Wanting to decline titanium markers during stereotactic biopsy pros and cons?
Hello,
I went in for a routine mammogram (my 10th one) and for the first time I had an abnormal mammogram, and a small mass was found that was given the BIRADS 4 rating. I am now waiting for a stereotactic core needle biopsy. I learned about the titanium marker that will be put in during the biopsy and after talking to my breast surgeon about it, I want to decline the marker. I have an allergy to nickel and I also have concerns about breast marker migration, which I understand is not uncommon. My breasts are on the fatty side, so I am especially concerned about the risk of marker migration which would render the purpose of the marker useless.
My question is: if the mass is benign, what are the cons of not having a marker? I am always planning to have my imaging done at the same imaging center, so moving out of state and not having my films is not a concern. Additionally, I am assuming that I will have an external scar from the biopsy that will show the area where the biopsy was done, and probably internal scarring as well.
Comments
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Hi @cookieveg, If you are allergic to nickel you are wise to be careful about any marker used since some of them are a mix of nickel and titanium. There are markers made of pure titanium or stainless steel. To check for an allergic reaction you can wear one taped to your skin for 48 hours.
If the biopsy is benign not leaving a marker has no real consequences. If you move you can always bring a cd of your mammogram images with you. If the biopsy is malignant not leaving a marker could be problematic. Most of the time a radiologist can find the needle track in the breast (the entry point is not necessarily helpful.) If the lesion is small and the needle track or mass can’t be seen on imaging they won’t know the exact location of the cancer. In that case the only surgery that will guarantee the removal of the cancer is a mastectomy.
You can ask if they would remove the biopsy marker if no cancer is found. Good luck and best wishes for a benign result.
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Thanks for your message. I have a follow up question, during the core needle biopsy they find the coordinates of the mass in order to do the biopsy. Wouldn't those same coordinates still be documented so they can use them to find the exact location of the mass again after a mammogram, and then place a wire for a wire guided lumpectomy? Thanks!
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I have a nickel allergy, too, but had a marker and multiple surgical clips in my chest and stomach for Diep flap. Maybe I had some inflammation at the beginning, but who can tell when your body is responding to surgery and trauma? This was four years ago, and I don’t have any problem with inflammation today. I wouldn’t like to have a larger piece like a joint with nickel, though.
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I have some metal allergies. I've never been tested for specifics, but I can't wear earrings (clip, because when I got them pierced decades ago they were constantly infected) unless I slather cortisone on my lobes, and my fingers get blisters if I wear rings that aren't high-grade silver or gold. It's enough of an issue that my hip replacement is non-metallic because the surgeon wanted no possibility of inlammation). When I had my breast biopsy, I mentioned it to the radiologist and she took the clip part off the needle/probe thingie so I wouldn't have metal in me. Since mine turned out to be cancer, the lump was enough to guide further imaging and surgery. A few markers were left in during my lumpectomy to identify the interior scar for future mammograms, and I've had those in me for seven years with no problem.
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You should ask the radiologist about that since my experience is with lab animals. As far as I know the coordinates are put within a window set by the radiologist to encompass the mass. It would probably depend on how much tissue was removed during the biopsy and the ability of the radiologist to reproduce the same window to place the wire. It would be easier to do by stereotactic biopsy using mammography than by core needle biopsy using ultrasound.
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