Percutaneous implantation
- Prostate
- Lung
- Abdominal organs such as liver, pancreas, kidney, adrenal gland and metastases in various places >
- Breast
- Cervix and other gynecologic organs
- Bladder wall
- Head & neck applications such as tonsil, nodules, base of tongue and close to the larynx
- Etc.
Endoscopic implantation
If the Gold Anchor marker is transferred over to longer EUS-FNA or EBUS-TBNA needles, Gold Anchor can also be placed in:
- Rectal
- Esophageal
- Pancreatic and
- Central lung tumors.
Prostate
Prostate cancer is the second most common cancer diagnosed in males worldwide. Fiducial markers are often used to guide external beam radiotherapy to provide target coverage while protecting nearby sensitive organs. Traditional markers are, however, implanted with relatively thick needles that can cause infections and bleeding. Traditional markers can also move in the needle tract some days after implantation because the markers have a smaller diameter than the needle tract. Medical teams therefore typically choose to wait 1-3 weeks for the markers to “settle in” before continuing with CT/MR for dose planning.
Gold Anchor’s industry leading thin needles and unique marker design makes it possible to proceed with CT/MR for dose planning on the same day as implantation.
Reduce implantation time
Transrectal
We generally recommend transrectal implementation of Gold Anchors. With Gold Anchors this is a low risk procedure that does not require anesthesia. Three Gold Anchors can typically be implanted by the doctor in less than five minutes.
Transperineal
If you prefer to implant markers transperineally you can also avoid anesthesia – using an anaesthetic patch 30 minutes before implantation is enough.
Reduce patient discomfort
Intensity of pain during transrectal implantation in prostate (not showing those answering “no pain”).
17G; 1.2x3mm markers
without anesthesia
0 = no pain 5 = worst possible pain
Share of patients (n=135)
18G; 1x5mm markers
with local anesthesia
0 = no pain 5 = worst possible pain
Share of patients (n=229)
22G; Gold Anchor
without anesthesia
0 = pain 10 = worst possible pain
Share of patients (n=362)
Source (17G): Igdem S, Akpinar H, Alço G et al. Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity. Br Radiol 2009;82:941-945.
Source (18G; 1x5 mm): S Gill, J Li, J Thomas, et al. Patient-reported complications from fiducial marker implantation for prostate image-guided radiotherapy. Br J Radiol. 2012 Jul;85(1015):1011-7.
Source (22G): Wioletta Mista, Leszek Miszczyk. An evaluation of side effects after gold markers (Gold Anchor™) implantation to prostate gland in patients with prostate cancer. Onkologia Info 2011;8;2:110-111.
Reduce complications from implantation
Gold Anchors can be implanted transrectally in prostate with a very low risk of infection vs. other transrectal procedures, see graph.
These results from Karolinska suggest that the thin Gold Anchor needles reduce the risk of UTI despite the use of only a single dose of non-broadspectrum antibiotics as prophylaxis.
“The application process for Gold Anchor is much easier than for other fiducial markers. With Gold Anchor we do not have to use local anesthesia – giving local anesthesia would be more painful than implanting the fine needle marker.
We have between 5-8 patients per week and have had almost no infections since we started using Gold Anchors in 2009 [see graph above].”
Save lead time and travel
With Gold Anchor there is no need to wait the usual 7-21 day before dose planning. The thin Gold Anchor needle, that causes minimal bleeding and swelling, in combination with the strong tissue attachment of the marker, makes it possible to proceed with CT and/or MR for dose plan on the same day as implantation.
Note: Most centers that use traditional markers send their patient home for 7-21 days after implantation to allow the traditional markers to “settle in”, i.e. to allow the potential bleeding and swelling subside to reduce the risk that the traditional markers migrate in the tissue.
We use two Gold Anchors per patient – one with line shape and one with ball shape. We have never seen any events of infection.
When we use these very thin needles we have stopped to give local anaesthesia – the tiny needles are usually tolerated very well by the patient. Instead we use a small EMLA patch.
We do the CT planning on the same day as the gold marker implantation.
Lung
Lung cancer is the most common cancer diagnosed worldwide. Lung tumors can often be visualized with cone-beam CT but there are cases that can benefit from using fiducial markers, e.g. when there is atelectasis or when the tumor edges as blurry. Many doctors, however, hesitate to use fiducial markers in lung due to the risk of pneumothorax when using the relatively thick needles that are required to implant traditional fiducial markers.
Gold Anchor’s industry leading thin needles drastically reduce the risk of transthoracic implantation. And the marker can also be placed endoscopically.
Peripheral lung tumors
Transthoracic implantation of Gold Anchor in peripheral lung tumors is almost complication-free in comparison to implantation of traditional markers. Experience from needle aspiration biopsy indicates that 18G needles (frequently used for traditional markers) cause ten times as many pneumothoraces needing treatment as 22G/25G needles (used for Gold Anchor).
Central lung tumors
Some Gold Anchor users have chosen to transfer the Gold Anchor marker into 22G EBUS-TBNA needles. This enables placement of Gold Anchor through bronchoscope in central lung and esophageal tumors.
Transferring the Gold Anchor marker is easy since the Gold Anchor needle (GA150) can be inserted into the needle tip of the 22G EBUS-TBNA needle.
In our radiation and interventional oncology practice at Austin Cancer Centers, we have found that by using the Gold Anchor system; this has allowed us to treat soft tissue tumors that were once considered inaccessible. Given the small gauge size of the needles, this has added a significant margin of safety that we had not previously enjoyed.
