US20040236213A1 - Marker delivery device with releasable plug - Google Patents

Abstract

The invention is directed to marker delivery devices and methods of using such devices. The delivery devices embodying features of the invention include a delivery cannula with a discharge opening and a releasable plug disposed in the inner lumen of the delivery cannula so as to at least partially occlude the discharge opening. The releasable plug prevents ingress of tissue, body fluids and the like into the bore of the tube, and prevents the premature discharge of any markers proximal to the releasable plug from passing through the discharge opening before the distal end of the cannula is properly positioned at a desired location within a patient's body. The releasable plug preferably has an MRI detectable element. Preferably, at least one remotely detectable marker mass is provided in the inner lumen of the cannula proximal to the releasable plug.

Description

RELATED APPLICATIONS
• This application is a continuation-in-part of application Ser. No. 10/444,770, filed on May 23, 2003 which is incorporated herein by reference in its entirety and from which priority is claimed.[0001]
FIELD OF THE INVENTION
• The invention is generally directed to devices and methods for the delivery of remotely detectable markers to a desired location within a patient's body. In particular, the invention is directed to devices, and methods configured to retain a remotely detectable marker within a delivery device before delivery to a desired intracorporeal location.[0002]
BACKGROUND OF THE INVENTION
• In diagnosing and treating certain medical conditions, it is often desirable to mark a suspicious body site for the subsequent taking of a biopsy specimen, for delivery of medicine, radiation, or other treatment, for the relocation of a site from which a biopsy specimen was taken, or at which some other procedure was performed. As is known, obtaining a tissue sample by biopsy and the subsequent examination are typically employed in the diagnosis of cancers and other malignant tumors, or to confirm that a suspected lesion or tumor is not malignant. The information obtained from these diagnostic tests and/or examinations is frequently used to devise a therapeutic plan for the appropriate surgical procedure or other course of treatment.[0003]
• In many instances, the suspicious tissue to be sampled is located in a subcutaneous site, such as inside a human breast. To minimize surgical intrusion into a patient's body, it is often desirable to insert a small instrument, such as a biopsy needle, into the body for extracting the biopsy specimen while imaging the procedure using fluoroscopy, ultrasonic imaging, x-rays, magnetic resonance imaging (MRI) or any other suitable form of imaging technique. Examination of tissue samples taken by biopsy is of particular significance in the diagnosis and treatment of breast cancer. In the ensuing discussion, the biopsy and treatment site described will generally be the human breast, although the invention is suitable for marking biopsy sites in other parts of the human and other mammalian body as well.[0004]
• Periodic physical examination of the breasts and mammography are important for early detection of potentially cancerous lesions. In mammography, the breast is compressed between two plates while specialized x-ray images are taken. If an abnormal mass in the breast is found by physical examination or mammography, ultrasound may be used to determine whether the mass is a solid tumor or a fluid-filled cyst. Solid masses are usually subjected to some type of tissue biopsy to determine if the mass is cancerous.[0005]
• If a solid mass or lesion is large enough to be palpable, a tissue specimen can be removed from the mass by a variety of techniques, including but not limited to open surgical biopsy, a technique known as Fine Needle Aspiration Biopsy (FNAB) and instruments characterized as “vacuum assisted large core biopsy devices”.[0006]
• If a solid mass of the breast is small and non-palpable (e.g., the type typically discovered through mammography), a vacuum assisted large core biopsy procedure is usually used. In performing a stereotactic biopsy of a breast, the patient lies on a special biopsy table with her breast compressed between the plates of a mammography apparatus and two separate x-rays or digital video views are taken from two different points of view. A computer calculates the exact position of the lesion as well as depth of the lesion within the breast. Thereafter, a mechanical stereotactic apparatus is programmed with the coordinates and depth information calculated by the computer, and such apparatus is used to precisely advance the biopsy needle into the small lesion. The stereotactic technique may be used to obtain histologic specimens. Usually at least five separate biopsy specimens are obtained from locations around the small lesion as well as one from the center of the lesion.[0007]
• The available treatment options for cancerous lesions of the breast include various degrees of mastectomy or lumpectomy, radiation therapy, chemotherapy and combinations of these treatments. However, radiographically visible tissue features, originally observed in a mammogram, may be removed, altered or obscured by the biopsy procedure, and may heal or otherwise become altered following the biopsy. In order for the surgeon or radiation oncologist to direct surgical or radiation treatment to the precise location of the breast lesion several days or weeks after the biopsy procedure was performed, it is desirable that a biopsy site marker be placed in the patient's body to serve as a landmark for subsequent location of the lesion site. A biopsy site marker may be a permanent marker (e.g., a metal marker visible under x-ray examination), or a temporary marker (e.g., a bioresorbable marker detectable with ultrasound). While current radiographic type markers may persist at the biopsy site, an additional mammography generally must be performed at the time of follow up treatment or surgery in order to locate the site of the previous surgery or biopsy. In addition, once the site of the previous procedure is located using mammography, the site must usually be marked with a location wire which has a hook on the end which is advanced into site of the previous procedure. The hook is meant to fix the tip of the location wire with respect to the site of the previous procedure so that the patient can then be removed from the confinement of the mammography apparatus and the follow-up procedure performed. However, as the patient is removed from the mammography apparatus, or otherwise transported the position of the location wire can change or shift in relation to the site of the previous procedure. This, in turn, can result in follow-up treatments being misdirected to an undesired portion of the patient's tissue.[0008]
• As an alternative or adjunct to radiographic imaging, ultrasonic imaging (herein abbreviated as “USI”) or visualization techniques can be used to image the tissue of interest at the site of interest during a surgical or biopsy procedure or follow-up procedure. USI is capable of providing precise location and imaging of suspicious tissue, surrounding tissue and biopsy instruments within the patient's body during a procedure. Such imaging facilitates accurate and controllable removal or sampling of the suspicious tissue so as to minimize trauma to surrounding healthy tissue.[0009]
