US20090088665A1 - Marker device and method of deploying a cavity marker using a surgical biopsy device - Google Patents

Abstract

A biopsy marker introduction assembly is configured for introduction through a specimen retrieval recess into a probe cutter lumen of a handheld breast biopsy handle. Advancing the cutter causes an extending deployment rod to distally translate within an introducer tube of the introduction assembly, pushing a biopsy marker out of a distal end of the probe at a surgical biopsy site. Thereby, the surgeon is able to position the probe and effect deployment of the marker even if using the other hand to position an imaging device such as an ultrasonic transceiver.

Description

FIELD OF THE INVENTION
• The present invention relates, in general, to an applier for delivering and deploying a marker for implantation in tissue of a surgical patient, and more particularly, to such an applier for delivering and deploying an implantable biopsy marker for defining specific locations in human tissue during a biopsy procedure, especially in a human breast.
BACKGROUND OF THE INVENTION
• One in nine American women will develop breast cancer in their lifetime. It is the leading cause of cancer deaths in women 40-55 years of age and the second leading cause of cancer deaths in women overall. Breast cancer will be diagnosed in approximately one in eight women in their lifetime, and one in 30 will die of this disease. Breast cancer does occur in males, but is much less common. Biopsy requests stem from a screening process generally performed via a physical examination (palpable) and/or mammogram (non-palpable). A biopsy is indicated if suspicious tissue is detected. Five out of six biopsies performed return benign indications.
• It is desirable and often necessary to perform procedures for detecting, sampling, and testing lesions and other abnormalities in the tissue of humans and other animals, particularly in the diagnosis and treatment of patients with cancerous tumors, pre-malignant conditions and other diseases or disorders. Typically, in the case of cancer, when a physician establishes by means of known procedures (i.e. palpation, x-ray, magnetic resonance imaging (MRI), or ultrasound imaging) that suspicious circumstances exist, a biopsy is performed to determine whether the cells are cancerous. Biopsy may be an open or percutaneous technique. Open biopsy removes the entire mass (excisional biopsy) or a part of the mass (incisional biopsy). Percutaneous biopsy on the other hand is usually done with a needle-like instrument and may be either a fine needle aspiration (FNA) or a core biopsy. In the FNA biopsy, very small needles are used to obtain individual cells or clusters of cells for cytologic examination. The cells may be prepared such as in a Papanicolaou (Pap) smear. In core biopsy, as the term suggests, a core or fragment of tissue is obtained for histologic examination, which may be done via a frozen section or paraffin section. The chief difference between FNA and core biopsy is the size of the tissue sample taken. An imaging system having spectroscopic capabilities, such as the stereotactic guidance system, is employed to guide the extraction instrument to the lesion.
• A significant advance in core biopsies in a diagnostic imaging modality such as X-ray, MRI, ultrasonic, etc. have been facilitated by a hand-held biopsy device, such as described in U.S. Pat. No. 6,086,544, the disclosure of which is hereby incorporated by reference in its entirety. Being handheld, this generally known “MAMMOTOME” breast biopsy system creates a less intimidating and more-comfortable arrangement for the patient with minimal procedure preparation time as compared to a tabletop fixed biopsy device. The procedure may be completed in less than an hour in a doctor's office or on an outpatient basis under a local anesthetic and requires no surgery or stitches. It allows the patient to lie comfortably on her back.
• A probe need only be inserted once into the patient's breast via a small incision. Once inserted and positioned via imaging (e.g., ultrasonic, MRI), the needlelike probe can collect multiple samples by means of vacuum aspiration and an internal rotating cutter. The vacuum draws the sample into the probe aperture within reach of the cutter. From there, tissue samples can be obtained in and around the targeted area. Even though the incision is smaller, these samples can be eight times the weight of samples obtained with traditional spring-loaded biopsy equipment.
• It should be appreciated that a generally known vacuum assisted breast biopsy system described above has incorporated an onboard microprocessor to automate the sampling process. A positioning sensor allows the color touch-screen monitor to reflect the exact position of the cutting tip. An easy-to-follow graphical user interface gives surgeons maximum control over the location from which the biopsy sample is taken. A two-motor cutting drive system self-contained in the base unit and connected to a lightweight handpiece eliminates the need to table-mount the cutter assembly. Lightweight, flexible cables connect the base to the disposable handpiece. This handheld unit, which incorporates cutter position sensors, allows physicians to place the sampling probe accurately and obtain larger samples of suspect tissue.
