|Publication number||US20080188768 A1|
|Application number||US 11/496,830|
|Publication date||Aug 7, 2008|
|Filing date||Jul 31, 2006|
|Priority date||Sep 10, 2001|
|Also published as||DE60239687D1, EP1424930A2, EP1424930A4, EP1424930B1, EP1424930B8, US6605047, US7083576, US20030050571, US20040049126, WO2003022133A2, WO2003022133A3, WO2003022133A9|
|Publication number||11496830, 496830, US 2008/0188768 A1, US 2008/188768 A1, US 20080188768 A1, US 20080188768A1, US 2008188768 A1, US 2008188768A1, US-A1-20080188768, US-A1-2008188768, US2008/0188768A1, US2008/188768A1, US20080188768 A1, US20080188768A1, US2008188768 A1, US2008188768A1|
|Inventors||Sascha Zarins, Steven Kim|
|Original Assignee||Sascha Zarins, Steven Kim|
|Export Citation||BiBTeX, EndNote, RefMan|
|Referenced by (35), Classifications (14), Legal Events (3)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This is a continuation of U.S. application Ser. No. 10/639,050, filed on Aug. 11, 2003, which is a continuation of U.S. application Ser. No. 09/954,792, filed on Sep. 10, 2001, which issued as U.S. Pat. No. 6,605,047, both of which are hereby expressly incorporated by reference in their entirety.
This invention is directed to delivery devices for delivering subcutaneous cavity marking devices. More particularly, the delivery device may be used with biopsy systems permitting efficient placement of a biopsy marker within a cavity. The device may include an intermediate member which assists in deployment of the marking device. The device may also include a deployment lock to prevent premature deployment of a biopsy marker. The invention may further include the capability to match an orientation of a biopsy probe that has been rotated upon procurement of a biopsy sample.
Over 1.1 million breast biopsies are performed each year in the United States alone. Of these, about 80% of the lesions excised during biopsy are found to be benign while about 20% of these lesions are malignant.
In the field of breast cancer, stereotactically guided and percutaneous biopsy procedures have increased in frequency as well as in accuracy as modern imaging techniques allow the physician to locate lesions with ever-increasing precision. However, for any given biopsy procedure, a subsequent examination of the biopsy site is very often desirable. There is an important need to determine the location, most notably the center, as well as the orientation and periphery of the subcutaneous cavity from which the lesion is removed.
In those cases where the lesion is found to be benign, for example, a follow-up examination of the biopsy site is often performed to ensure the absence of any suspect tissue and the proper healing of the cavity from which the tissue was removed. This is also the case where the lesion is found to be malignant and the physician is confident that all suspect tissue was removed and the tissue in the region of the perimeter of the cavity is “clean”.
In some cases, however, the physician may be concerned that the initial biopsy failed to remove a sufficient amount of the lesion. Such a lesion is colloquially referred to as a “dirty lesion” or “having a dirty margin” and requires follow-up observation of any suspect tissue growth in the surrounding marginal area of the initial biopsy site. Thus, a re-excision of the original biopsy site must often be performed. In such a case, the perimeter of the cavity must be identified since the cavity may contain cancerous cells. Moreover, the site of the re-excised procedure itself requires follow-up examination, providing further impetus for accurate identification of the location of the re-excised site. Therefore, a new marker may be placed after re-excision.
While biopsy markers are well known, examples of improved biopsy markers are described in U.S. patent application Ser. No. 09/285,329 entitled “SUBCUTANEOUS CAVITY MARKING DEVICE AND METHOD” and 09/347,185 entitled “SUBCUTANEOUS CAVITY MARKING DEVICE AND METHOD” each of which is incorporated by reference herein. Placement of such biopsy markers may occur through either invasive surgical excision of the biopsy, or minimally invasive procedures such as fine needle aspiration or vacuum assisted biopsy.
In a fine needle aspiration biopsy, a small sample of cells is drawn by a thin needle from the lump or area of suspect tissue. If the suspect area or lump cannot be easily felt, non-invasive imaging may be used to help the doctor guide the needle into the right area. A core biopsy is similar to a fine needle aspiration biopsy, except that a larger needle is used. Under a local anesthetic, the doctor makes a very small incision in the patient's skin and removes several narrow sections of tissue from the suspect area of tissue through the same incision. The core biopsy provides a breast tissue sample rather than just individual cells. Thus making it easier for the pathologist to identify any abnormalities.
