Reducing Clip Migration in Mammographic-Guided Vacuum Assisted Biopsy With Direct Insertion of the UltraCor Twirl Clip Marker: A Quality Improvement Project.

BACKGROUND

Clip migration is frequently observed in mammographic-guided vacuum-assisted biopsies (VAB) and is associated with greater tissue excision and re-excision rates. Our institutional baseline clip migration rate was 23.5%, with one-third of cases yielding borderline or malignant histology potentially requiring localisation. Studies on modifiable factors affecting clip migration have yielded mixed results.

MATERIALS AND

METHODS

We implemented a direct puncture technique using the UltraCor Twirl clip to reduce clip migration in mammographic-guided VAB, targeting below 15%. Data were collected from September 2021 to July 2023 across two PDSA cycles: PDSA 1 introduced UltraCor Twirl clip deployment; PDSA 2 incorporated education and stock supply securing. Primary outcome measured was clip migration rate. Additional factors were analysed using Chi Square test and multivariable analysis, tracked via run-chart.

RESULTS

790 procedures were analysed. Clip migration rate dropped from 23.5% to 21.0% after PDSA 1 and to 13.5% after PDSA 2, sustained over 6 months. UltraCor Twirl clip was the only statistically significant modifiable factor associated with reduced clip migration at 7.9%, compared to 20.7% for bare metal clips and 24.0% for clips with bioabsorbable coating (p = 0.000233). Fatty breast was associated with higher migration (p = 0.015) but is non-modifiable.

CONCLUSION

Deployment of the UltraCor Twirl clip via direct puncture, as part of a bundled intervention, was associated with significantly reduced clip migration rates. While the relative contributions of clip design, operator education, and system maturation cannot be fully isolated, the intervention is practical, sustainable, and potentially scalable. Multi-centre validation is needed to establish broader applicability.