Background: Detecting breast biopsy markers by ultrasound, especially in the axilla, remains challenging, notably during preoperative localizations after favorable response to neoadjuvant systemic therapy and before targeted axillary dissection. A few biopsy markers, such as one in development using bone cement[1], exhibit ultrasound color Doppler twinkling, a vendor-agnostic signal, which can be readily leveraged for marker detection.
Learning Objectives: 1. Learn what is color Doppler twinkling 2. Learn which markers twinkle 3. Learn how twinkling can be used as an adjunct for marker detection by both breast imagers and surgeons 4. Learn how to scan for twinkling
Abstract Content/Results: We will begin our presentation with a pictorial essay tracing the historical evolution of twinkling, its diagnostic applications (notably as a compelling sign for kidney stones), the ongoing investigations into the cause of twinkling (a 27-year enigma), and the wide availability and vendor-agnostic attributes of twinkling. (Figure 1).
Using images and videos, we will showcase 35 commercial biopsy markers, highlighting the appearance of a few after deployment. Based on the results from our investigation,[2] we will show which commercial markers twinkle. We will briefly show how we leveraged this information to develop a nonmetallic marker that twinkles and the results of preclinical and clinical trials (Figure 2).
Using case examples, we will show how twinkling aids marker detection―featuring a commentary from Dr. Gary Whitman.[3] We use three case examples to show the enduring nature of twinkling that allows for detection during placement, neoadjuvant therapy, and surgical excision. We highlight how the surgeon is able to use twinkling detection on a different ultrasound scanner to find the marked lymph node without preoperative localization (Figure 3).
We will conclude our presentation by showing how to use color Doppler for twinkling detection of biopsy markers. (Figure 4).
Conclusion: This educational electronic presentation will provide viewers with theoretical and practical knowledge on leveraging color Doppler twinkling as an adjunct for successful ultrasound detection of biopsy markers. Twinkling detection of markers can be widely adopted by breast imagers and surgeons for improved patient care.
1. Lee, C., et al., Twinkling-guided ultrasound detection of polymethyl methacrylate as a potential breast biopsy marker. Eur Radiol Exp, 2022. 2. Lee, C., et al., Factors Associated With Ultrasound Color Doppler Twinkling by Breast Biopsy Markers. American Journal of Roentgenology, 2022. 3. Whitman, G., Twinkling: A Useful Adjunct for Identifying Biopsy Clips on US Images. Radiology: Imaging Cancer, 2023.