• For example, during a breast biopsy procedure, the biopsy device is often imaged with USI while the device is being inserted into the patient's breast and activated to remove a sample of suspicious breast tissue. As USI is often used to image tissue during follow-up treatment, it may be desirable to have a marker, similar to the radiographic markers discussed above, which can be placed in a patient's body at the site of a surgical procedure and which are visible using USI. Such a marker enables a follow-up procedure to be performed without the need for traditional radiographic mammography imaging which, as discussed above, can be subject to inaccuracies as a result of shifting of the location wire as well as being tedious and uncomfortable for the patient.[0010]
• Placement of a marker or multiple markers at a location within a patient's body requires delivery devices capable of holding markers within the device until the device is properly situated within a breast or other body location. Accordingly, devices and methods for retaining markers within a marker delivery device while allowing their expulsion from the devices at desired intracorporeal locations are desired.[0011]
SUMMARY OF THE INVENTION
• The invention is generally directed to the delivery of one or more markers to an intracorporeal site within a patient's body. A marker delivery device embodying features of the invention include a delivery tube or cannula having an inner lumen leading to a discharge opening and having a releasable plug which is disposed at least in part within the inner lumen and which at least partially occludes the discharge opening in the distal end of the delivery tube.[0012]
• The releasable plug is configured to occlude or block off the discharge opening of the delivery cannula or the inner lumen leading thereto to prevent tissue and fluid from entering the inner lumen through the discharge opening during delivery and to hold in any other markers within the inner lumen proximal to the releasable plug during handling and delivery. In one embodiment having features of the invention, the delivery device has a releasable plug with a remotely detectable marker element incorporated therein. Preferably, the marker element incorporated into the releasable plug is non-magnetic and remotely detectable by magnetic resonance imaging.[0013]
• In yet another embodiment having features of the invention, the delivery device has a releasable plug and has at least one short term, remotely detectable marker mass in the inner lumen or at least one fibrous marker in the inner lumen proximal to the releasable plug. Preferably, at least one short term marker and at least one fibrous marker are disposed within the inner lumen of the delivery cannula.[0014]
• The releasable plug may be secured within the inner lumen by a variety of means, but It is preferred to press fit the plug into the distal portion of the inner lumen so as to occlude the discharge opening. However, the plug may alternatively be mechanically or adhesively secured within the distal portion of the inner lumen. For further plug details see co-pending application Ser. No. 10/174,401, filed on Jun. 17, 2002, entitled Plugged Tip Delivery Tube For Marker Placement which is incorporated herein in its entirety by reference. However, the releasable plug should be configured to be easily pushed out of the discharge opening of the delivery cannula, even if the releasable plug has swollen due to contact with a water based fluid. As described above, the releasable plug preferably has a non-magnetic, MRI detectable element which does not interfere with the subsequent imaging of adjacent tissue. The MRI detectable element is about 0.5 to about 5 mm in maximum dimension, preferably about 1 to about 3 mm. Suitable non-magnetic, MRI detectable materials include titanium, platinum, gold, iridium, tantalum, tungsten, silver, rhodium and the like.[0015]
• The releasable plug is formed of a biocompatible, preferably bioabsorbable material such as oxidized regenerated cellulose, polyethylene glycol, polylactic acid, polyglycolic acid, polycaproic acid, and copolymers, polymer alloys, polymer blends, and combinations thereof. Preferable materials are oxidized regenerated cellulose and polymers of polyethylene glycol with molecular weights of about 5000 to about 120,000 Daltons. The releasable plug should be formed of a water swellable material, so that it swells upon contact with water based fluids (e.g. body fluids) to further occlude or otherwise seal the discharge opening of the delivery cannula and thereby prevent premature contact of body fluids with any markers within the inner lumen proximal to the releasable plug. The plug may also be formed of fibrous materials and be in the form of a fibrous marker described below.[0016]
• The short term markers disposed within the inner lumen of the delivery cannula proximal to the releasable plug should be remotely detectable for at least two weeks, preferably at least up to six weeks, but not longer than about one year, preferably not more than about six months, so as to not interfere with subsequent imaging of the target site. The short term markers are preferably formed of bioabsorbable polymeric materials such as polymers of lactic acid, glycolic acid and caprolactones and copolymers and blends thereof. Other suitable materials include those described in co-pending application Ser. No. 09/717,909, filed Nov. 20, 2000 and co-pending application Ser. No. 10/124,757, filed on Jun. 17, 2002, both of which are incorporated by reference in their entireties. The plug and the short term markers may be formed of the same or similar material. The releasable plug may also be formed of fibrous material and be in the form of the fibrous markers described below.[0017]
• The fibrous marker should be slidably disposed within the inner lumen of the delivery cannula, preferably proximal to at least one short term marker so that upon discharge from the cannula into a target site, the fibrous marker will block the accessing passageway and prevent loss of marker material therethrough. A suitable material for forming the fibrous marker is a felt and/or fiber material formed of oxidized regenerated cellulose which has an in vivo lifetime of a few hours up to about 6 weeks, typically about 3 days to about 4 weeks. However, the fibrous marker may be formed of a bioabsorbable polymer such as polylactic acid or polyglycolic acid, a co-polymer of polylactic acid and polyglycolic acid, polycaprolactone, collagen and mixtures thereof, including mixtures with oxidized regenerated cellulose. Suitable oxidized, regenerated cellulose includes SURGICEL™ from the Ethicon Division of Johnson & Johnson or other suitable oxidized regenerated cellulose which are naturally hemostatic. Alternatively, a hemostatic agent such as collagen, gelatin or polysaccharides may be incorporated into the fibrous material to provide the hemostasis upon contact with blood. A wide variety of other hemostatic agents may be incorporated into the marker. The thrombus formed by the hemostasis is formed very quickly to fill the cavity at the biopsy site and at least temporarily hold the plug and any other markers in position within the cavity. Anesthetic agents to control post procedure pain, chemotherapeutic agents to kill any residual neoplastic tissue and coloring agents (e.g. carbon black and methylene blue) for visual location of the biopsy site, may also be incorporated into the fibrous marker.[0018]
• The fibrous material is formed into an elongated member, e.g. by rolling or folding, and bound in a compressed condition to provide sufficient column strength to facilitate introduction into and discharge from a tubular delivery device. Suitable binding agents for holding the fibrous marker in a compressed condition are water soluble polymers such as polyvinyl alcohol, polyethylene glycol, polyvinyl pyrollidone. One or more radiographically detectable marker elements are provided with at least one of the fibrous markers, preferably centrally located on the elongated marker to ensure that the radiographically detectable element is disposed at a more or less central location within the target site rather than at a site margin.[0019]