• The cutting drive system includes direct feedback control of both cutter translational and rotational speeds. When either the translational speed or rotational speed is not at the desired rate due to increased or decreased loading on the system, the control feature modifies the power to the motor. This allows the speeds to remain near their desired levels, enabling maximum control throughout the procedure. The cutter can sample both palpable and nonpalpable lesions, including spiculated masses, asymmetric densities, multifocal disease, and diffuse tissue.
• In addition, the handheld cutting probe includes ergonomic features to allow for easy manipulation and procedure control such as a soft-touch finger-control keypad. Precise position control lets the cutter close the aperture through which the sample enters without bottoming out at the end of the probe. Good position control (e.g., within 0.001 in.) enables the minimization of the length of the cushion, or “dead zone,” at the end of the probe. Incision of the tissue and completion of the sampling as directed is achieved without causing damage to healthy surrounding tissue.
• This hand-held biopsy device is capable of rapidly taking a number of biopsy samples, assisted by a vacuum capability that draws tissue into proximity with a cutter. A computer-controlled vacuum system enables the vacuum to cycle on and off, and optimizes the vacuum in accord with the cutter activity. The vacuum retrieval system allows the caregiver to take multiple samples of a lesion while the needle probe remains in the breast. Moreover, large enough samples are obtainable, avoiding dry taps, or the inability to obtain an adequately sized sample of the suspect tissue, a common problem associated with other breast biopsy systems. Moreover, the hand-held biopsy device may further completely remove suspicious material as a therapeutic treatment for suspicious lesions.
• With this ability to completely remove a lesion, however, comes a desire to mark this location for later reference, such as for further treatments or later diagnostic follow-up. To that end, an applier for an implantable surgical marker is advantageously used in conjunction with a hand-held biopsy device, such as described in U.S. Pat. No. 6,261,302, the disclosure of which is hereby incorporated by reference in its entirety. After a last specimen is retrieved from a probe of the hand-held biopsy device, the cutter is withdrawn so that an open lumen is presented between a specimen collection bowl and a distal aperture of the probe. A flexible introducer of the marker applier is inserted through the lumen and then the marker is released at the desired location by depressing a button on the marker applier.
• While this technique accomplishes the desired end, it would be desirable to simplify the procedure. For instance, when using ultrasonic imaging to position the probe of the biopsy device, the surgeon typically has to hold an ultrasonic transceiver with one hand. The other hand directs the biopsy device to the desired location and controls the taking of samples. Then a third hand is needed to actuate the marker applier. It would be desirable that a two-hand procedure would be adequate while maintaining the efficiency and convenience of using a handheld biopsy system.
• In addition, it would be desirable to have the same degree of control and repeatability in marker placement that is available in taking the tissue samples themselves. Generally-known marker placement devices, such as the MICROMARK II device described above, relies upon the user to insert its distal end fully through the open needle of the biopsy device. Actuating the marker placement device in some instances may fail to deploy the marker from the biopsy probe, however.
• Consequently, a significant need exists for an improved approach to placing a biopsy marker with the aid of a biopsy instrument.
BRIEF SUMMARY OF THE INVENTION
• The invention overcomes the above-noted and other deficiencies of the prior art by providing a marker introducing assembly that advantageously conforms to a biopsy probe and is actuated by a cutter of a biopsy handle to deploy a biopsy marker out of a distal end of the biopsy probe. Thereby, a surgeon may advantageously position the biopsy probe to a desired surgical site and actuate a cutter control to deploy the marker while having another hand free to perform other functions such as positioning an ultrasonic transceiver for imaging the biopsy probe.
• In one aspect of the invention, a biopsy introducing assembly includes an alignment feature that confirms a fully seated and oriented placement into the biopsy probe so that advancement of the cutter of the biopsy handle will achieve full travel without bottoming out to reliably deploy the marker.
