Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Radio-diagnosis

Background: Neoadjuvant chemotherapy has been widely used in treatment of breast cancer, strong response of some tumors can lead to pathological complete response and disappearance of tumor and hence impossiblity of identification of tumor bed by surgeon. Several studies have evaluated the usage of metallic clip for tumor localization. Objective: To study the use of clip and wire marker as a reliable method to overcome the breast conservation therapy difficulty in cases of pCR. Patients and methods: In the present study we prospectively assessed 20 patients who fulfilled the inclusion criteria, clip was placed inside the tumor and reassessment preoperatively with wire placement in patients with non-palpable lesions. Intraoperative specimen radiography is done to assess clip and wire retrieval and status of margin, then frozen and final paraffin examination is done to confirm the status of margin. Results: Clip placement was done to localize the lesion in all the 20 cases (100%) while us guided placement of wire 1 day pre-operative was done in 18 patient (90%) and wasn{u2019}t done in 2 patients where the masses were clinically palpable (10%). In Specimen radiography Clip and Wire retrieval was positive in all cases (100%) cases. Margin was free in (95%) and infiltrated in (5% )of the cases by frozen and paraffin examination while it was 100% free radiologically which means specimen radiology was accurate in 95% only of the cases. Conclusion: Clips used for tumor localization in breast cancer patients undergoing NACT without migration are well tolerated and safe for the patient, easily visualized on imaging, do not interfere with treatment response, and are cost-effective. Also, serves as a guide for post-NACT localization when the tumor is not palpable

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