• The releasable plug, the short term markers and the fibrous markers may include a variety of therapeutic or diagnostic materials such as hemostatic agents, anesthetic agents, coloring agents, antibiotics, antifungal agents, antiviral agents, chemotherapeutic agents, radioactive agents and the like.[0020]
• The delivery device preferably has a plunger slidably disposed within the inner lumen of the delivery cannula which is movable from an initial position accommodating the releasable plug and any markers proximal to the plug within the tube, to a delivery position to push the plug and any desired number of markers out of the discharge opening in the distal end of the cannula into the target tissue site.[0021]
• Upon being discharged into the intracorporeal target site, the markers at least partially fill the site to enable short term detection by remote imaging and preferably long term detection by remote imaging without interfering with imaging of tissue adjacent to the site. The markers may swell on contact with body fluid, e.g. blood so as to further fill the biopsy cavity. The fibrous marker partially fills the cavity at the target site, positioning the radiopaque marker element within the interior of the target cavity.[0022]
• The marker mass proximal to the releasable plug may be in the form of ultrasound-detectable, bio-resorbable finely-divided particulate material (such as a powder or granulated material), in which many of the particles have internal cavities. Such particulate materials preferably have particle sizes less than about 2000 microns, and typically between about 20 microns and about 2000 microns. For optimum delivery and marker resolution, the particulate should have a particulate size of about 20 microns to about 1500 microns, preferably about 500 microns to about 800 microns. The ultrasound-detectable, bio-resorbable particulate materials may be formed of polymeric materials such as polylactic acid, polyglycolic acid, polycaprolactone, and combinations of these polymers and the particulate may be bound by suitable binding agents such as gelatin, polyethylene glycol, polyvinyl alcohol, glycerin, polysaccharides, other hydrophilic materials, and combinations of these. Suitable gelatins include bovine collagen, porcine collagen, ovine collagen, equine collagen, synthetic collagen, agar, synthetic gelatin, and combinations of these. Further details of the particulate marker material and the delivery thereof can be found in co-pending application Ser. No. 10/124,757, which has been incorporated herein. Polysaccharide particulate or powder may be included with the other particulate materials as a hemostatic agent.[0023]
• The delivery tube of the device may be configured to fit within a guide cannula, such as a Mammotome® or SenoCor 360™ biopsy cannula or a coaxial needle guide.[0024]
• The ultrasound-detectable biopsy site markers of the present invention provide several advantages. A biopsy cavity with marker material having features of the present invention provides a large USI-bright mass, making it much easier, for example, to distinguish the ultrasound signal of the marker from signals arising naturally from within a breast. The marker materials produce bright ultrasound echo signals from one portion of the filled region, which contrasts with the dark ultrasound shadow region immediately behind the bright ultrasound echo region. The strength of the reflected signal, and the contrast with the shadow region, make the marked site readily detectable. Such ready detectability allows, for example, less-experienced physicians to perform the identification by USI and the subsequent surgical resection without the need for an interventional radiologist to identify and mark the biopsy cavity. When a MRI marker element is incorporated into the releasable plug or the short term markers, the target site in which the markers are deployed may be subsequently detected by ultrasound, magnetic resonance and X-ray without interfering with imaging adjacent tissue at a later date.[0025]
• The invention provides the advantages of securely retaining markers within a marker delivery device, improving accuracy and avoiding errors in placement of markers at desired locations within a patient's body, preventing ingress of tissue into the distal tip of the device when it is advanced through tissue, and guiding the device by use of an imaging device including ultrasound, X-ray and magnetic resonance based devices. These and other advantages of the invention will become more apparent from the following description when taken in conjunction with the accompanying drawings.[0026]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A is a partly cut-away perspective view of a marker delivery assembly embodying features of the invention.[0027]
• FIG. 1B is a transverse cross-sectional view of the marker delivery assembly of FIG. 1A taken at[0028]line1B-1B.
• FIG. 1C is a transverse cross-sectional view of the marker delivery assembly of FIG. 1A taken at[0029]line1C-1C.
• FIG. 2 is an end perspective view of a fibrous marker with a core member suitable for use with a marker delivery system embodying features of the invention.[0030]
• FIG. 3 is an end perspective view of an alternative fibrous marker without a core member suitable for use with a marker delivery system embodying features of the invention.[0031]
• FIG. 4A-4F illustrates forming a fibrous marker with a core member as depicted in FIG. 4.[0032]
• FIG. 5 is a partially cut away, perspective view of a human breast from which a biopsy specimen has been removed, showing a markers being delivered to the biopsy site with the marker delivery assembly shown in FIG. 1A.[0033]
• FIG. 6 is a partial cut-away view of a human breast shown in FIG. 2 with the markers delivered into the biopsy site and the delivery device removed.[0034]
• FIG. 7 is a longitudinal cross-sectional view of the distal portion of an alternative marker delivery device embodying features of the invention with a sharp, tissue penetrating distal tip.[0035]
• FIGS.[0036]8 is a longitudinal cross-sectional view of the distal portion of a marker delivery device embodying features of the invention having particulate marker mass proximal to the releasable plug.
DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION
• FIGS. 1A-1C illustrate a[0037]marker delivery device10 embodying features of the invention which includes a delivery tube orcannula11 with abore12, adistal portion13, and aproximal portion14 with ahandle15. A releasabledistal plug16, several (five)short term markers17, a pair offibrous markers18 and19 and aproximal plug20 are shown disposed within thebore12. Aplunger21 is slidably disposed within the tube bore12, and is provided with aproximal end22 configured to allow an operator to press the plunger further into thebore12 and push thereleasable plug16 and one or more of the other markers out of the discharge port or opening23 in thedistal end24 ofdelivery tube11. Cannula handle15 allows an operator to hold the cannula steady while pressingplunger21 to discharge thereleasable plug16 andmarkers17 and18.
• [0038]Releasable plug16 may substantially fill thedischarge opening23, as shown in FIG. 1, or may occupy or block only a portion of thedischarge opening23. The exposed face ofplug16 is preferably provided with an inclined configuration to conform with the inclination of thedischarge opening23.
