Breast markers and clips – what are they?

14th October 2025, NIA Diagnostic Imaging

Breast cancer is a major public health issue. It is the most common cancer in Australian women and the second most common cancer overall (Breast Cancer Network Australia, n.d.). Breast markers (or clips) are small (2–3 mm) biocompatible metallic or bioabsorbable markers placed in a breast lesion or area of abnormality. These markers provide a permanent visual reference (unless removed during surgery) for certain procedures and for correlation with imaging across different modalities. Breast marker/clip insertion is available at NIA Imaging, performed by our highly trained Radiologists.

PURPOSE AND FUNCTION

1. Localisation for Future Imaging or Surgery

After a biopsy, a marker allows the exact location of the lesion or abnormality to be identified for follow-up, even when the lesion has resolved or is no longer visible. This is pivotal for:

Follow-up imaging such as mammography, ultrasound, or MRI Preoperative localisation prior to lumpectomy

Monitoring treatment response (e.g., post-neoadjuvant chemotherapy)

2. Treatment Planning

In cases of malignancy, markers assist surgeons and oncologists by identifying the original tumour bed, enabling accurate targeting for surgery or radiotherapy.

3. Documentation and Quality Assurance

Markers provide a permanent visual reference for radiologic–pathologic correlation and help confirm biopsy accuracy.

INDICATIONS

Marking the location of a lesion that has been completely or almost completely removed during needle or vacuum-assisted biopsy (e.g., calcifications or small masses)
Confirming biopsy sites when multiple lesions are present. It is recommended that a different shaped marker is used for each biopsied lesion, and this should be clearly documented during the procedure.
Identifying the location of an ill-defined lesion.
Assisting with future surgery or preoperative localisation when visibility is expected to be challenging, or when localisation will be performed using a different imaging modality.
Lesion mapping for cross-modality correlation during diagnostic work-up.

TYPES OF BREAST MARKERS

1. Metallic Markers

Materials: Titanium or stainless steel (MRI-safe and biocompatible) Shapes: Various, including coil, ribbon, or butterfly designs

2. Bioabsorbable Markers

Materials: Biodegradable polymers that dissolve over time May contain a radiopaque core for long-term imaging visibility

PROCEDURE

Markers are typically inserted immediately following a core needle biopsy under ultrasound or stereotactic guidance. The marker is deployed through the biopsy needle track into the targeted site.

Post-procedure ultrasound is used to confirm the position of the marker relative to the targeted lesion (if placed under ultrasound guidance). Two-view mammography (craniocaudal and mediolateral oblique) is often performed to document final placement.

On ultrasound, the marker appears as a small echogenic focus with posterior shadowing or reverberation artefacts, depending on the material used. On mammograms, the marker appears as a small, metallic, high-density object on a mammogram, visible as a white or bright spot.

SAFETY AND PATIENT CONSIDERATIONS

Allergy check: Confirm any known allergies (e.g., nickel allergy) before selecting the marker material.

Informed consent: Must be obtained prior to the procedure.

Safety: Markers are MRI-safe (conditional) and travel-safe, posing no issues with metal detectors.

Existing Marker/Clip: Before inserting a new breast marker or clip, check whether the patient already has an existing marker at the intended site. If a marker is present, it is essential to use a clip of a different shape or design to avoid confusion on imaging and to minimise the risk of incorrect preoperative localisation during surgical excision.

POST PROCEDURE CARE

Patients are provided with a Patient Implant Information Card, which includes:

Details of the marker or clip used
Patient’s name and procedure date
Name of the clinic and radiologist who performed the procedure

Patients should be advised to keep this card with them and present it to medical personnel before undergoing any future medical procedures or imaging.
Breast marker/clip insertion is available at NIA Imaging. Please call us for more information.

Image 1. Tissue marker was placed adjacent to the residual lesion after
ultrasound-guided core biopsy. Small white arrow: marker.

Image 2. Left breast post-biopsy mammogram with biopsy markers
Subareolar 12 o’clock region biopsied mass with ring-shaped biopsy marker (red circles).
1 o’clock 5 cm from nipple biopsied mass with barbell-shaped biopsy marker (blue circles).
1 o’clock 6 cm from nipple biopsied calcifications with bar-shaped biopsy marker (green circles).
Craniocaudal (left image) and mediolateral (right image) views. L CC, left craniocaudal; L ML, left mediolateral

