancer in up to 75% of cases (5). A clip is deployed at the biopsy site, which will facilitate preoperative localization in those patients who will require additional surgery (1). Appropriate localization is needed to ensure accurate surgical excision and a good outcome. Additional indications for marker clip placement include the following: to allow confirmation of biopsy of the correct lesion(s), to provide ultrasonographic (US) and mammographic correlation of lesion(s), to allow confirmation of the accuracy of biopsy, to mark the location for preoperative localization of lesions of concern, to mark the lesion site if all imaging findings are removed, to allow monitoring for changes in benign lesions on follow-up mammograms, and to provide imaging documentation of prior biopsy when an imaging history is unavailable.
Reports have shown that clip deployment following stereotactic core-needle biopsy is an accurate method for marking the biopsy site (2,6,7). Other studies reported that clips may be deployed off the biopsy site or migrate from the biopsy site (1,2). To improve the accuracy of clip localization, several generations of clips have been developed.
Clip markers that are deployed through the biopsy probe can be divided into those with a clip alone or those with additional US-visible material, which fills the cavity to center the clip. The MicroMark II clips (Ethicon Endo-Surgery, Cincinnati, Ohio) adhere to tissue with the aid of a vacuum. Unpublished data from our institution show no significant difference in placement accuracy or migration between the MicroMark II and Gel Mark (SenoRx, Aliso Viejo, Calif) clips after US-guided core biopsy in 50 patients and after stereotactically guided vacuum-assisted biopsy in 100 patients.
The metallic clip can be used as a target when subsequent preoperative needle localization and surgical excision are indicated (2).
Measurement of Clip Placement
Several measurement systems have been proposed to assess the accuracy of clip placement and should be able to reveal clip displacement when present. Postprocedure screen-film mammographic measurement of clip-to–biopsy site distances may be performed on dedicated postprocedure screen-film (craniocaudal and lateral) mammograms obtained immediately after the biopsy. This technique allows the breast to decompress after the procedure to its original volume and shape (2). Comparing coordinates on stereoradiographs of the target and clip obtained after the clip has been deployed is easily reproducible and provides measurements in the x, y, and z axes (7,8). The measurements are obtained while the breast is compressed, and the accordion effect can be underestimated (2,9).
The direct method of measurement is used when the biopsy site or residual lesion is visible; the distance from the center of the lesion or biopsy cavity to the clip is measured in both projections (2). The mask measurement system uses a mask in both projections (craniocaudal and lateral), which is created by marking on clear films the location of the localizing markers on the postbiopsy image and the location of the target lesion on the prebiopsy images in both projections (6). The measured distance from the clip to the center of the lesion on both masks is used to determine the distance off target. The true distance between the clip and the lesion is calculated as the mean distance off target minus a correction factor. The direct method of measurement and mask measurement system combines both methods of measurement. The distance between the center of the lesion or biopsy cavity and the clip is measured on the masks, which are created by marking on clear films the location of the localizing markers on the postbiopsy image and the location of the target lesion on the prebiopsy images in both projections.
Routine evaluation of pre- and postbiopsy images and prospective identification of inaccurate clip placement before needle localization and excision should be performed.
Reasons for Clip Migration
Accordion Effect.—
The clip is deployed at the end of the stereotactic biopsy with the breast compressed in the craniocaudal or lateral plane (7,9). When the compression is released, the breast expands to its original shape and size and the clip can migrate in the direction of compression, which is along the direction of the probe or needle track (z axis) either proximal or distal to the biopsy cavity. The accordion effect is best evaluated in the plane orthogonal to the plane of compression used in the biopsy (2,6,7,10,11). The accordion effect may become apparent immediately after the breast has expanded to its normal shape (Fig 1) or on delayed views, even months later (Fig 2) (10). In theory, a clip without gel pellets will be affected more commonly by the accordion effect due to the fact that it may anchor to the tissues that are being compressed during the procedure, which will return to their original position after the compression is released. The term delayed accordion effect refers to clip migration that is seen on later follow-up mammograms and is presumably due to the accordion effect (10). Delayed clip migration can be related to the sequence of postprocedure mammograms or may be related to simple clip migration within or outside the biopsy cavity (10). Fatty tissue is more compressible and fatty breasts are usually compressed to a greater degree during core biopsy, increasing the chances of the accordion effect taking place and predisposing for clip migration.
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Figure 1a. Accordion effect. (a) Lateral mammogram of the right breast obtained after biopsy shows a clip placed at the site of a nodule. (b) Craniocaudal mammogram obtained immediately after biopsy shows that the clip is medially displaced in the direction of the biopsy track.