• [0039]Markers17,18 and19 andproximal plug20 are preferably configured to slide readily within tube bore12.Releasable plug16 is configured to be tight enough, e.g. press fit, in thebore12 to prevent its inadvertent release which would allow premature discharge ofmarkers17 and18 fromdelivery tube11 and undesirable contact with body fluid. But theplug16 must be easily released when theplunger21 is pressed deeper into thebore12 of thedelivery tube11. An adhesive or mechanical element(s) may be used to hold thereleasable plug16 in a position within thebore12 to occlude thedischarge opening23. Suitable adhesives include polyurethane or polyacrylic based adhesives, polyhydroxymethacrylate base adhesives, fibrin glue (e.g., Tisseal™), collagen adhesive, or mixtures thereof. Suitable mechanical means for securing thereleasable plug16 are described in co-pending application Ser. No. 10/174,401 which has been incorporated herein. Thedistal end24 of thedelivery cannula11 is provided with aramp25 which guides the dischargedplug16 andmarkers17,18 and19 out of theside port26 into the target site. Thedistal tip27 may be tapered for delivery through a guide tube as shown.
• The[0040]delivery tube11 may be provided withmarkings28 which serve as visual landmarks to aid an operator in accurately placing thedistal end24 of thecannula11 in a desired location within a patient“s body for discharging the markers. Themarkings24 also be radiopaque, ultrasound-reflective, or otherwise configured to be detectable by remote imaging devices and imaging methods.
• [0041]Short term markers17 are made at least in part with detectable, biocompatible materials. Suitable marker materials include bioresorbable polymeric materials such as poly(esters), poly(hydroxy acids), poly(lactones), poly(amides), poly(ester-amides), poly(amino acids), poly(anhydrides), poly(ortho-esters), poly(carbonates), poly(phosphazines), poly(thioesters), poly(urethanes), poly(ester urethanes), polysaccharides, polylactic acid, polyglycolic acid, polycaproic acid, polybutyric acid, polyvaleric acid, and copolymers, polymer alloys, polymer blends, and combinations thereof. Preferable polymeric materials are polymers of lactic acid, glycolic acid and caprolactones. Theshort term markers17 may also be formed at least in part of gelatin. One or more of theshort term markers17 may include a remotely detectable preferablyradiopaque element28.
• [0042]Releasable plug16 is preferably formed at least in part of oxidized regenerated cellulose or polyethylene glycol, but may be made from the same or similar bioabsorbable materials asmarker17. The polyethylene glycol quickly expands when contacting a water based fluid such as blood, which ensures that the releasable plug seals off the discharge opening to prevent premature contact between body fluid (or other water based fluid) and themarkers17 and18 within thebore12. The polyethylene glycol should have a molecular weight of about 5000 to about 20000 Daltons, preferably about 8000 to about 10000 Daltons in the final plug form. The releasable plug16 preferably has anon-magnetic element29 incorporated within the body of the releasable plug that is remotely detectable by magnetic resonance imaging (MRI). It may be formed of titanium, platinum, gold, iridium, tantalum, tungsten, silver, rhodium and the like. The MRIdetectable element29 should have a maximum dimension of about 0.5 to about 5 mm, preferably about 1 to about 3 mm to be MRI detectable. Elements with dimensions greater than about 5 mm tend to interfere with the imaging of adjacent tissue.
• [0043]Releasable plug16 andmarkers17 and18 are configured for a slidable fit within thebore15 of thedelivery tube11. The exterior of thedelivery tube11 is preferably configured to fit within a guide cannula sized to accept a Mammotome®, Tru-Cut®, or SenoCor® biopsy device. Typically, plug16 andmarkers17 and18 will have diameters determined by the size of abore15 and typically will be about 0.02 inch (0.5 mm) to about 0.5 inch (12 mm), preferably about 0.04 inch (1 mm) to about 0.3 inch (8 mm).Plug16 may have slightly larger transverse dimensions to provide a tight fit. In addition, plugs16 and19 andshort term marker17 will have a length of about 0.04 inch (1 mm) to about 0.8 inch (20 mm), preferably about 0.1 inch (2.5 mm) to about 0.6 inch (15 mm).
• [0044]Releasable plug16,markers17,18 and19 and plug20 are configured for a slidable fit within thebore15 of thedelivery tube11. The exterior of thedelivery tube11 is preferably configured to fit within a guide cannula sized to accept a Mammotome®, Tru-Cut®, or SenoCor® biopsy device. Typically, plug16 andmarkers17 and18 will have diameters determined by the size of abore15 and typically will be about 0.02 inch (0.5 mm) to about 0.5 inch (12 mm), preferably about 0.04 inch (1 mm) to about 0.3 inch (8 mm).Plug16 may have slightly larger transverse dimensions to provide a tight fit. In addition, plugs16 and20 andshort term markers17 will have a length of about 0.04 inch (1 mm) to about 0.8 inch (20 mm), preferably about 0.1 inch (2.5 mm) to about 0.6 inch (15 mm).
• The[0045]fibrous markers18 and19 are preferably rolled or folded pieces of fibrous material such as oxidized cellulose or oxidized, regenerated cellulose which has been compressed and impregnated with a binding agent such as polyethylene glycol and freeze dried in the compressed condition. The fibrous material may be rolled up by itself, as shown in FIG. 5, or wrapped about a matt-like core30 as shown in FIG. 4. The fibrous marker is generally configured to be slidably disposed within the inner lumen of thedelivery cannula11, and before delivery is about 0.5 mm to about 12 mm, preferably about 1 to about 8 mm in diameter and about 5 to about 30 mm, preferably about 10 to about 25 mm in length. Upon contact with a body fluid or other water based fluid, the length of the fibrous marker remains about the same but the wrapped structure unfolds upon swelling to a width of about 5 to about 25 mm, usually about 10 to about 20 mm. With a radiopaque marker element clamped about a center portion of the wrapped fibrous marker, the fibrous marker expands into a generally bow-tie shape when exposed to body fluids. However, even though secured to the fibrous marker, the radiopaque marker element need not restrict the expansion of the fibrous marker.
• The manufacture and use of[0046]fibrous marker18 with acore30 is schematically illustrated in FIGS. 4A-4F. A felt pad ormat31 of oxidized, regenerated cellulose about 0.125 to about 0.375 inch (3.2-9.3 mm), preferably about 0.25 inch (6.4 mm) thick is impregnated with a 10% (Wt.) polyethylene glycol in a 70% isopropyl alcohol solution and then compressed to a mat about 0.03 to about 0.05 inch (0.76-1.3 mm) thick. A reduction in thickness of 80% or more is suitable. Thecompressed mat31 is cut up intoelongated strips32 with square or near square transverse cross-sectional shapes which form thecore30. Thecore30 is wrapped in afabric33 of oxidized regenerated cellulose about 5 to about 10 mm in width and about 20 mm in length, compressed and impregnated with the 10% PEG dispersion and then freeze dried to a diameter of about 0.065 inch (1.65 mm). Elevated temperatures may be employed to dry the material. Thefabric33 should make at least one, preferably two or more complete wraps about thecore30. The wrapped and compressed product may then be cut to a desired length to form thefibrous marker18. Alternatively, theuncompressed mat31, thestrip32 andfiber wrap33 may be provided at the desired length for thefibrous marker18, wrapped and then compressed. A radiographicallydetectable marker element34 may be formed of a radiopaque wire about 0.005 to about 0.01 inch, (0.13-0.25 mm) may then be crimped about or embedded in a central portion (or other desired portion) of themarker13. Thefibrous marker18 is then ready for deployment. As shown in FIG. 1A, onlyfibrous marker18 is provided withmarker element34.Marker19 may be formed in the same or similar manner but without theradiopaque element34.
