For Radiologists

The Vector Surgical Tissue Orientation System includes both MarginMarker sterile dye and CorrectClips radiographic markers.

Radiologists can more quickly and efficiently evaluate the intra-operative images to confirm that adequate margins of healthy tissue are present in the specimen.


The Problem

In cancer surgery, the single most important predictor of local recurrence is the tissue margins.1 Customary methods used to label tissue margins cause error. Medical research shows discordance rates of 31% to 52% in the identification of specimen margins between surgery, pathology and radiology.2, 3 This error may lead to unnecessary re-excisions or cancer recurrence.4

The Solution

Vector Surgical's Tissue Orientation System, consisting of the MarginMarker® sterile ink kit and CorrectClips® radiographic markers, provides secure and accurate designation of specimen margins, potentially resulting in fewer unnecessary re-excisions, more accurate re-excisions, lower cancer recurrence and improved OR safety.

Clarity and Efficiency

Radiology receives images on which the specimen is fully visible and margins are labeled with CorrectClips to indicate the orientation. The tissue is displayed without obstruction or confounding elements that can otherwise cause error or delay.

Confidence

Validity of Orientation on the Image
  • CorrectClips allow a complete view of tissue so that lesions are quickly located. The Clips are translucent on the image; only the letters indicating orientation show brightly. This is superior to metal tags, which block the view of tissue behind the tag, and which cast a “shadow” that also occludes visibility of the tissue on the image.
  • CorrectClips grip dense or fatty tissue securely and are compatible with compression. Each letter tag rotates and features two perpendicular faces on which the letter appears for optimal visibility on the image.
  • CorrectClips maintain orientation of the specimen over the recommended two orthogonal views. 1, 2, 3
Validity of Microcalcifications on the Image
  • MarginMarker sterile inks are compatible with intraoperative imaging. Non-sterile inks can mimic microcalcifications, confounding the identification of actual microcalcifications on the image. 4

Results

Better Patient Outcomes
  • Fewer unnecessary re-excisions 1, 9
  • More accurate re-excisions 1, 9, 10
  • Potentially lower cancer recurrence 11, 12, 13
Efficiency
  • Less time lost to re-imaging due to an obstructed view of the lesion or ambiguous orientation. 
  • Less possible confusion due to artifacts from non-sterile inks.
  • More efficient radiologist-surgeon communication.

References

 

1. Dooley, W.C. and Parker, J. “Understanding the Mechanisms Creating False Positive Lumpectomy Margins.” American Journal of Surgery 190 (2005): 606-608.

2. Britton, P.D.; Sonoda, L.I.; Yamamoto, A.K.; Koo, B.; Soh, E.; and Goud, A. “Breast Surgical Specimen Radiographs: How Reliable Are They?” European Journal of Radiology 79 (2011): 245-249.

3. Molina, M.A.; Snell, S.; Franceschi, D.; Jorda, M.; Gomez, C.; Moffat, F.L.; Powell, J.; and Avisar, E. “Breast Specimen Orientation.” Annals of Surgical Oncology 16 (2009): 285-288.

4. McCahill, L.E.; Single, R.M.; Aiello Bowles, E.J.; Feigelson, H.S.; James, T.A.; Barney, T.; Engel, J.M.; and Onitilo, A.A. “Variability in Reexcision Following Breast Conservation Surgery.” Journal of the American Medical Association 307.5 (2012): 467-475.

5. Rebner, M; Pennes, D.R.; Baker, D.E.; Adler, D.D.; and Boyd, P. “Two-View Specimen Radiography in Surgical Biopsy of Nonpalpable Breast Masses.” American Journal of Roentgenology 149 (1987): 283-285.

6. “Practice Guideline for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma.” American College of Radiology. Jan. 1, 2002.

7. McCormick, J.T.; Keleher, A.J.; Tikhomirov, V.B.; Budway, R.J.; and Caushaj, P.F. “Analysis of the Use of Specimen Mammography in Breast Conservation Therapy.” American Journal of Surgery 188.4 (2004): 433-436.

8. Wong, J.W.; Bai, H.; Abdul-Karim, F.W.; and MacLennan, G.T. “Simulation of Microcalcifications on Specimen Radiographs of Breast Biopsies by Inks Used in Marking the Surgical Resection Margins.”, The Breast Journal 10.5 (2004): 423-426.

9. Singh, M.; Singh, G.; Hogan, K.T.; Atkins, K.A.; and Schroen, A.T. “The Effect of Intraoperative Specimen Inking on Lumpectomy Re-excision Rates.” World Journal of Surgical Oncology 8.4 (2010).

10. Lovrics, P.J.; Cornacchi, S. D.; Farrokhyar, F.; Garnett, A.; Chen, V.; Franic, S.; and Simunovic, M. “The Relationship Between Surgical Factors and Margin Status After Breast-Conservation Surgery for Early Stage Breast Cancer.” The American Journal of Surgery (2009): 197, 740-746.

11. Gibson, G.R.; Lesnikoski, B.A.; Yoo, J.; Mott, L.A.; Cady, B.; and Barth, R.J. Jr. “A Comparison of Ink-Directed and Traditional Whole-Cavity Re-Excision for Breast Lumpectomy Specimens with Positive Margins.” Annals of Surgical Oncology 8.9 (2001): 693-704.

12. Menes, T.S.; Tartter, P.I.; Bleiweiss, I.; Godbold, J.H.; Estabrook, A.; and Smith, S.R. “The Consequence of Multiple Re-excisions to Obtain Clear Lumpectomy Margins in Breast Cancer Patients.” Annals of Surgical Oncology 12.11 (2005): 881-885.

13. Gage, I.; Schnitt, S.J.; Nixon, A.J.; Silver, B.; Recht, A.; Troyan, S.L.; Eberlein, T.; Love, S.M.; Gelman, R.; Harris, J.R.; and Connolly, J.L. “Pathologic Margin Involvement and the Risk of Recurrence in Patients Treated with Breast-Conserving Therapy.” Cancer 78.9 (1996): 1921-1928.

Additional Medical References