Vacuum-assisted biopsy is performed through the skin and may rely upon ultrasound or stereotactic guidance to determine the location of a suspect area of tissue. Two commonly used vacuum-assisted breast biopsy systems are Mammotome® supplied by Johnson & Johnson Ethicon Endo-surgery or MIBB® supplied by Tyco International. Examples of such devices may be found in U.S. Pat. No. 5,526,822 entitled “Methods and Apparatus for Automated Biopsy and Collection of Soft Tissue,” U.S. Pat. No. 5,649,547 entitled “Methods and Devices for Automated Biopsy and Collection,” U.S. Pat. No. 6,142,955 entitled “Biopsy Apparatus and Method” and U.S. Pat. No. 6,019,733 entitled “Biopsy Apparatus and Method” the entirety of each of which is incorporated by reference herein. Such breast biopsy systems include a probe that is inserted through the skin and is usually adapted to provide a vacuum to assist in obtaining the biopsy sample.
Once inserted through the skin, the cutting member 12 of the probe 10 aligns with suspect tissue 1 via stereotactic, ultrasound, or other means. After proper positioning of the probe 10, a vacuum draws the breast tissue 1 through the probe aperture 14 into the probe 10. As illustrated in
The biopsy system is often adapted such that the cutting member 12 and aperture 14 rotate (e.g., via manipulation of a thumbwheel on the probe or biopsy system) with respect to the biopsy system. After excision of a tissue sample from the area of suspect tissue, the radiologist or surgeon may rotate the probe 10 and the aperture 14 to a new position relative to the biopsy system.
The entire cycle may be repeated until sampling of all desired areas occurs (typically, 8 to 30 samples of breast tissue are taken up to 360 degrees around the suspect area). Accordingly, it is important that the operator of the biopsy system is able to identify the orientation of the probe aperture 14 relative to the biopsy system at any given time while the probe aperture 14 remains within the tissue. Often, demarcations on the thumbwheel permit the identification of the probe orientation.
The above described removal of tissue samples creates tissue cavities. Hence, for reasons that are apparent to those familiar with such biopsy procedures, placement of a biopsy marker through the probe is most desirable. For example, repeated removal of the probe and insertion of a biopsy marking device may cause unneeded additional discomfort to the patient undergoing the procedure; removal of the probe may introduce error in placement of the biopsy marker into the desired location; repeated removal and insertion of each of the devices may prolong the duration of the procedure or spread cancer cells; after the probe removes a tissue sample, it is in the optimal location to deposit a marker; etc.
Biopsies may be performed with other tissue sampling devices as described in U.S. Pat. Nos. 4,699,154; 4,944,308, and 4,953,558 the entirety of each of which is incorporated by reference herein. Such devices obtain a biopsy sample through a hollow biopsy needle having an aperture located in a distal end of the biopsy needle. As with the biopsy devices previously described, once the tissue sampling devices removes tissue and creates a biopsy cavity, it may be desirable to place a marker in the area of the biopsy cavity.
In view of the above, there remains a need for an improved biopsy marker delivery system that may facilitate placement of a biopsy marker and also may be used with commercially available biopsy systems.
This invention relates to delivery systems for delivery of biopsy cavity marking devices. A basic variation of the invention includes a tissue marker delivery device comprising a tube having a lumen extending there through, a tissue marker removably seated in a distal end of the tube, a rod slideably located within the tube lumen and having a first end extending through a proximal end of tube and a second end in the tube lumen; and an intermediate member separating the rod from the biopsy marker, where advancement of the rod in a distal direction displaces the intermediate member to displace the tissue marker from said marker seat. In a variation of this invention, the intermediate member is discrete from both the rod and the tissue marker. The intermediate member may comprise a flexible covering as described herein.
