Reducing Clip Migration in Mammographic-Guided Vacuum Assisted Biopsy With Direct Insertion of the UltraCor Twirl Clip Marker: A Quality Improvement Project

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2026-07-01 Epub Date: 2026-05-22 DOI:10.1016/j.clbc.2026.05.007

Sabrina Omar Bintalib, Shiu Suwn Yeo, Hin Yeung Marcus Loh, Awesh Shamrao Gambre, Ling Fung Amanda Liew

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引用次数: 0

Abstract

Background

Clip migration is frequently observed in mammographic-guided vacuum-assisted biopsies (VAB) and is associated with greater tissue excision and re-excision rates. Our institutional baseline clip migration rate was 23.5%, with one-third of cases yielding borderline or malignant histology potentially requiring localisation. Studies on modifiable factors affecting clip migration have yielded mixed results.

Materials and Methods

We implemented a direct puncture technique using the UltraCor Twirl clip to reduce clip migration in mammographic-guided VAB, targeting below 15%. Data were collected from September 2021 to July 2023 across two PDSA cycles: PDSA 1 introduced UltraCor Twirl clip deployment; PDSA 2 incorporated education and stock supply securing. Primary outcome measured was clip migration rate. Additional factors were analysed using Chi Square test and multivariable analysis, tracked via run-chart.

Results

790 procedures were analysed. Clip migration rate dropped from 23.5% to 21.0% after PDSA 1 and to 13.5% after PDSA 2, sustained over 6 months. UltraCor Twirl clip was the only statistically significant modifiable factor associated with reduced clip migration at 7.9%, compared to 20.7% for bare metal clips and 24.0% for clips with bioabsorbable coating (p = 0.000233). Fatty breast was associated with higher migration (p = 0.015) but is non-modifiable.

Conclusion

Deployment of the UltraCor Twirl clip via direct puncture, as part of a bundled intervention, was associated with significantly reduced clip migration rates. While the relative contributions of clip design, operator education, and system maturation cannot be fully isolated, the intervention is practical, sustainable, and potentially scalable. Multi-centre validation is needed to establish broader applicability.

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通过直接插入UltraCor旋转夹标记物减少乳房x线摄影引导的真空辅助活检中的夹移动：一个质量改进项目。

背景：在乳房x线摄影引导下的真空辅助活检（VAB）中经常观察到夹子迁移，并且与更高的组织切除和再切除率相关。我们的机构基线clip迁移率为23.5%，其中三分之一的病例产生边缘性或恶性组织学可能需要定位。对影响夹子迁移的可变因素的研究得出了不同的结果。材料和方法：我们使用UltraCor Twirl夹子实现了直接穿刺技术，以减少乳房x线摄影引导下VAB的夹子迁移，靶向率低于15%。数据收集于2021年9月至2023年7月，分为两个PDSA周期：PDSA 1引入了UltraCor Twirl夹子部署；PDSA 2结合了教育和库存供应保障。测量的主要结果是夹子迁移率。其他因素采用卡方检验和多变量分析进行分析，通过运行图进行跟踪。结果：分析了790例手术。在PDSA 1和PDSA 2后，Clip迁移率分别从23.5%和13.5%下降到21.0%和13.5%，持续时间超过6个月。UltraCor Twirl夹子是唯一具有统计学意义的可修改因素，与7.9%的夹子迁移减少有关，而裸金属夹子为20.7%，生物可吸收涂层夹子为24.0% （p = 0.000233）。脂肪性乳房与较高的迁移相关（p = 0.015），但不可改变。结论：通过直接穿刺部署UltraCor Twirl夹，作为捆绑干预的一部分，可显著降低夹的迁移率。虽然卡箍设计、作业人员培训和系统成熟度的相关贡献不能完全隔离，但修井是实用的、可持续的，并且具有潜在的可扩展性。需要多中心验证以建立更广泛的适用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.