Hydromark: A Breast Biopsy Site Marker That Elicits a Deceiving Tissue Response, Difficult To Identify as Biopsy Site on Subsequent Excision.
Makkalon Em, Philip Kane, Clifford Bernstein, Roxanne Palermo, Carmen Tornos. Stony Brook University Medical Center, NY
Background: Marking devices are commonly deployed after core biopsies of breast to identify the area and facilitate the localization of future surgical excision. There are many different types of marking devices, and most are associated with florid foreign body giant cell reaction and other stromal changes that allow the pathologist to easily recognize the site of a previous biopsy under the microscope. We have encountered a series of cases in which the biopsy site was more difficult to visualize, and all had prior core biopsies in which the marking device was a HydroMARK. This is a report of these 9 cases.
Design: Nine cases identified within the last 7 months were retrieved from the radiology files. They were all patients who had an US guided core biopsy using Hydromark as a marking device and who underwent subsequent surgical excision. Radiological and clinical information was obtained from the radiologist performing the core biopsies. All H&E slides from the excisional biopsies were reviewed
Results: All core biopsies were performed for a radiological density and US abnormality. Time elapsed between core biopsy and excision ranged from 11 to 148 days (mean 26 days). All 9 cases underwent needle localized surgical excision, with the clip and / or the biopsy site found by the radiologist on the specimen radiograph. Histologic sections from the biopsy site showed cystically dilated empty spaces that on low magnification were similar to dilated large ducts seen with fibrocystic changes. On high magnification, the spaces were lined by orderly arranged histiocytes with pseudostratification, also mimicking the lining of a cystic duct. Five of the cases had associated isolated multinucleated giant cells within the lining, only seen on higher magnification. None of the cases had stromal reaction outside these cystic spaces. Foreign material was not identified in any of the cases.
Conclusions: The HydroMARK radiographic marking device creates a tissue response that on low magnification mimics fibrocystic changes and can easily be overlooked, making the identification of a biopsy site more difficult. This type of reaction is probably due to the type of bioabsorbable material (polyethylene glycol-based hydrogel) deployed in association with the device, which hydrates after placement. Pathologists should be aware of this histomorphology when trying to confirm the presence of a biopsy site in a surgical excision specimen.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 26, Tuesday Morning