Another variation of the invention includes a delivery device for use with a biopsy probe having an aperture, the delivery device comprising a body having proximal and distal ends and a passageway extending therethrough, an elongate sheath having a lumen extending therethrough, the sheath extending distally from the distal end of the body, the sheath lumen in fluid communication with the body passageway, an access tube having a proximal and a distal end and a lumen extending from at least a portion of the access tube through the proximal end, the access tube slideably located within the body passageway and the sheath lumen, a marker seat located towards the distal end of the access tube, a rod slideably located within the access tube lumen and having a first end extending through the proximal end of the body and a second end in communication with the marker seat, wherein advancement of the rod in a distal direction advances the marker seat distally until the marker seat is adjacent to the probe aperture such that a marker in the marker seat may be deployed from the aperture. For example, when using a biopsy probe having an aperture in a side wall of the probe, the marker seat may be advanced within the aperture and subsequently deploys a marker. When the inventive device is used with biopsy probes having an aperture in a distal end of the probe, the marker seat may be advanced just proximal to the aperture in preparation for subsequent deployment of the marker.
The rod may advance the marker seat through a number of configurations. For example, the rod may be sized to have an interference fit with a portion of the access tube lumen. Another example includes a device configured such that the rod engages a marker which is situated in the marker seat. In such a case, a sheath may restrain the marker in the marker seat. Thus, until the marker is no longer constrained by the sheath, the rod will advance the marker within the sheath. In another variation, the rod may be in communication with a fluid that is itself in communication with the marker seat. In such a case, the rod may apply a force on the fluid to advance the marker seat and/or displace a marker from the marker seat. In some variations, the fluid may serve to displace a flexible covering out of the marker seat. It is contemplated that the rod of the present invention may advance the marker seat through a combination of configurations either described herein or known to those familiar with similar delivery devices.
A variation of the invention also includes a delivery device as described above, wherein the body father comprises a keyway along the passageway, and the body has an orientation being defined relative to the keyway, the delivery device further comprising an access tube key located on the access tube and adapted to be slideably located within the body keyway, the access tube key adapted to maintain an orientation of the access tube with the body orientation.
Variations of the invention may also include a deployment lock having a first end and a second end, the first end moveably located in the body and the second end located outside of the body, the first end adapted to engage a portion of the rod to prevent at least distal movement of the rod, whereupon disengagement of the first end of the deployment lock from the portion of the rod permits distal movement of the rod. The deployment lock may be removable from the device or may be moveable within the device so as to permit disengagement of the lock from the rod while still being attached to the body of the device.
The invention also may include a rod stop fixedly located on the rod, wherein after the rod is advanced into the marker seat, the rod stop engages the access tube stop preventing further distal movement of the rod. The rod stop may also include a rod key that is adapted to maintain an orientation of the rod with the body orientation.
A variation of the device includes an access tube stop fixedly located on a portion of the access tube being located within the body, wherein advancement of the rod in a distal direction advances the marker seat distally until the access tube stop engages the distal end of the body preventing further distal movement of the access tube whereupon further distal advancement of the rod advances into the marker seat. In one variation of the invention, engagement of the access tube stop against the distal end of the body places the marker seat adjacent to the biopsy probe aperture.
In another variation of the invention a portion of the distal end of the access tube is removed to define the marker seat. The invention may also include a covering located over at least the marker seat, where at least a portion of the covering is adapted to displace into and out of the marker seat. Movement of the rod into the marker seat displaces the covering out of the marker seat. In variations of the invention using such a covering, there is no direct contact between the actuator (e.g., rod, etc.) and a marker placed within the marker seat.
In another variation of the invention, the inventive device includes a delivery device key adapted to seat in the biopsy probe and maintain an orientation of the access tube with an orientation of the biopsy probe. The delivery device key may be located on the elongated sheath or on the body of the device. In some variations of the invention, seating the delivery device key in the biopsy probe will cause a distal end of the outer sheath to be placed immediately proximal to the biopsy probe aperture.
Variations of the invention also may include a biopsy marker that is seated in the marker seat.
Although the delivery device and method described herein for delivering a marking device to a subcutaneous cavity is suited for use with a biopsy probe, the invention is not necessarily limited as such. Variations of the inventive device may be used with any type of biopsy procedure.
The invention also contains a kit containing a biopsy marker delivery device as described herein and an introducer cannula. The introducer cannula may be used to facilitate insertion of the delivery device into the patient to assist in delivery of a biopsy marker. The kit may also include a biopsy probe. The biopsy probe may be a spring-loaded biopsy probe.