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Figure 1b. Accordion effect. (a) Lateral mammogram of the right breast obtained after biopsy shows a clip placed at the site of a nodule. (b) Craniocaudal mammogram obtained immediately after biopsy shows that the clip is medially displaced in the direction of the biopsy track.
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Figure 2a. Migration of a clip wire into the biopsy track. (a) Lateral mammogram obtained 2 months after biopsy at the time of needle localization shows a clip located 5 cm inferior to the biopsy site along a linear density (arrow), which represents the biopsy track. (b) Lateral mammogram shows two wires, which indicate the lesion at the top of the biopsy track (arrow) and the clip at the inferior edge of the biopsy track (arrowhead). One wire was targeted toward the clip with a medial approach but migrated superiorly along the biopsy track to the lesion site (arrow). The other wire was also targeted toward the clip with a medial approach and remains at the site of the clip (arrowhead). The surgeon was able to remove the lesion and the entire biopsy track by taking the tissue around both wires.
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Figure 2b. Migration of a clip wire into the biopsy track. (a) Lateral mammogram obtained 2 months after biopsy at the time of needle localization shows a clip located 5 cm inferior to the biopsy site along a linear density (arrow), which represents the biopsy track. (b) Lateral mammogram shows two wires, which indicate the lesion at the top of the biopsy track (arrow) and the clip at the inferior edge of the biopsy track (arrowhead). One wire was targeted toward the clip with a medial approach but migrated superiorly along the biopsy track to the lesion site (arrow). The other wire was also targeted toward the clip with a medial approach and remains at the site of the clip (arrowhead). The surgeon was able to remove the lesion and the entire biopsy track by taking the tissue around both wires.
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Simple Clip Migration in Fatty Tissue.—
The clip can migrate within the predominantly fatty tissue of the breast (5,11). Wires used for needle localization prior to surgery have been reported to migrate within the breast and to remote areas of the body (10,12,13). Simple clip migration may occur either within or outside the biopsy cavity and is unrelated to postbiopsy breast compression during mammography performed between the biopsy and the time when follow-up mammograms are obtained (10). Therefore, biopsy-marking clips have the potential to migrate some distances within or away from the breast (11).
Clip Migration Out of the Lesion.—
Postprocedure oozing or bleeding may explain why some clips are extruded through the skin incision (13) (Fig 3). If the clip is not firmly attached to the breast tissue when deployed, bleeding can cause the clip to travel through the needle track and even out of the breast (11,13). In theory, bleeding into a large biopsy cavity or a patent track may affect those markers that do not adhere to tissue, such as gel clips. A hematoma may prevent any type of clip from adhering to tissue. Radiographs of other parts of the body can be obtained in case of disappearance of the clip to search for distant migration (10).
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Figure 3a. Clip migration out of the lesion. (a) Craniocaudal mammogram obtained after biopsy shows a clip at the site of biopsy of faint calcifications. The compression applied for bleeding at the biopsy site of the superficial lesion led to extrusion of the clip through the incision. (b) Lateral mammogram obtained for needle localization 2 months after biopsy shows that the clip is no longer present.
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Figure 3b. Clip migration out of the lesion. (a) Craniocaudal mammogram obtained after biopsy shows a clip at the site of biopsy of faint calcifications. The compression applied for bleeding at the biopsy site of the superficial lesion led to extrusion of the clip through the incision. (b) Lateral mammogram obtained for needle localization 2 months after biopsy shows that the clip is no longer present.
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Clip Floating in a Hematoma.—
Formation of a hematoma at the biopsy site and subsequent degeneration into a seroma have been related to clip movement. The formation of a large seroma cavity decreases the chances of good clip attachment because the clip may float within the large biopsy cavity (Fig 4).
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Figure 4a. Clip floating in a hematoma. (a) Lateral mammogram obtained 20 days after biopsy shows inferior migration of a clip. (b, c) Craniocaudal (superior view) (b) and 90° lateral (c) mammograms show attempted placement of a localization needle. The needle is placed at the clip on the craniocaudal view (b); however, after repeated attempts at placement, it is persistently off on the lateral view (c). An attempt to localize the clip stereotactically was also unsuccessful.
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Figure 4b. Clip floating in a hematoma. (a) Lateral mammogram obtained 20 days after biopsy shows inferior migration of a clip. (b, c) Craniocaudal (superior view) (b) and 90° lateral (c) mammograms show attempted placement of a localization needle. The needle is placed at the clip on the craniocaudal view (b); however, after repeated attempts at placement, it is persistently off on the lateral view (c). An attempt to localize the clip stereotactically was also unsuccessful.