Abdominal organs
Primary liver cancer is the sixth most common cancer diagnosed worldwide. Fiducial markers can be used to guide both radiotherapy and ablation treatments. The implantation of traditional markers can, however, lead to bleeding, painful bile leakage and, for example in the case of colorectal metastases, to the spread of tumor cells (seeding).
Pancreatic cancer is the 12th most common cancer diagnosed worldwide. Fiducial markers can be used to guide both radiotherapy and surgical resection. Implantation of traditional markers can lead to bleeding, inflammation (pancreatitis) and abdominal pain.
Gold Anchor is available in the same type of ultrathin needles that has been used for over 60 years for fine needle aspiration cytology (FNAC) with no to very little harm.
Gold Anchor is suitable for percutaneous implantation in most soft tissue organs, e.g. liver, pancreas, kidney, adrenal gland, breast, oligomets in abdomen and inguinal metastases. At Karolinska the implantation of Gold Anchors in abdominal tumors are sometimes done by oncologists but in most cases the patient is referred to radiologists – every physician who take needle biopsies is skilled to implant Gold Anchor.
I have used the spinal needles (25G, that is 0.5 mm) for ultrasound guided biopsies and ultrasound guided deposition of gold markers for seven years. In my clinic we perform at least 120 such interventions per month. I have put these needles through all abdominal organs, including hollow organs such as the stomach, the colon or the small bowel, and the urinary bladder. I have taken biopsies by access through the abdominal aorta, the inferior vena cava, the liver veins and the jugular vein. In the last seven years I have not recorded (personally or for the rest of my unit) a single complication that ever required any therapeutic measure whatsoever.
In most cases, I use no anesthesia when I insert the 25G needles. After the intervention, our patients go home without observation.
It is easier to implant Gold Anchor than to perform Fine Needle Aspiration Cytology, which requires cell sampling from an exact location. Oncologists who refer the patients for implantation tell us that it is enough that the fiducial marker is delivered in the vicinity of the lesion. With the ultra-thin needle of 0.5 mm, we do not have to order blood coagulation tests, unless the patient is on blood-thinners. Furthermore, when using the thin Gold Anchor needle on liver lesions, we never observe any bile leakage that causes painful irritation of the peritoneum.
The Gold Anchor has been used for our SBRT liver patients and for palliative cases with large tumors located close to risk organs.
The fine needle deposition is smooth and painless. It is a top of the line equipment.
Percutaneous placement
Gold Anchors are typically implanted percutaneously into abdominal organs. This x-ray video shows a 0.28x20 mm marker (GA200-20) implanted in liver while the patient breathes. This example illustrates the value of positioning soft tissue based on a fiducial marker rather than on distant bony anatomy.
X-ray video courtesy of Jun Ishida, MD, PhD, Vice Director, Diagnostic Radiology, Kobe Minimally invasive Cancer Center, Japan.
Endoscopic placement
Some Gold Anchor users have chosen to transfer the Gold Anchor marker into 22G EUS-FNA needles. This enables placement of Gold Anchor through endoscope in pancreatic and rectal tumors.
Transferring the Gold Anchor fiducial marker is easy since the Gold Anchor needle (GA150) can be inserted into the needle tip of the 22G EUS-FNA needle.
The image shows a 0.28x10 mm Gold Anchor marker implanted in pancreas.
Image courtesy of Reiko Ashida, MD, PhD, Co-Director, Departments of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Japan.
EUS guided fiducial marker placement (EUS-FP) is an important method to place a fiducial marker safely and precisely especially into pancreatic cancer. Gold Anchor is an ideal marker for EUS-FP as it is easily back loaded into a FNA needle.
Breast
Breast cancer is the most common cancer diagnosed in women worldwide. It is common to mark the surgical cavity after lumpectomy with surgical clips that can be visualized on CBCT. Those clips may, however, not provide sufficient visibility for automated marker tracking systems. And it is sometimes also difficult to attach these markers to the tumor bed.
Radiotherapy boost treatment are becoming more and more common as well as the delineation of the target area on MRI. Gold Anchor markers provide strong tissue attachment in the tumor bed and provide good visibility both on kV and MR images.
Gold Anchors can be implanted during surgery to mark the surgical cavity after lumpectomy. The markers can then be used to improve accuracy in delineation of the surgical cavity and for the verification of breast position during IGRT.
Image guidance may improve whole breast irradiation outcomes by ensuring adequate coverage of the target tissue on a daily basis while allowing smaller margins around the targets, thereby reducing exposure to lung and heart (for left sided cases).
Marker based IGRT is also useful for APBI (Accelerated Partial Breast Irradiation).
Gold Anchor can also be placed percutaneously in breast, e.g. to facilitate a boost to breast tumors prior to surgery.
Gynecologic organs
Cervical cancer is the seventh most common cancer diagnosed worldwide. The cervix is prone to movement. Changes in target position and shape may be caused by rectum- and bladder-filling changes, but may also be due to tumor shrinkage during radiotherapy. Fiducial markers are therefore useful to guide both external-beam and internal radiotherapy (brachy). However, traditional markers have a tendency to migrate and fall out of the vaginal wall and cervix while Gold Anchors expand outside the needle and anchor in the tissue.
We are using Gold Anchors to achieve a more reliable localization over time for our gynecology patients.