The invention also includes a method for marking a biopsy cavity. In one variation, the inventive method includes using a delivery device having a marker, a tube removably seating the marker, a rod within the tube, and an intermediate member separating the rod and the marker, the method comprising, advancing the marker and delivery device to the biopsy cavity, actuating the rod to displace the intermediate member on the delivery device; and depositing the marker in the cavity upon displacing the intermediate member.
The following discussion of the variations of the invention and the reference to the attached drawings are for explanatory purposes and do not exhaustively represent the possible combinations and variations of the invention. Those skilled in the art will readily appreciate that many variations may be derived using the following description. The following examples are intended to convey certain principles of the invention. These examples are not intended to limit the scope of the claims to any particular example. It is understood that the claims are to be given their broadest reasonable interpretation in view of the description herein, any prior art, and the knowledge of those of ordinary skill in the field. Furthermore, it is understood that the invention is not limited to the markers described herein. Instead, the invention may be used with any type of biopsy marker or tissue marker.
As will be apparent, the device 20 may incorporate features to permit ease in handling the device 20. For example, the proximal ends of the body 22 and the rod 30 each may have portions 40, 42 of increased surface area that assist in the ability to actuate the device. Also, the second end 36 of the deployment lock may have raised surface areas 44 that permit an operator to grip the deployment lock 32 when an operator disengages the first end 34 of the deployment lock 32 from the rod 30. Such features, which permit ease in handling the device, are well known to those skilled in the art and are not meant to limit the scope of the invention.
In the variation depicted in
The inventive device also includes an elongate sheath 28 extending distally from a distal end 24 of the body 22. The elongate sheath 28 contains a lumen (not shown) that extends through the sheath 28. The sheath lumen is in fluid communication with the body passageway 46. By fluid communication, it is meant that the passageways merely intersect or join one another. The elongate sheath 28 may be flexible such that the sheath 28 may be advanced to a biopsy site, either through a device, such as a biopsy probe, cannula, etc., or through a biopsy tract created by the biopsy procedure. In any case, variations of the invention may include sheaths 28 that may have sufficient rigidity to access the biopsy cavity (in some cases the sheath 28 may even contain a reinforcing member, e.g., a braid, stiffening member.) The sheath may comprise materials such as polyethylene (PE), especially high density PE (HDPE), nylon, urethane, or a fluoropolymer.
A variation of the inventive device, as illustrated in
As illustrated in
The access tube 58 will contain a marker seat 62 located towards a distal end 70 of the tube 58. The marker seat 62 will be adapted depending upon the biopsy marker used with the device. For example, a marker seat 62 may be formed by removing a portion of the access tube 58. In some variations of the invention, the invention may have an intermediate member that separates the biopsy marker from the actuating member of the device (e.g., the rod, etc.) and ejects/deploys the marker from the device. The intermediate covering may be discrete from the tube and tissue marker, e.g., a flexible covering 64 as described below. However, it is also contemplated that a portion of the tube itself could be configured to serve as the intermediate member (e.g., a weakened section of a tube that is adapted to fold into the tube lumen to seat the marker and unfold from the lumen to deploy the marker.)
As described above, a variation of the invention includes an intermediate member that is a flexible covering 64. The flexible covering 64 may be located over a portion of the tube 58 which includes the marker seat 62.
In another variation, the distal end of the rod 30 and the lumen 72 of the access tube 58 may be sized such to provide a friction fit between the lumen 72 and the rod 30. Thus, the friction fit permits the rod 30 to advance the access tube 58 until the access tube 58 meets with sufficient resistance to permit the rod 30 to advance independently of the access tube 58. In any case, advancement of the rod 30 in a distal direction advances the marker seat 62 distally until the marker seat 62 is adjacent to the probe aperture such that a marker located in the marker seat 62 may be ejected from the probe aperture.
The invention includes variations where the rod advances the marker seat through a combination of configurations either described herein or known to those familiar with similar delivery devices.
In some variations of the invention the rod 30 may be entirely replaced with fluid. In such a case, a syringe or similar apparatus would provide an actuator/pressure source to displace the fluid and deploy the marker. Moreover, the flexible covering 64 may also be fluid-tight such that the fluid cannot escape from the device. For example,
It should be noted that the rod 30 and access tube 58 of the present invention may be sufficiently flexible to navigate through a biopsy probe, cannula, etc., to access a biopsy site. However, some applications may require variations of the invention having a rigid access tube and rod.