• In another aspect of the invention, a biopsy system and method alters a direct feedback control of the cutter of the biopsy handle to a desired translation distance appropriate for the marker introducing assembly to reliably deploy the marker without bottoming out a plunger therein that communicates between the marker and the cutter. In addition to translation distance control, rate of translation and disabling cutter revolution may be included. Thereby, the surgeon is able to use biopsy controls in a familiar manner for deploying the marker as is used in taking the biopsy samples.
• These and other objects and advantages of the present invention shall be made apparent from the accompanying drawings and the description thereof
BRIEF DESCRIPTION OF THE FIGURES
• The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention.
• FIG. 1 is a left side elevation view with a left half cut-away of a biopsy system with a cutter of a biopsy handle retracted allowing placement of a biopsy marker introduction assembly into a biopsy probe.
• FIG. 2 is a left side elevation view in cross section of the biopsy marker introduction assembly ofFIG. 1.
• FIG. 3 is a left side elevation view in cross section of the biopsy marker introduction assembly seated in the biopsy probe ofFIG. 1.
• FIG. 4 is a left side elevation view in cross section with the cutter advanced to drive a plunger through an introducer tube to deploy the marker out of the biopsy probe of the biopsy handle ofFIG. 1.
• FIG. 5 is a perspective view of a handheld breast biopsy device in phantom with a flexible marker introduction assembly being inserted.
• FIG. 6 is a perspective view of the handheld breast biopsy device ofFIG. 5 with the flexible marker introduction assembly further inserted.
• FIG. 7 is a right-side elevation view of the handheld breast biopsy device taken in longitudinal cross section along lines7-7 ofFIG. 6.
• FIGS. 8-11 are right side elevation views of a cutter of the handheld breast biopsy device and the marker introduction assembly taken in longitudinal cross section along lines7-7 ofFIG. 6 depicting a sequence respectively of the cutter engaging the pusher, the cutter advanced to expose a marker in a specimen opening of the probe, the cutter advanced to ramp a distal end of the marker against an angled surface of the assembly, and the cutter advanced to fully deploy the marker by underrunning a driver tip of the pusher.
• FIG. 12 is a sequence of operations or procedures for controlling a biopsy system to deploy a biopsy marker at a surgical biopsy site.
DETAILED DESCRIPTION OF THE INVENTION
• Turning to the Drawings, wherein like numerals refer to like components throughout the several views, inFIG. 1, a breast biopsy handle10 of abiopsy system12, a minimally invasive device, is used under local anesthetic and ultrasound guidance to collect multiple biopsy samples with a single insertion of aprobe14 into the breast of a patient. After which, acutter16 is retracted proximally in ahousing18 of the biopsy handle10 to expose a distallyopening entry cone20 of acutter lumen22 of theprobe12. The surgeon may then insert and seat a biopsymarker introduction assembly24, which is shown separately inFIG. 2.
• Also shown inFIG. 2 is aMylar sealing cap26 that has been removed just prior to use from adistal end28 of theintroduction assembly24 to expose a laterally disposeddeployment opening30 in anintroducer tube32. Amarker34 is positioned inside of theintroducer tube32 proximal to thedeployment opening30 that has sufficient length to allow themarker34 to be laterally expelled when adistal end36 of themarker34 ramps against anangled surface38 at thedistal end28 of theintroduction assembly24. Thus, aproximal end40 of themarker34 resides approximately twice the length (2×) of themarker34 from theangled surface38 when in its initial state as depicted. Abutting thisproximal end40 is a marker pusher, depicted as aplunger tip42 of amarker deployment rod44 that longitudinally translates within theintroducer tube32. Theplunger tip42 in some applications dynamically seals to the interior of theintroducer tube32 to form a sterile environment for themarker34 and to pneumatically assist in deploying themarker34. For instance, theplunger tip42 may push air toward themarker40 as a syringe, which may advantageously reduce the amount of travel required for thecutter16. Alternatively or in assistance thereof, avacuum lumen45 in theprobe14 may provide vacuum assist to draw theplunger tip42 and bleed any excess pressure from the surgical site.
• Aproximal end46 of themarker deployment rod44 terminates in acutter seat48 that extends proximally beyond theentry cone20 of the cutter lumen22 a sufficient distance to provide full travel of themarker deployment rod44 yet fit within aspecimen retrieval recess50 formed within thehousing18 of thebiopsy handle10. Thecutter seat48 has a greater lateral diameter than the tube-shapedcutter16 to ensure contact. Since thecutter16 closely fits the inner diameter of thecutter lumen22, thecutter seat48 reaches full travel at theentry cone20.
