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SAVI SCOUT® localization of breast lesions as a practical alternative to wires: Outcomes and suggestions for trouble-shooting. Clin Imaging 2018; 52:280-286. [PMID: 30193186 DOI: 10.1016/j.clinimag.2018.07.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the frequency of successful SAVI SCOUT® localizations, to identify the factors contributing to unsuccessful procedures, and to provide a problem-solving algorithm to address those factors. SUBJECTS AND METHODS This retrospective study was performed following IRB approval. We included all consecutive patients with SCOUT® reflector placement performed at a single tertiary-care cancer center. Each case was reviewed and the following data were recorded: patient age, breast density, localization target, imaging modality used for guidance, post procedure mammogram reflector to skin and reflector to target distances, presence of the reflector in the specimen radiograph, excisional biopsy pathology and any procedure complications. RESULTS In 129 women, 152 SAVI SCOUT® reflectors were placed. Most patients had only 1 reflector placed, but 19 (15%) women had multiple reflectors placed for the purposes of bracketing, multiple excisions in 1 breast, bilateral excisions, or any combination thereof. The most common target was a mass (65%) and the most common modality for guidance was ultrasound (73%). SAVI SCOUT® localization was successful in 97%of reflectors, including 89% of reflectors targeting axillary lymph nodes. The most common failure encountered was the inability to obtain a signal in the radiology suite, due to (1) excessive target depth for the radiology suite handpiece and console, (2) obscuration by a hematoma, or (3) faulty reflector. No post-operative complications occurred. CONCLUSION The SAVI SCOUT® surgical guidance system is an accurate and reliable method for localization of non-palpable breast lesions, bracketing, and axillary lymph nodes.
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Greenwood HI, Dodelzon K, Katzen JT. Impact of Advancing Technology on Diagnosis and Treatment of Breast Cancer. Surg Clin North Am 2018; 98:703-724. [PMID: 30005769 DOI: 10.1016/j.suc.2018.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New emerging breast imaging techniques have shown great promise in breast cancer screening, evaluation of extent of disease, and response to neoadjuvant therapy. Tomosynthesis, allows 3-dimensional imaging of the breast, and increases breast cancer detection. Fast abbreviated MRI has reduced time and costs associated with traditional breast MRI while maintaining cancer detection. Diffusion-weighted imaging is a functional MRI technique that does not require contrast and has shown potential in screening, lesion characterization and also evaluation of treatment response. New image-guided preoperative localizations are available that have increased patient satisfaction and decreased operating room delays.
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Affiliation(s)
- Heather I Greenwood
- Department of Radiology, University of California San Francisco, UCSF Medical Center at Mount Zion, 1600 Divisadero Street Room C-250, San Francisco, CA 94115, USA.
| | - Katerina Dodelzon
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
| | - Janine T Katzen
- Department of Radiology, Weill Cornell Medical Center, New York-Presbyterian, 425 East 61st Street, 9th Floor, New York, NY 10065, USA
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Harvey JR, Lim Y, Murphy J, Howe M, Morris J, Goyal A, Maxwell AJ. Safety and feasibility of breast lesion localization using magnetic seeds (Magseed): a multi-centre, open-label cohort study. Breast Cancer Res Treat 2018; 169:531-536. [PMID: 29453521 PMCID: PMC5953977 DOI: 10.1007/s10549-018-4709-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/03/2018] [Indexed: 12/03/2022]
Abstract
Purpose Wire localization has several disadvantages, notably wire migration and difficulty scheduling the procedure close to surgery. Radioactive seed localization overcomes these disadvantages, but implementation is limited due to radiation safety requirements. Magnetic seeds potentially offer the logistical benefits and transcutaneous detection equivalence of a radioactive seed, with easier implementation. This study was designed to evaluate the feasibility and safety of using magnetic seeds for breast lesion localization. Methods A two-centre open-label cohort study to assess the feasibility and safety of magnetic seed (Magseed) localization of breast lesions. Magseeds were placed under radiological guidance into women having total mastectomy surgery. The primary outcome measure was seed migration distance. Secondary outcome measures included accuracy of placement, ease of transcutaneous detection, seed integrity and safety. Results Twenty-nine Magseeds were placed into the breasts of 28 patients under ultrasound guidance. There was no migration of the seeds between placement and surgery. Twenty-seven seeds were placed directly in the target lesion with the other seeds being 2 and 3 mm away. All seeds were detectable transcutaneously in all breast sizes and at all depths. There were no complications or safety issues. Conclusions Magnetic seeds are a feasible and safe method of breast lesion localization. They can be accurately placed, demonstrate no migration in this feasibility study and are detectable in all sizes and depths of breast tissue. Now that safety and feasibility have been demonstrated, further clinical studies are required to evaluate the seed’s effectiveness in wide local excision surgery.
