Comparison of ultrasound visibility and retrieval success of two ultrasound-visible clips in targeted axillary dissection after neoadjuvant chemotherapy.

Authors

Naomi Sakamoto, Hiroki Matsui, Eisuke Fukuma

Published in

Breast cancer (Tokyo, Japan). Jul 26, 2026. Epub Jul 26, 2026.

Abstract

Targeted axillary dissection (TAD) is a less invasive alternative to axillary lymph node dissection (ALND) for patients with clinically node-positive breast cancer who convert to node-negative status after neoadjuvant chemotherapy (NAC). However, the effect of preoperative ultrasound visibility of different clip types on TAD outcomes remains unclear.
We conducted a single-center retrospective cohort study of patients with biopsy-proven axillary node-positive breast cancer who underwent NAC followed by TAD between August 2017 and December 2024. Two ultrasound-visible clips, the UltraCor™ Twirl™ (Twirl) and HydroMARK™, were evaluated. Outcomes included ultrasound visibility, clipped node retrieval success, localization techniques, and false-negative rate (FNR).
Twenty-nine patients were included (Twirl, n = 15; HydroMARK, n = 14). Ultrasound visibility was higher with Twirl than with HydroMARK (86.7% versus 64.3%; p = 0.330). All Twirl cases underwent combined wire and dye-guided localization, whereas HydroMARK cases used multiple localization techniques. Retrieval success reached 100% with Twirl and 78.6% with HydroMARK (p = 0.199). When clips were visible on ultrasound, retrieval rates were high for both clips at 100% for Twirl and 88.9% for HydroMARK (p = 0.850). When clips were not clearly visible, Twirl maintained 100% retrieval compared with 60.0% for HydroMARK (p = 0.895). Among patients who underwent scheduled ALND, the FNR of TAD was 0% (0/6).
Preoperative ultrasound visibility of the clip was associated with successful clip-based TAD. Twirl showed more consistent ultrasound visibility and retrieval success than HydroMARK, which suggests that Twirl may be a more reliable clip for routine clinical practice.

PMID:
42503074
Bibliographic data and abstract were imported from PubMed on 26 Jul 2026.

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