• Fibrous markers without the[0047]core member30 may be formed by rolling or folding into the desired configuration. The fibrous material, oxidized rayon felt is first impregnated with a 10% PEG dispersion, compressed and then freeze dried. The dried felt material is rolled again compressed in the rolled state, impregnated with a 10-30% PEG solution, and freeze dried in the rolled compressed condition. The rayon felt material can be initially oxidized by treating in a solution of 80% (by vol.) Nitric Acid, 20% (by vol.) Sulfuric Acid and 1% (by weight) Sodium Nitrite. The felt is treated in the oxidizing, acidic solution at room temperature for about 4.5 hours and then rinsed with deionized water.
• [0048]Radiopaque elements28 and34 may be made with suitable radiopaque material, including stainless steel, platinum, gold, iridium, titanium, tantalum, tungsten, silver, rhodium, nickel, bismuth, other radiopaque metals, alloys and oxides of these metals, barium salts, iodine salts, iodinated materials, and combinations of these. Theradiopaque elements28 and34 may also be configured for detection by MRI. Radiopaque materials and markers may be permanent, or may be temporary and not detectable after a period of time subsequent to their placement within a patient. Colorants, such as dyes (e.g., methylene blue and carbon black) and pigments (e.g., barium sulfate), may also be included inmarkers17 and18 and plugs16 and19 embodying features of the invention.
• FIG. 5 schematically illustrates the use of a[0049]marker delivery system10 to deliver markers to a desiredlocation35 within a patient's body. The desiredlocation35 is typically a cavity from which a biopsy sample has been, or is to be, taken, or a lesion that has been or will be removed or otherwise treated. In FIG. 4, themarker delivery system10 is shown inserted into abreast40 through aguide cannula41 until thedistal end24 is disposed at the delivery site,cavity35 where a tissue specimen has been removed. While an operator holds thesystem10 by thehandle15 of thedelivery tube11, theplunger20 is pressed further into thebore12 ofdelivery cannula11 to discharge thereleasable plug16 andmarkers17 and18 into thecavity35. FIG. 6 schematically illustrates theplug16 andmarkers17,18 and19 within thecavity35 after deployment. When the markers contact body fluid within thecavity35, they tend to swell and thereby further fill the cavity. Thefibrous markers18 and19 generally block the accessingtrack36 to thecavity35 so that none of thesmaller markers17 will be lost through thetrack36.Marks37 are provided on the proximal end ofcannula11 to provide end location information to the operator.
• FIG. 7 illustrates the[0050]distal portion50 ofcannula51 of an alternative delivery system that is essentially the same as that shown in FIGS. 1A-1C except that thedistal tip52 ofcannula51 is configured in a needle-like shape. Thedelivery system cannula51 may be used in conjunction with a guide cannula (not shown) or thecannula51 can be inserted directly through tissue to reach the target site without the need for a guide cannula. Thereleasable plug53 is secured in thedischarge opening54 as in the previously discussed embodiment. The exposedface55 of theplug53 is preferably flush with the discharge opening54 of thedistal tip52.
• Insertion of marker delivery devices embodying features of the invention may be performed with or without the aid of an imaging device, such as an ultrasound imaging device, an X-ray imaging device, a MRI device, or other imaging device. Alternatively, or additionally, insertion may be visually guided, or may be guided by palpation or by other means.[0051]
• The size and composition of the[0052]short term markers17 are selected so as to remain in place within the patient and be detectable by ultrasound for at least 2 weeks, preferably at least 6 weeks to have practical clinical value. However, the short term markers should not be detectable by ultrasound after about one year, preferably not after about six months, so as to avoid interfering with subsequent site examination. For most clinical purposes, a suitable in-situ lifespan when the short term marker is ultrasonically detectable is about six to about twenty weeks. The radiopaque and MRI detectable marker elements generally will have much longer lifespans.
• FIG. 8 illustrates the[0053]distal shaft section60 of analternative delivery cannula61 which has a fibrous releasable plug62 in theinner lumen63 of the distal shaft section which at least partially occludes thedischarge opening64 in the distal end of the shaft. The fibrous releasable plug62 may be formed as shown in FIGS. 2, 3 and4A-F.
• The inner lumen proximal to the fibrous releasable plug[0054]62 is filled with aparticulate marker material65. The corresponding parts of the system are the same as that shown in FIGS. 1A-1C.Plunger66 is slidably disposed within theinner lumen63 to eject the powderedmass65. Theparticulate marker material65 may be discharged dry or mixed with a suitable fluid and discharged as a slurry.
• The particulate may be formed of a biocompatible and bio-resorbable polymeric material such as polylactic acid, polyglycolic acid, polycaprolactones, poly(esters), poly(hydroxy acids), poly(lactones), poly(amides), poly(ester-amides), poly(amino acids), poly(anhydrides), poly(ortho-esters), poly(carbonates), poly(phosphazines), poly(thioesters), poly(urethanes), poly(ester urethanes), polysaccharides, polybutyric acid, polyvaleric acid, and copolymers, polymer alloys, polymer mixtures, and combinations thereof. Of those, polylactic acid, polyglycolic acid, and polycaproic acid are preferred. The polymeric material in particulate form should have cavities or entrap bubbles which facilitate remote detection.[0055]
• Suitable particulate materials have particle sizes typically about 20 microns to about 2000 microns, preferably about 20 microns to about 800 microns and more preferably about 300 microns to about 500 microns. The particulate should have cavities for USI with maximum dimensions of about 10 microns to about 500 microns, preferably about 20 microns to about 200 microns. The polymeric particulate materials suitable for use in making ultrasound-detectable biopsy marker materials typically have a bulk density of about 0.8 g/ml to about 1.5 g/ml, preferably about 0.8 g/ml to about 1 g/ml. The particulate may also contain or be mixed with binding agents such as polyethylene glycol, polyvinyl alcohol and the like. Polysaccharide particulate or powder may be incorporated into the particulate mass in amounts up to about 50% (by weight) of the total particulate mass for purposes of hemostasis.[0056]
• While particular forms of the invention have been illustrated and described herein in the context of a breast biopsy site, it will be apparent that the device and methods having features of the invention may find use in a variety of locations and in a variety of applications, in addition to the human breast. Moreover, various modifications can be made without departing from the spirit and scope of the invention. Accordingly, it is not intended that the invention be limited to the specific embodiments illustrated. It is therefore intended that this invention to be defined by the scope of the appended claims as broadly as the prior art will permit, and in view of the specification if need be. Moreover, those skilled in the art will recognize that features shown in one embodiment may be utilized in other embodiments. Terms such as “element”, “member”, “device”, “section”, “portion”, “step”, “means” and words of similar import when used in the following claims shall not be construed as invoking the provisions of 35 U.S.C. §112(6) unless the following claims expressly use the terms “means” followed by a particular function without specific structure or “step” followed by a particular function without specific action. All patents and patent applications referred to above are hereby incorporated by reference in their entirety.[0057]

