37-year-old patient, invasive ductal cancer

Prof. Dr. Jörg Heil, Heidelberg University Women’s Hospital, Heidelberg, Germany.

Case description

The patient presented in February 2017 to evaluate an unclear finding that was discovered during a screening in her left breast. Mammographic evidence of a lesion found in 2 levels in imaging, left side, 1 o’clock position, extending over 11x10 mm, ACR 3, BIRADS 5. Sonographic evidence of an unclear and suspicious lesion left, 1 o’clock position, extending over 10x10x11 mm, BIRADS 5. Ultrasound-guided punch biopsy result is a moderately differentiated HER2 phenotype breast cancer NST G2.

Prior to neoadjuvant chemotherapy, ultrasound-guided lesion marking was performed with Tumark Vision (image 1).

Course of treatment

During ultrasound and mammography follow-ups performed 2, 3 and 5 months after marking, the clipmarker was clearly visible in ultrasound and mammographic imaging within the tumour bed (images 2-6) in a no longer clearly differentiated finding.

Upon completion of NACT consisting of 6xTCbHP, segment resection with ALND was performed. After sample radiography and radiological examination (confirmation with mammography), a second resection, medio-cranial, was recommended and performed. In sample radiography, the Tumark Vision was clearly visible in the resected segment tissue (image 8).

 The histological finding suggests a pathological complete remission (ypT0, ypNo, Lo).

Conclusion

In the presented case, the Tumark Vision was clearly differentiated in the ultrasound scans as hyperechoic, ring-shaped structure throughout the complete course of neoadjuvant therapy. Because of limited tumour differentiation – here in complete remission already after the first NACT cycle -, long-term differentiation of the clip was helpful during follow-ups.

Images

Sonographic depiction of the Tumark Vision within the cancer lesion immediately after marking and before NACT initiation.

Image 1: Sonography
Sonographic depiction of the Tumark Vision within the cancer lesion immediately after marking and before NACT initiation.

Sonographic depiction of the Tumark Vision 2 months after marking and after 2 NACT cycles. Finding cannot be clearly differentiated (anymore). Marker within tumour bed.

Image 2: Sonography
Sonographic depiction of the Tumark Vision 2 months after marking and after 2 NACT cycles. Finding cannot be clearly differentiated (anymore). Marker within tumour bed.

Mammography left ML (left image) and CC (right image) 
2 months after marking after 2 NACT cycles. Finding cannot be clearly differentiated (anymore), marker within tumour bed.

Image 3: Mammography
Mammography left ML (left image) and CC (right image) 2 months after marking after 2 NACT cycles. Finding cannot be clearly differentiated (anymore), marker within tumour bed.

Sonographic depiction of the Tumark Vision 3 months after marking. Finding cannot be clearly differentiated (anymore), marker within tumour bed.

Image 4: Sonography
Sonographic depiction of the Tumark Vision 3 months after marking. Finding cannot be clearly differentiated (anymore), marker within tumour bed.

Sonographic depiction of the Tumark Vision 5 months after marking upon completion of NACT (6xTCbHP). Finding cannot be clearly differentiated (anymore), marker within tumour bed.

Image 5: Sonography
Sonographic depiction of the Tumark Vision 5 months after marking upon completion of NACT (6xTCbHP). Finding cannot be clearly differentiated (anymore), marker within tumour bed.

Image 6: Mammography
Mammography left ML (left image) and CC (right image) 5 months after marking upon completion of NACT (6xTCbHP). Finding cannot be clearly differentiated (anymore), marker within tumour bed.

Image 7: Sample radiography

Image 8: Sample radiography