• With reference toFIGS. 2-3, afunnel50 flared proximally and attached to aproximal end52 of theintroducer tube32 encompasses thecutter seat48 and the portion of themarker deployment rod44 that extends proximal to theentry cone20. Thefunnel50 advantageously includes an alignment feature, such as a transversely extendingkey54, that mates with a corresponding alignment feature in thebiopsy probe14, such as a proximally openedrecess56. These alignment features54,56 ensure that themarker introduction assembly30 is correctly rotated to present itsdeployment opening30 to aspecimen opening58 of theprobe14. In addition, visual and tactile confirmation is given that theintroduction assembly24 is fully inserted into theprobe14 so that reliable deployment of themarker34 may be achieved.
• InFIG. 4, thecutter16 has been advanced, distally translating thedeployment rod44 to deploy themarker34. Then theprobe14 may be withdrawn leaving themarker34 behind. In some applications, the existing controls of thebiopsy system12 may be used to achieve deployment as depicted inFIG. 4. Thus, thecutter seat48 may advantageously resist damage from acutter16 that is rotating (e.g., hardened surface, low friction surface, or configured to be rotated by the cutter). The surgeon would command forward translation of the cutter until visually confirming full travel or the cutter is prevented from further travel by thecutter seat48 engagingintroducer tube32.
• InFIGS. 1-4, the breast biopsy handle10 depicted is similar to stereotactic devices attached to a tabletop. A handheld MRI-compatible biopsy device60 is depicted in phantom inFIGS. 5-6 for use with amarker introduction assembly62. In some applications, access to anentry cone64 of acutter lumen66 of aprobe68 may be constrained by the shape of aspecimen retrieval recess70 formed in ahandle72 of the handheldbreast biopsy device60. Consequently, portions of themarker introduction assembly62 are formed of a sufficiently flexible material, as depicted inFIG. 5, to be bent during insertion into thebiopsy handle70. InFIGS. 5-6, analignment key74 along the top of afunnel76 rotationally and longitudinally orients an attachedintroducer tube78 within thecutter lumen66 of theprobe68. Theintroducer tube78 is sufficiently thin to allow advancement of a cutter80 (depicted inFIGS. 8-11) as desired within thecutter lumen66 without binding. This has an added advantage of thus being usable in specimen retrieval recesses70 that are not at least twice the length of amarker82 or when it is otherwise desirable to advance thecutter80 more fully during deployment of themarker82.
• InFIG. 7, themarker introducing assembly62 has been inserted into theprobe68 in preparation for the surgeon initiating deployment of themarker82. InFIG. 8, thecutter80 has been advanced into contact with acutter seat84. InFIG. 9, thecutter80 has further distally advanced, driving apusher rod86 and itsdriving tip88, and thus the distally placedmarker82 to expose the marker in adistal opening90 of theintroducer tube78. InFIG. 10, thecutter80 has been further advanced so that the distal end of themarker82 ramps outward against anangled surface92 of thedistal opening90. InFIG. 11, thecutter80 has further advanced so that the drivingtip88 has underrun the fully deployedmarker82 and has been received within atip slot94 of the introducer tube78 (shown also inFIG. 6).
• Thepusher rod86 advantageously closes thedistal opening90 of theintroduction assembly62 and thus a specimen opening96 of theprobe68. This may be an advantageous feature that allows retracting theprobe68 without inadvertently dragging out themarker82. Thus, there is no requirement to rotate theprobe68 as an additional step or alternatively to remove theintroduction assembly62 and replace it with a stylus (not shown) to close theprobe68.
• It is desirable to include a marker deployment mode into the controls of thebiopsy system12 to optimize this function. For instance, if two motors are used, one for longitudinal translation of the cutter and one for rotating thecutter16, then dedicated control logic would allow disabling cutter rotation during deployment. Also, the amount of longitudinal travel and the rate of travel may be optimized for marker deployment. InFIG. 5, an illustrative sequence of operations orprocedure100 for biopsy device control of marker deployment is depicted as a flow diagram.
• A surgical cite within the patient's breast is imaged (e.g., ultrasonic imaging) (block102) to guide the surgeon to insert and position the probe (block104). Vacuum is applied through the probe to assist in drawing tissue into a specimen bowl of the probe (block106) while the cutter is rotated and distally translated to cut the tissue. The probe may be repositioned, such as by rotating the probe to present the specimen bowl at a different angle with the specimen bowl blocked by the extended cutter. Thereafter, the cutter and sample are proximally retracted (block110). These actions of blocks104-108 may be repeated to the surgical site between biopsies or by otherwise repositioning the probe.
