The following article features coverage from the 2021 San Antonio Breast Cancer Symposium. Click here to read more of Cancer Therapy Advisor’s conference coverage.

A substantial proportion of patients with breast cancer being considered for neoadjuvant chemotherapy do not have a marker clip placed at the time of biopsy, indicating a need for education, according to a presentation at the 2021 San Antonio Breast Cancer Symposium (SABCS).

“If no clip is placed at the time of biopsy, this can delay neoadjuvant chemotherapy or even result in mastectomy in a patient who would have otherwise qualified for breast-conserving therapy,” explained Charlotte J. Yong-Hing, MD, of the BC Cancer in Vancouver, Canada, who is the lead author of the study.

The study retrospectively evaluated data from 800 patients with breast cancer at a single center who were being considered for neoadjuvant chemotherapy between 2018 and 2019. In addition, an online survey of radiologists was conducted to determine practice patterns.

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The aim of the study was to decrease the number of patients without a marker clip placed at biopsy to less than 5% by the end of 2020.

A marker clip was placed at initial biopsy in 49% of patients. Of the patients without clip placement at the time of biopsy, 42% had one placed prior to the initiation of neoadjuvant chemotherapy.

In the survey, radiologists who did not place a clip during biopsy reported that the primary reason was that the lesion was large (33%). They also indicated other reasons, including the cost of the clip (20%), patient refusal (14%), the amount of time it takes to insert a clip (13%), the belief that a clip is not useful (13%), and the biopsy was repeated so a clip was already present (7%).

The timing of neoadjuvant chemotherapy was affected by lack of clip placement. Patients who did not have a clip placed at the time of biopsy experienced a 5.5 day delay in the initiation of neoadjuvant chemotherapy compared with patients who had their clip placed at biopsy.

Overall, 79% of radiologists who participated in the survey indicated that they were not aware of national guidelines for clip placement.

This delay was associated with significant anxiety among the patients who were interviewed, Dr Yong-Hing said.

Dr Yong-Hing concluded that, as a result of the study, “a targeted approach to education for other community practices will be taken, including engaging surgeons and the Breast Tumor group to explain the impact on clinical outcomes when clips are not used.”

Read more of Cancer Therapy Advisor’s coverage of SABCS 2021 by visiting the conference page.


Yong-Hing CJ, Ito C, Corke L, et al. Clip placement after ultrasound guided biopsy in the setting of neoadjuvant chemotherapy. Presented at SABCS 2021; December 7-10, 2021; San Antonio, TX. Abstract P1-03-02.