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Figure 4c. Clip floating in a hematoma. (a) Lateral mammogram obtained 20 days after biopsy shows inferior migration of a clip. (b, c) Craniocaudal (superior view) (b) and 90° lateral (c) mammograms show attempted placement of a localization needle. The needle is placed at the clip on the craniocaudal view (b); however, after repeated attempts at placement, it is persistently off on the lateral view (c). An attempt to localize the clip stereotactically was also unsuccessful.
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Clip Displacement by a Hematoma.—
The formation of a hematoma at the biopsy site may cause significant mass effect and displace the clip from its deployed site (Fig 5).
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Figure 5a. Clip displacement by a hematoma. (a) US scan obtained 2 months after US-guided core biopsy shows a hematoma at the biopsy site. (b, c) Craniocaudal mammograms obtained immediately after biopsy (b) and 2 months after biopsy (c) show anterior migration of the clip.
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Figure 5b. Clip displacement by a hematoma. (a) US scan obtained 2 months after US-guided core biopsy shows a hematoma at the biopsy site. (b, c) Craniocaudal mammograms obtained immediately after biopsy (b) and 2 months after biopsy (c) show anterior migration of the clip.
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Figure 5c. Clip displacement by a hematoma. (a) US scan obtained 2 months after US-guided core biopsy shows a hematoma at the biopsy site. (b, c) Craniocaudal mammograms obtained immediately after biopsy (b) and 2 months after biopsy (c) show anterior migration of the clip.
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Change in Clip Site Due to Resorption of Air at the Biopsy Cavity.—
Larger-volume tissue samples improve the core-biopsy technique by reducing volume-sampling errors and small lesions are often completely removed, increasing the need for clip placement to guide any subsequent excision (10). The larger the biopsy cavity, the greater the chances for clip migration (2) (Fig 6). A clip in a dependent portion of the biopsy cavity may indicate poor clip adherence to the tissue. A free-floating clip in the biopsy cavity may move even to a different quadrant of the breast, and this may occur in a delayed time period after clip deployment (10,11). Applying the vacuum suction while the clip is deployed may improve the adherence of the clip to the breast tissue.
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Figure 6a. Clip site change due to resorption of air at the biopsy site. (a) Craniocaudal mammogram obtained after biopsy shows a clip anterior to a region of microcalcifications (arrow), where an unusually large air cavity is seen. (b) Lateral mammogram obtained 2 months after biopsy shows scarring at the biopsy site and resorption of air from the large cavity with a consequent change in the position of the clip relative to the microcalcifications (arrow).
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Figure 6b. Clip site change due to resorption of air at the biopsy site. (a) Craniocaudal mammogram obtained after biopsy shows a clip anterior to a region of microcalcifications (arrow), where an unusually large air cavity is seen. (b) Lateral mammogram obtained 2 months after biopsy shows scarring at the biopsy site and resorption of air from the large cavity with a consequent change in the position of the clip relative to the microcalcifications (arrow).
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Change in Clip Site after Changes in Breast Anatomy or in Size and Shape of the Lesion.—
The size and shape of the tissue in which the clip is deployed may change after chemotherapy or radiation therapy, and this may be misinterpreted as clip migration (Fig 7). Rarely, microcalcification displacement may occur with stereotactic core biopsies and may be misinterpreted as clip migration. Targeted microcalcifications may be pulled by the probe as it travels through the breast (9).
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Figure 7a. Change in clip site after neoadjuvant therapy. (a) US scan obtained after clip deployment shows pellets on either side of the central clip (arrowheads). (b) Lateral mammogram obtained after US-guided core biopsy shows the clip (arrowhead) in the lesion (arrows). (c) Lateral mammogram obtained 3 months later after completion of neoadjuvant chemotherapy shows the clip (arrow). The apparent change in the location of the clip was due to tumor shrinkage.
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Figure 7b. Change in clip site after neoadjuvant therapy. (a) US scan obtained after clip deployment shows pellets on either side of the central clip (arrowheads). (b) Lateral mammogram obtained after US-guided core biopsy shows the clip (arrowhead) in the lesion (arrows). (c) Lateral mammogram obtained 3 months later after completion of neoadjuvant chemotherapy shows the clip (arrow). The apparent change in the location of the clip was due to tumor shrinkage.
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Figure 7c. Change in clip site after neoadjuvant therapy. (a) US scan obtained after clip deployment shows pellets on either side of the central clip (arrowheads). (b) Lateral mammogram obtained after US-guided core biopsy shows the clip (arrowhead) in the lesion (arrows). (c) Lateral mammogram obtained 3 months later after completion of neoadjuvant chemotherapy shows the clip (arrow). The apparent change in the location of the clip was due to tumor shrinkage.