• Once the biopsies at the surgical site are complete, then the surgeon engages the marker introduction assembly (“introducer”) into the biopsy probe (block112) and enables deployment mode of the marker (block114). The interface between the introducer and the biopsy handle may be such that its presence is sensed by a sensor (block116) and automatically prepares the biopsy system for deployment mode, preventing inadvertent rotation of the cutter or an inappropriate application of the vacuum assist system and/or adjusting cutter travel and/or rate of travel. Enabling deployment mode may be manual (block118) wherein the surgeon uses a control, such as pushing a deployment soft button, to initiate deployment mode. As a further example, a remote control unit that is spaced away from the biopsy handle may initiate deployment mode (block120). For example, a control unit may be elsewhere in the surgical suite, for instance in an MRI or CTI facility wherein the biopsy system is remotely actuated.
• If marker deployment mode has been enabled, then cutter rotation may advantageously be disabled in a two-motor biopsy system (block122). Distal translation speed is set (block124). For instance, a greater rate of travel may be desired to better propel the marker from the probe. Maximum cutter travel may be set (block126) to avoid binding and damage, especially if the mechanical advantage of the motor and mechanization is such as to cause damage before full travel may be sensed. It may be desirable to use a fluid drainage capability of the biopsy system at this point, such as using the vacuum assist system to remove fluid from the surgical site and/or to insufflate the surgical site to provide a cavity to receive the biopsy marker (block128).
• Then the cutter is advanced to deploy the marker (block130), which may be a programmed mode that is initiated by the surgeon (block132) or a manual process (block134) with a deployment command maintained by the surgeon. Imaging may be performed contemporaneously or subsequently to confirm that the marker has been deployed at the surgical site (block136). Advancement continues until a determination is made that the marker is deployed (block138), which may be determined based on one or more conditions such as the biopsy system sensing full travel, sensing of cutter binding at full travel, visual confirmation of the marker deployment, etc.
• In some applications, the introducer and/or biopsy probe may be determined to be insufficiently closed at this point (block140), such as the introducer prevents closure. To prevent inadvertently dislodging the marker, the cutter is retracted (block142), the marker introducer is removed with the probe still in place (block144), the probe is rotated (e.g., 180 degrees) so that the specimen bowl is moved away from the marker to prevent its inadvertent entry (block146), and the cutter is advanced to close the port (block148). Once the port is determined to be closed inblocks140 or148, then the probe is removed (block150).
• While the present invention has been illustrated by description of several embodiments and while the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art.
• For example, it should be appreciated that the illustrative embodiment describes a handheld biopsy procedure guided by ultrasonic imaging to accentuate advantages of incorporating marker placement into biopsy instrument controls. However, aspects of the present invention pertain to tabletop fixed biopsy instruments, biopsy instruments used for tissue other than the breast, biopsy instruments positioned with other imaging modalities such as X-ray and Magnetic Resonance Imaging (MRI), and remotely actuated biopsy instruments.
• For example, although a vacuum-assisted biopsy system has been advantageously depicted herein as benefiting from a marker introduction device, it should be appreciated that application of a marker introduction device to a core needle biopsy device would provide similar advantages, allowing a surgeon to place a marker while positioning the core needle device with reference to a diagnostic image.
• For another example, although a specific handheld biopsy device is described, it should be appreciated that a detachable probe may be used in conjunction with a marker introduction device.
• As yet another example, although affirmatively driving the marker with the cutter of a biopsy handle has a number of advantages, it should be appreciated that the vacuum assist control system of a biopsy system consistent with aspects of the invention may be used to draw a plunger of a biopsy marker introduction device toward the distal end of the probe. With the plunger fully translated distally, the marker would deploy and then the vacuum assist may be removed, leaving the marker in place as the biopsy probe is removed.