In variations of the invention not having an access tube stop 60, distal movement of the rod 30 advances the marker seat distally due to the distal end of the rod pushing against a marker within the marker seat. Since the marker is constrained by the sheath and/or biopsy probe, it remains within the marker seat. Once the marker is advanced out of the sheath 28 and is placed adjacent to the probe aperture, it is no longer constrained by the sheath 28 or the biopsy probe. At this point, further distal movement of the rod 30 ejects the now unconstrained marker from the marker seat through the probe aperture and into a biopsy cavity.
In the bodies of
In the case of the ring-shaped markers (154) of
Obviously, marker (150), (154) may reside in locations other than those demonstrated in
Tissue regrowth in a particular orientation can also be promoted by a body design shown in
A trio of markers is also shown in
Shell (142) may be designed to have a varying bioabsorption rate depending upon the thickness and type of material making up the shell (142). In general, the shell can be designed to degrade over a period ranging from as long as a year or more to as little as several months, weeks, or even days. It is preferred that such a bioabsorbable shell be designed to degrade between two and six months; especially preferred is three months. In the design of
As will be described in additional detail with respect to
Each of the bodies depicted in
Examples of synthetic bioabsorbable polymers that may be used for the body of the device are polyglycolide, polyglycolic acid (PGA), polylactide, polylactic acid (PLA), poly .epsilon.-caprolactone, polydioxanone, polylactide-coglycolide, e.g., block or random copolymers of PGA and PLA, and other commercial bioabsorbable medical polymers. Preferred is spongy collagen or cellulose. As mentioned above, materials such as hemostatic and pain-killing substances may be incorporated into the body and marker of the cavity marking device. The use of hemostasis-promoting agents provides an obvious benefit as the device not only marks the site of the biopsy cavity but it aids in healing the cavity as well. Furthermore, such agents help to avoid hemotomas. These hemostatic agents may include AVITENE Microfibrillar Collagen Hemostat, ACTIFOAM collagen sponge, sold by C. R. Bard Inc., GELFOAM, manufactured by Upjohn Company, SURGICEL Fibrillar from Ethicon Endosurgeries, Inc., and TISSEEL VH, a surgical fibrin sealant sold by Baxter Healthcare Corp. The device may also be made to emit therapeutic radiation to preferentially treat any suspect tissue remaining in or around the margin of the biopsy cavity. It is envisioned that the marker would be the best vehicle for dispensing such local radiation treatment or similar therapy. Also, the body itself may be adapted to have radiopaque, echogenic, or other characteristics that allow the body to be located by non-invasive technique without the use of a marker. Such characteristics permit the possibility of locating and substantially identifying the cavity periphery after deployment but prior to absorption of the device. Furthermore, an echogenic coating may be placed over the radiopaque marker to increase the accuracy of locating the marker during ultrasound imaging.
Further, as illustrated in
The hollow sphere (152) marker design of
An important aspect of the invention is that the marker may be radiopaque, echogenic, mammographic, etc., so that it can be located by non-invasive techniques. Such a feature can be an inherent property of the material used for the marker. Alternatively, a coating or the like can be added to the marker to render the marker detectable or to enhance its detectability. For radiopacity, the marker may be made of a non-bioabsorbable radiopaque material such as platinum, platinum-iridium, platinum-nickel, platinum-tungsten, gold, silver, rhodium, tungsten, tantalum, titanium, nickel, nickel-titanium, their alloys, and stainless steel or any combination of these metals. By mammographic we mean that the component described is visible under radiography or any other traditional or advanced mammography technique in which breast tissue is imaged.