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Change in Clip Site after Reduction Mammaplasty.—
Another cause of delayed migration after clip deployment is breast surgery. The distortion of the breast anatomy may cause the clip to move to a different quadrant (Fig 8).
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Figure 8a. Change in clip site after reduction mammaplasty. (a) Craniocaudal mammogram obtained immediately after biopsy shows a clip at the biopsy site. (b) Craniocaudal mammogram obtained 1 year after biopsy shows that the clip is in the lateral aspect of the breast. (c) Lateral mammogram obtained after biopsy shows the clip at the biopsy site. (d) Mediolateral oblique mammogram obtained 1 year after biopsy shows that the clip is in the superior aspect of the breast.
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Figure 8b. Change in clip site after reduction mammaplasty. (a) Craniocaudal mammogram obtained immediately after biopsy shows a clip at the biopsy site. (b) Craniocaudal mammogram obtained 1 year after biopsy shows that the clip is in the lateral aspect of the breast. (c) Lateral mammogram obtained after biopsy shows the clip at the biopsy site. (d) Mediolateral oblique mammogram obtained 1 year after biopsy shows that the clip is in the superior aspect of the breast.
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Figure 8c. Change in clip site after reduction mammaplasty. (a) Craniocaudal mammogram obtained immediately after biopsy shows a clip at the biopsy site. (b) Craniocaudal mammogram obtained 1 year after biopsy shows that the clip is in the lateral aspect of the breast. (c) Lateral mammogram obtained after biopsy shows the clip at the biopsy site. (d) Mediolateral oblique mammogram obtained 1 year after biopsy shows that the clip is in the superior aspect of the breast.
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Figure 8d. Change in clip site after reduction mammaplasty. (a) Craniocaudal mammogram obtained immediately after biopsy shows a clip at the biopsy site. (b) Craniocaudal mammogram obtained 1 year after biopsy shows that the clip is in the lateral aspect of the breast. (c) Lateral mammogram obtained after biopsy shows the clip at the biopsy site. (d) Mediolateral oblique mammogram obtained 1 year after biopsy shows that the clip is in the superior aspect of the breast.
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Clip Displacement by Another Clip.—
Deployment of two clips with gel pellets in the same location may cause displacement of the first clip by the second clip. The gel pellets of the second clip will produce enough mass effect within the cavity to cause the first clip to migrate out of the biopsy site (Fig 9). At our institution, two MicroMark (Ethicon Endo-Surgery) clips (clips without gel pellets) have been accurately deployed at the same biopsy site.
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Figure 9a. Clip displacement by another clip. (a) Craniocaudal mammogram of the right breast shows cluster microcalcifications at two sites. (b) Lateral mammogram shows the two clusters of microcalcifications in the superior right breast. (c) Craniocaudal mammogram obtained after biopsy shows two clips at site 1, in the medial aspect of the breast. A second clip was placed at this site because the stereoradiograph pair did not show the first clip. Both clips were placed with a superior approach. A different type of marker was placed at site 2 (arrowhead), in the lateral aspect of the breast, to differentiate the two lesions. (d) Magnified lateral mammogram obtained after biopsy shows that the first clip placed at site 1 has been displaced inferiorly by the second clip placed at that site.
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Figure 9b. Clip displacement by another clip. (a) Craniocaudal mammogram of the right breast shows cluster microcalcifications at two sites. (b) Lateral mammogram shows the two clusters of microcalcifications in the superior right breast. (c) Craniocaudal mammogram obtained after biopsy shows two clips at site 1, in the medial aspect of the breast. A second clip was placed at this site because the stereoradiograph pair did not show the first clip. Both clips were placed with a superior approach. A different type of marker was placed at site 2 (arrowhead), in the lateral aspect of the breast, to differentiate the two lesions. (d) Magnified lateral mammogram obtained after biopsy shows that the first clip placed at site 1 has been displaced inferiorly by the second clip placed at that site.
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Figure 9c. Clip displacement by another clip. (a) Craniocaudal mammogram of the right breast shows cluster microcalcifications at two sites. (b) Lateral mammogram shows the two clusters of microcalcifications in the superior right breast. (c) Craniocaudal mammogram obtained after biopsy shows two clips at site 1, in the medial aspect of the breast. A second clip was placed at this site because the stereoradiograph pair did not show the first clip. Both clips were placed with a superior approach. A different type of marker was placed at site 2 (arrowhead), in the lateral aspect of the breast, to differentiate the two lesions. (d) Magnified lateral mammogram obtained after biopsy shows that the first clip placed at site 1 has been displaced inferiorly by the second clip placed at that site.
