Clip migration after stereotactic macrobiopsy and presurgical localization: technical considerations and tricks

Purpose. Clipping migration occurs frequently in clinical practice (13-20%), irrespective of the approach. The purpose of this article is to suggest tricks in order to decrease clip migration and optimize presurgical localization. Materials and methods. Retrospective study of breast macrobiopsy from a lateral approach performed between March 2003 and June 2004 : 447 clips were placed. Sixty clips showed migration > 20 mm, due to the accordion effect in 59 cases (98.4%). These 59 procedures were analyzed to try and understand the underlying mechanisms of clip migration. Results. From these 59 clips, more migrations were noted on CC compression (16.6%) compared to MLO compression (5.2%). This difference was statistically significant. Therefore, we promote the use of MLO compression. This incidence also allows optimal presurgical localization in case of clip migration, by placing the patient in the same position while modulating depth based on the extent of clip displacement. Conclusion. For quality purpose, it is imperative to know the clip position relative to the initial target. By using MLO compression from a lateral approach, it is possible to reduce clip migration and optimize future presurged localization.