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Affiliation(s)
- James R Harvey
- Manchester Academic Health Science Centre, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, University of Manchester, Southmoor Road, Manchester, M23 9LT, UK.
| | - Yit Lim
- Manchester Academic Health Science Centre, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, University of Manchester, Southmoor Road, Manchester, M23 9LT, UK
| | - John Murphy
- Manchester Academic Health Science Centre, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, University of Manchester, Southmoor Road, Manchester, M23 9LT, UK
| | - Miles Howe
- Manchester Academic Health Science Centre, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, University of Manchester, Southmoor Road, Manchester, M23 9LT, UK
| | - Julie Morris
- Manchester Academic Health Science Centre, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, University of Manchester, Southmoor Road, Manchester, M23 9LT, UK
| | - Amit Goyal
- Royal Derby Hospital, Derby, Derbyshire, DE22 3NE, UK
| | - Anthony J Maxwell
- Manchester Academic Health Science Centre, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, University of Manchester, Southmoor Road, Manchester, M23 9LT, UK.,Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK
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Taback B, Jadeja P, Ha R. Enhanced Axillary Evaluation Using Reflector-Guided Sentinel Lymph Node Biopsy: A Prospective Feasibility Study and Comparison With Conventional Lymphatic Mapping Techniques. Clin Breast Cancer 2018; 18:e869-e874. [PMID: 29544701 DOI: 10.1016/j.clbc.2018.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recently there are efforts to use sentinel lymph node biopsy (SLNB) techniques after neoadjuvant chemotherapy (NAC) to minimize axillary surgery. However, studies have shown higher false negative rates in this scenario, which might result in inaccurate assessment of treatment response and patient prognosis as well as leaving residual disease behind. In this study, we describe the use of reflector-guided excision of the percutaneously biopsied node (PBN) as an aid to conventional SLNB and its predictor of the axillary status after NAC. PATIENTS AND METHODS This was a single-institution analysis of patients who underwent axillary fiducial-reflector placement and subsequent SLNB compared with conventional SLNB. RESULTS Nineteen patients in the reflector group were matched with 19 patients who underwent conventional SLNB (conventional group). The PBN was identified in the SLNB in 19 patients (100%) in the reflector group and in 9 patients (47.3%) in the conventional group (P = .002). In the remaining 10 patients in the conventional group, the PBN was identified in the axillary lymph node dissection specimen in 4 patients (21%) and not identified in 6 patients (31.7%). Among the 38 patients, traditional mapping failed to identify the PBN in 13 patients (34.2%). The PBN was negative in 10 patients (36%) and positive in 18 patients (64%); no additional positive nodes were identified among patients with a negative PBN, correctly reflecting the status of the axilla in 100% of cases. CONCLUSION Mapping failure after NAC might compromise SLNB. Reflector-guided excision of the PBN is not only facile and feasible, but more accurately reflects the status of the axilla after NAC.
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Affiliation(s)
- Bret Taback
- Department of Breast Surgery, Columbia University Medical Center, New York, NY.
| | - Priya Jadeja
- Department of Breast Surgery, Columbia University Medical Center, New York, NY
| | - Richard Ha
- Department of Breast Imaging, Columbia University Medical Center, New York, NY
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Cheang E, Ha R, Thornton CM, Mango VL. Innovations in image-guided preoperative breast lesion localization. Br J Radiol 2018; 91:20170740. [PMID: 29271240 DOI: 10.1259/bjr.20170740] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Screening mammography increases detection of non-palpable breast lesions requiring image-guided localization prior to surgery. Accurate preoperative localization is crucial for successful surgical outcomes. Wire-guided localization is currently the most widely used localization method for non-palpable breast lesions; however, this technique has multiple disadvantages including patient discomfort, possible wire transection and migration, suboptimal surgical incision placement due to wire location and limited scheduling flexibility decreasing operating room efficiency. As a result, promising new techniques including radioactive seed localization, non-radioactive radar localization and magnetic seed localization have been developed as alternatives. In this article, we provide an overview of these techniques and discuss their advantages, drawbacks and currently available outcome data.
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Affiliation(s)
- Ellen Cheang
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, Breast and Imaging Center , New York, NY , USA
| | - Richard Ha
- 2 Department of Radiology, Columbia University Medical Center , New York, NY , USA
| | - Cynthia M Thornton
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, Breast and Imaging Center , New York, NY , USA
| | - Victoria L Mango
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, Breast and Imaging Center , New York, NY , USA
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