As previously discussed, the marker can alternatively be made of or coated with a bioabsorbable material. In this case, the marker can, for instance, be made from an additive-loaded polymer. The additive is a radiopaque, echogenic, or other type of substance that allows for the non-invasive detection of the marker. In the case of radiopaque additives, elements such as barium- and bismuth-containing compounds, as well as particulate radio-opaque fillers, e.g., powdered tantalum or tungsten, barium carbonate, bismuth oxide, barium sulfate, etc. are preferred. To aid in detection by ultrasound or similar imaging techniques, any component of the device may be combined with an echogenic coating. One such coating is ECHO-COAT from STS Biopolymers. Such coatings contain echogenic features which provide the coated item with an acoustically reflective interface and a large acoustical impedance differential. As stated above, an echogenic coating may be placed over a radiopaque marker to increase the accuracy of locating the marker during ultrasound imaging.
Note that the radiopacity and echogenicity described herein for the marker and the body are not mutually exclusive. It is within the scope of the present invention for the marker or the body to be radiopaque but not necessarily echogenic, and for the marker or the body to be echogenic but not necessarily radiopaque. It is also within the scope of the invention that the marker and the body are both capable of being simultaneously radiopaque and echogenic. For example, if a platinum ring marker were coated with an echogenic coating, such a marker would be readily visible under x-ray and ultrasonic energy. A similar configuration can be envisioned for the body or for a body coating.
The marker is preferably large enough to be readily visible to the physician under x-ray or ultrasonic viewing, for example, yet be small enough to be able to be percutaneously deployed into the biopsy cavity and to not cause any difficulties with the patient. More specifically, the marker will not be large enough to be palpable or felt by the patient.
Another useful version of the invention is shown in
Here one or more markers may traverse two or more body member segments through the interior of the body members (302) as shown in
Of course, when used in conjunction with other connecting markers, marker (318) need not necessarily connect each body member; it may be used solely to indicate the orientation or location of each individual sponge or the entire device, depending on the material, geometry, size, orientation, etc. of marker (318). When not used in this connecting function, therefore, marker (318) need not traverse two body members (302) as shown in
A variety of patterns can be envisioned in which all or part of the perimeter of the sponge body is marked. For example, a marker (322) can wrap around the body (302) in a helical pattern (
Another possible configuration is obtained by combining the suture or wire markers (158) in a body with any other type marker (150, 152, 154, or 156) or vice versa. For example, in
Also, turning back to the marking device (101) in
Any of the previously-described additional features of the inventive device, such as presence of pain-killing or hemostatic drugs, the capacity for the marker to emit therapeutic radiation for the treatment of various cancers, the various materials that may make up the marker and body, as well as their size, shape, orientation, geometry, etc. may be incorporated into the device described above in conjunction with
From the foregoing, it is understood that the invention provides an improved biopsy marker delivery system. While the above descriptions have described the invention for use in the marking of biopsy cavities made through a vacuum-assisted breast biopsy procedure, the invention is not limited to such. The invention disclosed herein may be used with any biopsy procedure discussed herein or otherwise known.
The invention herein has been described by examples and a particularly desired way of practicing the invention has been described. However, the invention as claimed herein is not limited to that specific description in any manner. Equivalence to the description as hereinafter claimed is considered to be within the scope of protection of this patent.
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|International Classification||A61B17/00, A61B10/02, A61B10/00, A61B19/00|
|Cooperative Classification||A61B2019/5487, A61B10/0275, A61B19/54, A61B2019/304, A61B2017/00539, A61B10/0283, A61B2019/308|
|European Classification||A61B19/54, A61B10/02P6N|
|Jul 12, 2007||AS||Assignment|
Owner name: ETHICON ENDO-SURGERY, INC., OHIO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:VIVANT MEDICAL, INC.;REEL/FRAME:019675/0755
Effective date: 20031003
Owner name: ETHICON ENDO-SURGERY, INC.,OHIO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:VIVANT MEDICAL, INC.;REEL/FRAME:019661/0884
Effective date: 20031006
|Jul 9, 2010||AS||Assignment|
Owner name: DEVICOR MEDICAL PRODUCTS, INC., WISCONSIN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ETHICON ENDO-SURGERY, INC.;REEL/FRAME:024656/0606
Effective date: 20100709
|Jul 13, 2010||AS||Assignment|
Owner name: GENERAL ELECTRIC CAPITAL CORPORATION, AS AGENT, MA
Free format text: SECURITY AGREEMENT;ASSIGNOR:DEVICOR MEDICAL PRODUCTS, INC.;REEL/FRAME:024672/0088
Effective date: 20100709