Claims (106)

What is claimed is:

1. A marker delivery device for an intracorporeal tissue site, comprising:

a) an elongated delivery cannula which has a distal end, an inner lumen and a discharge opening in the distal end in communication with the inner lumen;

b) at least one remotely detectable marker mass which is disposed within the inner lumen of the delivery cannula; and

c) a releasable plug which has a remotely detectable element incorporated therein and which is disposed at least in part within a distal portion of the inner lumen distal to the remotely detectable marker mass so as to occlude the discharge opening in the distal end.

2. The marker delivery device ofclaim 1 wherein the releasable plug is formed at least in part of oxidized cellulose.

3. The marker delivery device ofclaim 1 wherein the releasable plug is formed at least in part of a material which expands in the presence of body fluids.

4. The marker delivery device ofclaim 1 wherein the releasable plug is formed at least in part of polyethylene glycol.

5. The marker delivery device ofclaim 4 wherein the polyethylene glycol of which the releasable plug is at least partially formed has a molecular weight of about 5000 to about 120,000 Daltons.

6. The marker delivery device ofclaim 4 wherein the polyethylene glycol of which the releasable plug is at least partially formed has a molecular weight of about 5000 to about 20,000 Daltons.

7. The marker delivery device ofclaim 4 wherein the polyethylene glycol of which the releasable plug is at least partially formed has a molecular weight of about 8000 to about 10,000 Daltons.

8. The marker delivery device ofclaim 1 wherein the releasable plug has a non-magnetic marker element which is remotely detectable by magnetic resonance.

9. The marker delivery device ofclaim 1 wherein the marker element is formed of a material selected from the group consisting of titanium, platinum, gold, iridium, tantalum, tungsten, silver, rhodium.

10. The marker delivery device ofclaim 1 wherein the at least one remotely detectable marker body is formed at least in part of fibrous material.

11. The marker delivery device ofclaim 10 wherein the at least one fibrous marker body has a radiographic detectable element

12. The marker delivery device ofclaim 10 wherein the at least one fibrous marker body is formed at least in part of a bioabsorbable fibrous material.

13. The marker delivery device ofclaim 10 wherein the at least one fibrous marker body is formed of oxidized cellulose.

14. The marker delivery device ofclaim 10 wherein at least one fibrous marker body is formed of oxidized regenerated cellulose.

15. The marker delivery device ofclaim 11 wherein the radiographically detectable element surrounds an exterior portion of the fibrous marker body.

16. The marker delivery device ofclaim 1 wherein at least one remotely detectable marker mass is formed of polymeric material selected from the group consisting of polylactic acids, polyglycolic acids, copolymers and blends thereof and is disposed in the inner lumen proximal to the releasable plug.

17. The marker delivery device ofclaim 15 wherein at least one remotely detectable fibrous marker body formed at least in part of bioabsorbable fibrous material selected from the group consisting of oxidized cellulose and oxidized regenerated cellulose is disposed proximal to the remotely detectable marker bodies formed of polymeric material.

18. The marker delivery device ofclaim 1 wherein the releasable plug tip is formed at least in part of fibrous material.

19. The marker delivery device ofclaim 18 wherein the fibrous releasable plug tip has a radiographic detectable element.

20. The marker delivery device ofclaim 18 wherein the releasable plug tip is formed at least in part of a bioabsorbable fibrous material.

21. The marker delivery device ofclaim 18 wherein the fibrous releasable plug tip is formed of oxidized cellulose.

22. The marker delivery device ofclaim 18 wherein the fibrous releasable plug tip is formed of oxidized regenerated cellulose.

23. The marker delivery device ofclaim 19 wherein the radiographically detectable element surrounds an exterior portion of the fibrous releasable plug tip.

24. The marker delivery device ofclaim 18 wherein at least one remotely detectable marker mass is formed of polymeric material selected from the group consisting of polylactic acids, polyglycolic acids, copolymers and blends thereof and is disposed in the inner lumen proximal to the fibrous releasable plug.

25. The marker delivery device ofclaim 21 wherein the fibrous releasable plug tip is formed at least in part of bioabsorbable fibrous material selected from the group consisting of oxidized cellulose and oxidized regenerated cellulose is disposed proximal to the remotely detectable marker bodies formed of polymeric material.

26. The marker delivery device ofclaim 1 including a plunger which is slidably disposed within the inner lumen of the cannula and which has a distal end proximal to marker bodies in the inner lumen.

27. A marker delivery device for an intracorporeal tissue site, comprising:

a) an elongated delivery cannula which has a distal end, a discharge opening in the distal end and an inner lumen extending to and in communication with the discharge opening; and

b) a releasable plug which has an MRI detectable marker element incorporated therein and which is disposed at least in part within a distal portion of the inner lumen so as to occlude the discharge opening in the distal end.