Claims (24)

1. A method of deployment of a biopsy marker at a biopsy surgical site within a body by use of a biopsy device, the method comprising:

retracting a cutter to expose a cutter lumen of a biopsy probe;

inserting a marker and pusher into the cutter lumen; and

distally advancing the cutter to drive the pusher and thus the marker to cause deployment at the biopsy surgical site.

2. The method ofclaim 1, wherein a distal portion of the cutter lumen communicates with a pneumatic source, the method further comprising:

insufflating the biopsy surgical site with the pneumatic source.

3. The method ofclaim 1, further comprising:

assembling an introduction device by inserting the marker and pusher into an introducer tube sized for the cutter lumen.

4. The method ofclaim 3, further comprising:

forming a pneumatic seal between the pusher and the introducer tube, wherein distally advancing the cutter forms a syringe pressure proximally to the pneumatic seal.

5. The method ofclaim 3, further comprising:

forming a pneumatic seal between the pusher and the introducer tube; and

forming a vacuum assist pressure in a distal portion of the cutter lumen, thereby distally drawing the pusher to deploy the marker.

6. The method ofclaim 2, further comprising sizing a thickness of the introducer tube to enable advancing the cutter into the cutter lumen with the introduction assembly inserted therein, wherein distally advancing the cutter comprises distally advancing the cutter into the cutter lumen.

7. The method ofclaim 2, further comprising sizing a thickness of the introducer tube to enable advancing the cutter into the cutter lumen with the introduction assembly inserted therein, wherein distally advancing the cutter comprises distally advancing the cutter into the cutter lumen.

8. The method ofclaim 1, further comprising proximally extending the pusher from the cutter lumen wherein distally advancing the cutter deploys the marker as the cutter approaches the cutter lumen.

9. The method ofclaim 1, further comprising distally advancing the cutter to position the pusher across a distal lateral opening in the biopsy probe enabling retraction of the biopsy probe without disturbing the deployed marker.

10. The method ofclaim 1, further comprising distally advancing the cutter to position the pusher across a distal lateral opening in the biopsy probe enabling retraction of the biopsy probe without disturbing the deployed marker.

11. The method ofclaim 1, further comprising percutaneously deploying the marker during a core needle biopsy procedure.

12. A device for deploying a biopsy marker through a biopsy instrument having a probe defining a cutter lumen including a distal opening and an accessible proximal opening and a cutter translatable through the cutter lumen, the device comprising:

a tube configured to be received in the cutter lumen and having a lateral distal opening;

a marker slidingly received in the tube; and

a pusher proximal to the marker and slidingly received in the tube, and having a proximal extension configured for abutment with the cutter to deploy the marker through the lateral distal opening.

13. The device ofclaim 12, further comprising a proximal collar attached proximally to the tube and configured for manipulating the device into the cutter lumen.

14. The device ofclaim 12, further comprising an alignment feature configured to rotationally orient the tube in the cutter lumen.

15. The device ofclaim 12, further comprising a pneumatic sealing feature dynamically sealing the pusher to the tube.

16. The device ofclaim 13, wherein the tube distally includes a deployment opening, the device further comprising a removable sealing tip engageable over the deployment opening.

17. The device ofclaim 12, wherein the distal opening includes a ramped surface to rampingly eject a distal end of the marker.

18. The device ofclaim 17, wherein the pusher distally terminates in a driving surface for rampingly ejecting a proximal end of the marker.

19. The device ofclaim 12, wherein at least a portion of the tube and pusher comprise a resilient material for flexibly inserting the device into the biopsy instrument.

20. A biopsy system for obtaining a biopsy sample, the biopsy system comprising:

a core biopsy probe including a cutter lumen that communicates between a distal opening and an accessible proximal opening;

a biopsy handle having an actuator for cutting the biopsy sample through the biopsy probe; and

a marker introduction device comprising:

a tube configured to be received in the cutter lumen and having a lateral distal opening,

a marker slidingly received in the tube, and

a pusher proximal to the marker and slidingly received in the tube, and having a proximal extension configured for abutment with the cutter to deploy the marker through the lateral distal opening.

21. The biopsy system ofclaim 20, wherein the pusher is operably configured to dynamically seal to the tube, the biopsy system further comprising a vacuum assist system communicating pneumatically with a distal portion of the probe to assist in marker deployment.

22. The biopsy system ofclaim 21, wherein the vacuum assist system is operably configured to insufflate a surgical site.

23. The biopsy system ofclaim 21, wherein the vacuum assist system is operably configured to distally draw the pusher to deploy the marker.

24. The biopsy system ofclaim 20, wherein the pusher is operably configured to close the distal opening in the biopsy probe subsequent to marker deployment.

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