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Figure 9d. Clip displacement by another clip. (a) Craniocaudal mammogram of the right breast shows cluster microcalcifications at two sites. (b) Lateral mammogram shows the two clusters of microcalcifications in the superior right breast. (c) Craniocaudal mammogram obtained after biopsy shows two clips at site 1, in the medial aspect of the breast. A second clip was placed at this site because the stereoradiograph pair did not show the first clip. Both clips were placed with a superior approach. A different type of marker was placed at site 2 (arrowhead), in the lateral aspect of the breast, to differentiate the two lesions. (d) Magnified lateral mammogram obtained after biopsy shows that the first clip placed at site 1 has been displaced inferiorly by the second clip placed at that site.
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Preventive Measures
Although placement inaccuracies or migration can be inevitable with any type of clip, there are certain preventive measures that can be taken at the time of the procedure. For example, the accordion effect can be exaggerated in a fatty breast. In those patients, compression can be partially released immediately prior to clip deployment to minimize the accordion effect; the breast is againcompressed to obtain stereotactic images to confirm clip deployment prior to ending the procedure. For stereotactic biopsies, targeting is often performed anterior or posterior to calcifications so that they are not obscured by the needle. Prior to biopsy, the center of the calcifications can also be targeted and the needle can be readjusted to the center for clip placement. Under US guidance, the probe can be removed prior to clip placement. A probe-independent–type clip can then be advanced into the center of the biopsy cavity under direct US visualization. This eliminates the inaccuracy in clip placement that may result from targeting off center even though the biopsy is adequate. The residual lesion can often be better identified when there are no ring down artifacts from the probe. Furthermore, if a hematoma is present, it can be aspirated and compression can be applied to achieve hemostasis prior to placing the clip. This technique will facilitate adherence of the clip to tissue and minimize displacement of the clip by the hematoma. When a Gel Mark or Gel Mark Ultra clip (SenoRx) is used to mark a superficial lesion, several of the pellets can be manually extruded prior to placing the clip to ensure that the clip remains in the breast.
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Recommendations
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1. Postprocedure lateral and craniocaudal screen-film mammograms should be used to document the initial accuracy of clip placement, instead of stereotactic images (2,6,7).
2. The first postbiopsy mammogram should be obtained in the same projection used during core biopsy because the potential for migration is in the direction of the biopsy. The effect of this compression (accordion effect) will be seen on the orthogonal view, which should be obtained after compressing the breast in the same view. (If the orthogonal view is obtained first, the effect of compression on the clip may not be realized before the patient leaves the department.)
3. To ensure successful needle localization when definitive breast surgery is required, any clip displacement should be measured and documented in the written report.
4. To allow adjustment for clip placement errors, 90° lateral and craniocaudal mammograms should be used in planning needle localization to demonstrate the location of the clip in relation to the biopsy site (2).
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Conclusions
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To ensure accurate localization of lesions that will require surgical excision, it is important to understand that there is a potential for clip placement error and clip migration. It should not be assumed that the clip is correctly located at the biopsy site on subsequent mammograms.
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Acknowledgments
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We thank our colleagues, Shari-Lynn Umlas Odzer, MD, and Susan Weisberg, MD, for contributing cases.
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References
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R. L. Rahman, S. Crawford, A. Larkin, and R. Quinlan
Superiority of Sonographic Hematoma Guided Resection of Mammogram Only Visible Breast Cancer: Wire Localization Should be an Exception Not the Rule
Ann. Surg. Oncol.,
August 1, 2007;
14(8):
2228 - 2232.
[Abstract]
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R. Layeequr Rahman, E. Iuanow, S. Crawford, and R. Quinlan
Sonographic Hematoma-Guided vs Wire-Localized Lumpectomy for Breast Cancer: A Comparison of Margins and Volume of Resection
Arch Surg,
April 1, 2007;
142(4):
343 - 346.
[Abstract]
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J. R. Parikh
Delayed Migration of Gel Mark Ultra Clip Within 15 Days of 11-Gauge Vacuum-Assisted Stereotactic Breast Biopsy
Am. J. Roentgenol.,
July 1, 2005;
185(1):
203 - 206.
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D. M. Lanners, K. K. Amrami, R. S. Jonsgaard, J. J. Gisvold, and J. P. Felmlee
Safety and MRI Artifact Evaluation at 1.5 T of Metallic Mounting Sheath of a Marking Clip Inadvertently Deployed at Stereotactic Biopsy
Am. J. Roentgenol.,
September 1, 2004;
183(3):
825 - 829.
[Abstract]
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Abstract
LEARNING OBJECTIVES FOR TEST...