28. The marker delivery device ofclaim 27 wherein the releasable plug is formed at least in part of a material selected from the group consisting of oxidized cellulose or oxidized regenerated cellulose.

29. The marker delivery device ofclaim 27 wherein the releasable plug is formed at least in part of a material which expands in the presence of body fluids.

30. The marker delivery device ofclaim 29 wherein the releasable plug is formed at least in part of polyethylene glycol.

31. The marker delivery device ofclaim 27 wherein at least one remotely detectable marker body is slidably disposed within the inner lumen of the delivery cannula proximal to the releasable plug.

32. The marker delivery device ofclaim 31 wherein the at least one remotely detectable marker body disposed proximal to the releasable plug is formed at least in part of fibrous material.

33. The marker delivery device ofclaim 32 wherein the fibrous marker body is expandable upon contact with body fluid or other water based fluid.

34. The marker delivery device ofclaim 32 wherein the fibrous material is bioabsorbable.

35. The marker delivery device ofclaim 34 wherein the fibrous material is oxidized cellulose.

36. The marker delivery device ofclaim 34 wherein the fibrous material is oxidized regenerated cellulose.

37. The marker delivery device ofclaim 32 wherein the at least one marker body formed of fibrous material has a radiographic imageable element.

38. The marker delivery device ofclaim 37 wherein the radiographically detectable element surrounds a portion of the fibrous marker body.

39. The marker delivery device ofclaim 27 wherein a plunger is slidably disposed within the inner lumen of the cannula with a pusher end proximal to the marker bodies in the inner lumen.

40. The marker delivery device ofclaim 27 wherein the MRI detectable marker element is about 0.5 to about 5 mm in maximum dimension.

41. The marker delivery device ofclaim 27 wherein the MRI detectable marker element is about 1 to about 3 mm in maximum dimension.

42. A marker delivery device system for an intracorporeal site within a patient, comprising:

a. an elongated delivery cannula which has a distal end, a discharge opening in the distal end and an inner lumen extending to and in communication with the discharge opening;

b. a releasable plug disposed within the inner lumen so as to at least partially occlude the discharge opening; and

c. at least one remotely detectable, short term marker disposed within the inner bore proximal to the releasable plug; and

d. at least one fibrous marker disposed within the inner lumen proximal to the at least one short term marker.

43. The marker delivery device ofclaim 42 wherein the releasable plug is formed at least in part of a material which expands in the presence of body fluids.

44. The marker delivery device ofclaim 42 wherein the releasable plug is formed at least in part of polyethylene glycol.

45. The marker delivery device ofclaim 42 wherein the releasable plug is covered with polyethylene glycol.

46. The marker delivery device ofclaim 42 wherein at least one remotely detectable marker body is slidably disposed within the inner lumen of the delivery cannula distal to the releasable plug.

47. The marker delivery device ofclaim 42 wherein the at least one remotely detectable marker body disposed distal to the releasable plug is formed at least in part of fibrous material.

48. The marker delivery device ofclaim 47 wherein the fibrous material is bioabsorbable.

49. The marker delivery device ofclaim 46 wherein the fibrous material is oxidized cellulose.

50. The marker delivery device ofclaim 46 wherein the fibrous material is oxidized regenerated cellulose.

51. The marker delivery device ofclaim 46 wherein the at least one marker body formed of fibrous material has a radiographic imageable element

52. The marker delivery device ofclaim 51 wherein the radiographically detectable element surrounds a portion of the fibrous marker body.

53. The marker delivery device ofclaim 42 wherein a plunger is slidably disposed within the inner lumen of the cannula with a pusher end proximal to the marker bodies in the inner lumen.

54. The marker delivery device ofclaim 42 wherein the releasable plug has a non-magnetic, MRI detectable marker element incorporated therein.

55. The marker delivery device ofclaim 54 wherein the non-magnetic, MRI detectable marker element is formed of a material selected from the group consisting of titanium, platinum, gold, iridium, tantalum, tungsten, silver and rhodium.

56. The marker delivery device ofclaim 54 wherein the non-magnetic, MRI detectable marker element is about 0.5 to about 5 mm in maximum dimension.

57. The marker delivery device ofclaim 54 wherein the non-magnetic, MRI detectable marker element is about 1 to about 3 mm in maximum dimension.

58. A marker delivery device for an intracorporeal tissue site, comprising:

a) an elongated delivery cannula which has a distal end, an inner lumen and a discharge opening in the distal end in communication with the inner lumen;

b) at least one remotely detectable marker mass which is formed at least in part of particulate and which is disposed within the inner lumen of the delivery cannula; and

c) a releasable plug which has a remotely detectable element incorporated therein and which is disposed at least in part within a distal portion of the inner lumen distal to the remotely detectable marker mass so as to occlude the discharge opening in the distal end.

59. The marker delivery device ofclaim 58 wherein the marker mass is remotely detectable by ultrasound.

60. The marker delivery device ofclaim 58 wherein the particulate of the marker mass is formed of bio-resorbable material.

61. The marker delivery device ofclaim 58 wherein the particulate has a particle size of about 20 to about 2000 microns.

62. The marker delivery device ofclaim 58 wherein the particulate has a particle size of about 100 microns to about 1500 microns.

63. The marker delivery device ofclaim 58 wherein the particulate has a particle size of about 500 microns to about 900 microns.

64. The marker delivery device ofclaim 58 wherein the particulate has bubble cavities.

65. The marker delivery device ofclaim 64 wherein the bubble cavities of the particulate is about 10 microns to about 500 microns in maximum dimension.

66. The marker delivery device ofclaim 64 wherein the bubble cavities of the particulate are about 50 microns to about 200 microns.

67. The marker delivery device ofclaim 60 wherein the particulate is formed at least in part of bio-resorbable polymeric material selected from the group consisting of poly(esters), poly(hydroxy acids), poly(lactones), poly(amides), poly(ester-amides), poly(amino acids), poly(anhydrides), poly(ortho-esters), poly(carbonates), poly(phosphazines), poly(thioesters), poly(urethanes), poly(ester urethanes), polysaccharides, polylactic acids, polyglycolic acids, polycaproic acids, polybutyric acids, polyvaleric acids, and copolymers, polymer alloys, polymer mixtures, and combinations thereof.