REFERENCES

Australian Government Department of Health. (2018). Guidance for the use of marker clips by BreastScreen Australia screening and assessment services (Version 2.0). Retrieved from https://www.health.gov.au/sites/default/files/documents/2020/03/guidance-for-the-use-of-marker-clips-by-breastscreen-australia-screening-andassessment- services_0.pdf
Breast Cancer Network Australia. (n.d.). Breast statistics: Cancer in Australia. Retrieved from https://www.bcna.org.au/resources/about-breast-cancer/breast-statisticscancer- in-australia/
Skaane, P. (2022). Breast Imaging: A Core Review (2nd ed.). Wolters Kluwer.
Jackman, R. J., Burbank, F., Parker, S. H., Evans, W. P., & Lechner, M. C. (2020). Tissue marker placement during breast biopsy: Techniques and clinical considerations. American Journal of Roentgenology, 214(3), 728–737.
Mansel, R. E., Sweetland, H. M., & Kissin, M. W. (2021). Breast cancer surgery and localization: The evolving role of biopsy clips. Breast Journal, 27(5), 402–410.
Royal College of Radiologists. (2019). Breast imaging and image-guided intervention: Guidance for practice. London: RCR.
Lee SYS, Win T, Lee YS, Teo SY. Sonographic visibility of the UltraCorTM TwirlTM tissue marker. Breast Disease. 2022;41(1):535-543. doi:10.3233/BD-210078
Nguyen, Quan & Tavana, Anahita & Saddrudin, Sarfaraz & Chao, Celia. (2020). Successful Lumpectomy in a Patient With Multicentric Breast Cancer. Cureus. 12. 10.7759/cureus.10072.

PFO Closure

Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012; 366: 991–

A multicenter, randomized, open-label trial of closure with a percutaneous device, as compared with medical therapy alone, in patients between 18 and 60 years of age who presented with a cryptogenic stroke or transient ischemic attack (TIA) and had a patent foramen ovale. The primary end point was a composite of stroke or transient ischemic attack during 2 years of follow-up, death from any cause during the first 30 days, or death from neurologic causes between 31 days and 2 years.

Results:

Primary end point was 5.5% in the closure group as compared with 6.8% in the medical-therapy group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.45 to 1.35; P = 0.37)

Conclusion:

“In patients with cryptogenic stroke or TIA who had a patent foramen ovale, closure

with a device did not offer a greater benefit than medical therapy alone for the

prevention of recurrent stroke or TIA”

2 Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 2017; 377: 1022–

A multicenter, randomised, open-label trial ,randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomisation.

Results:

Recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient years, respectively (hazard ratio 0.55; 0.31 – 0.999; P = 0.046)

Conclusion:

“Among adults who had had a cryptogenic ischemic stroke, closure of a PFO was associated with a lower rate of recurrent ischemic strokes than medical therapy alone during extended follow-up.”

Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013; 368: 1083–

A prospective, multicenter, randomised, event-driven trial, randomly assigned patients to medical therapy alone (anti-platelet or warfarin therapy) or closure of the patent foramen ovale.

Results:

9 patients in the closure group and 16 in the medical-therapy group had a recurrence of stroke (hazard ratio with closure, 0.49; 0.22 – 1.11; P = 0.08). The primary analysis of the intentionto- treat cohort showed a nominal 51% hazard rate reduction with closure, but the reduction did not reach significance.

Conclusions:

” …there was no significant benefit associated with closure of a patent foramen ovale in adults who had had a cryptogenic ischaemic stroke.”

Sondergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 2017; 377: 1033–

Multinational trial involving patients with a PFO who had had a cryptogenic stroke, randomly assigned patients to undergo PFO closure plus antiplatelet therapy or to receive antiplatelet therapy alone.

Results:

During a median follow-up of 3.2 years, clinical ischemic stroke occurred in 6 of 441 patients (1.4%) in the PFO closure group and in 12 of 223 patients (5.4%) in the antiplatelet-only group (hazard ratio, 0.23; 0.09 to 0.62; P=0.002).

Conclusions:

“Among patients with a PFO who had had a cryptogenic stroke, the risk of subsequent ischemic stroke was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone; however, PFO closure was associated with higher rates of device complications and atrial fibrillation.”

Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017; 377: 1011–

In a multicenter, randomised, open-label trial patients 16-60 years of age who had had a recent stroke attributed to PFO, to transcatheter PFO closure plus long-term antiplatelet therapy, antiplatelet therapy alone or oral anticoagulation.

Results:

No stroke occurred among patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet- only group (hazard ratio, 0.03; 0 to 0.26; P<0.001). Large number of patients discontinued anti-coagulation in the anti-coagulant group and statistical significance was not analysed because the study was not adequately powered to compare outcomes.

Conclusion:

“Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation.”

Lee PH, Song J-K, Kim JS, et al. Cryptogenic stroke and high-risk patent foramen ovale: the DEFENSE-PFO Trial. J Am Coll Cardiol 2018; 71: 2335–

Patients with cryptogenic stroke and high-risk PFO were divided between a transcatheter PFO closure and a medication-only group.

Results:

No events occurred in the PFO closure group. 12.9% of patients in the medication group had an event (p= 0.023).

Conclusion:

“PFO closure in patients with high-risk PFO characteristics resulted in a lower rate of the primary endpoint as well as stroke recurrence”