68. The marker delivery device ofclaim 60 wherein the particulate is formed at least in part of bio-resorbable polymeric material selected from the group consisting of polylactic acids, polyglycolic acids, polycaproic acids, and copolymers, polymer alloys, polymer mixtures, and combinations thereof.

69. The marker delivery device ofclaim 52 wherein the bio-resorbable material comprises about 65% by weight polylactic acid and about 35% by weight polyglycolic acid.

70. The ultrasound-detectable biopsy marker mass ofclaim 58, wherein said bio-resorbable polymeric material comprises a polymeric material having an average molecular weight of less than about 60 kD selected from the group consisting of polylactic acid and polycaproic acid polymers, copolymers, polymer alloys, polymer mixtures, and combinations thereof.

71. The marker delivery device ofclaim 60 wherein the particulate has a bulk density of about 0.8 g/ml to about 1.1 g/ml.

72. The marker delivery device ofclaim 60 wherein the particulate is held together by a binding agent.

73. The marker delivery device ofclaim 72 wherein the binding agent is selected from the group consisting of gelatin, polyethylene glycol, polyvinyl alcohol, glycerin, acrylic hydrogels, organic hydrogels, polysaccharides and combinations thereof.

74. The marker delivery device ofclaim 60 wherein the marker mass comprises gelatin and bio-resorbable polymeric particulate material having bubble cavities.

75. The marker delivery device ofclaim 74 wherein the gelatin binding agent is selected from the group consisting of bovine collagen, porcine collagen, ovine collagen, equine collagen, synthetic collagen, agar, synthetic gelatin, and combinations thereof.

76. An intracorporeal marker comprising an expandable bioabsorbable fibrous body with a radiopaque marker element secured to the fibrous body.

77. The intracorporeal marker ofclaim 76 wherein the radiopaque marker element is incorporated into the fibrous body.

78. The intracorporeal marker ofclaim 76 wherein the radiopaque marker is disposed about the fibrous body.

79. The intracorporeal marker ofclaim 76 wherein the radiopaque marker is incorporated into the fibrous body.

80. The intracorporeal marker ofclaim 76 wherein the fibrous body is formed at least in part of a bioabsorbable material selected from the group consisting of oxidized cellulose, oxidized regenerated cellulose, polylactic acid, a copolymer of polylactic acid and glycolic acid, and polycaprolactone.

81. The intracorporeal marker ofclaim 80 wherein the cellulose is oxidized, regenerated cellulose.

82. The intracorporeal marker ofclaim 76 wherein the fibrous body is formed of material which swells in the presence of body fluids or other water based fluids.

83. The intracorporeal marker ofclaim 76 wherein the fibrous body is formed at least in part of woven fabric.

84. The intracorporeal marker ofclaim 76 wherein the fibrous body is formed at least in part of felt fabric.

85. The intracorporeal marker ofclaim 76 wherein the fibrous body is compressed.

86. The intracorporeal marker ofclaim 85 wherein the compressed fibrous body has incorporated therein a binding agent to hold the fibrous body in the compressed condition.

87. The intracorporeal marker ofclaim 86 wherein the binding agent is selected from the group consisting of water soluble polymers selected from the group consisting of polyvinyl alcohol, polyethylene glycol and polyvinyl pyrollidone.

88. The intracorporeal marker ofclaim 76 wherein the fibrous body includes at least one bioactive component selected from the group consisting of therapeutic and diagnostic agents incorporated therein.

89. The intracorporeal expandable marker ofclaim 88 wherein the incorporated therapeutic or diagnostic agent is selected from the group consisting of a hemostatic agent, an anesthetic agent, a coloring agent, an antibiotic agent, an antifungal agent, an antiviral agent, a chemotherapeutic agent and a radioactive agent.

90. The intracorporeal expandable marker ofclaim 78 wherein the fibrous body contains a bioabsorbable material selected from the group consisting of polylactic acid, a co-polymer of polylactic acid and glycolic acid, polycaprolactone, collagen and mixtures thereof, including mixtures with the oxidized cellulose.

91. The intracorporeal expandable marker ofclaim 78 wherein the fibrous body includes a binding agent.

92. The intracorporeal expandable marker ofclaim 76 wherein the radiographically detectable marker element is disposed at a central portion of the fibrous body.

93. The intracorporeal expandable marker ofclaim 76 wherein a constricting member holds a portion of the fibrous body to prevent its expansion.

94. The intracorporeal expandable marker ofclaim 93 wherein the constricting member holds a central portion of the fibrous body to prevent its expansion.

95. The intracorporeal expandable marker ofclaim 76 wherein the radiographically detectable marker element is a constricting member which holds a portion of the fibrous body to prevent its expansion.

96. The intracorporeal expandable marker ofclaim 95 wherein the radiographically detectable constricting member holds a central portion of the fibrous body to prevent its expansion.

97. The intracorporeal expandable marker ofclaim 96 wherein the constricted fibrous body is configured to expand into a bow-tie shape when exposed to body fluid or other water based fluid.

98. The intracorporeal expandable marker ofclaim 76 wherein the fibrous body has a core formed of bioabsorbable felt surrounded by a bioabsorbable fabric jacket.

99. The intracorporeal expandable marker ofclaim 95 wherein the radiographically detectable marker element is a radiopaque wire element clamped about a central exterior portion of the fibrous body.

100. The expandable intracorporeal marker ofclaim 95 wherein the fibrous mass has been compressed at least 25%.

101. An intracorporeal marker comprising a compressed expandable bioabsorbable fibrous body which has been compressed and bound in the compressed condition.

102. The intracorporeal marker ofclaim 101 wherein the fibrous body is bound by a binding agent selected from the group consisting of water soluble polymers selected from the group consisting of polyvinyl alcohol, polyethylene glycol and polyvinyl pyrollidone.

103. The intracorporeal marker ofclaim 101 wherein the fibrous body is about 0.5 mm to about 12 mm in diameter.

104. The intracorporeal marker ofclaim 101 wherein the fibrous body is, about 1 to about 8 mm in diameter.

105. The intracorporeal marker ofclaim 101 wherein the fibrous body is about 5 to about 30 mm in length.

106. The intracorporeal marker ofclaim 101 wherein the fibrous body is about 10 to about 25 mm in length.

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