Comparison of wire localization, radioactive seed, and Savi scout ^® radar for management of surgical breast disease

Abstract

Background Radioactive seed localization (RSL) and the Savi scout® radar (SSR) are newer alternatives to wire‐guided localization (WL) for nonpalpable breast lesions. Objective To compare three types of localization devices used in breast conserving surgery. Methods A total of 293 patients had a partial mastectomy (n = 194) or breast biopsy (n = 99) with preoperative image‐guided localization of a single nonpalpable lesion between July 2017 to July 2018. Lesions were localized by WL, RSL, or SSR. Although all operations performed were outpatient, due to workflow differences at our institution, operations performed in the hospital operating rooms were defined as “hospital setting.” Operations performed at an outpatient surgery facility without the capacity to admit patients were defined as “ambulatory.” Delay in operating room start times and total perioperative times in both the hospital and ambulatory setting, localization time, explant of localization device, positive margins, volume of tissue excised, and 30‐day complications were evaluated. Results A total of 126 patients (43%) had WL; 59 patients (20%) had RSL; and 108 patients (37%) had SSR localization. SSR localization took longer to perform with an average time of 19 minutes, compared with 15 minutes for WL and 14 minutes for RSL (P = .020). In 93.52% of cases, the first specimen contained both the clip and localization device, which was similar among groups (P = .073). There was no difference in retained biopsy clip among the groups (average 3.4%, P = .173). For operations performed in the hospital, the time from patient arrival to the preoperative area and incision was significantly longer in the WL group with a median of 233 minutes (range 56‐486), 130 minutes (range 64‐294) in RSL, and 108 minutes (range 59‐240) for SSR (P < .001). There was no difference in operative time among the groups with a median of 51 minutes (range 17‐122) (P = .108). There was, however, significantly longer perioperative time of 469 minutes (range 210‐926) in the WL group compared with 399 minutes (range 240‐871) for RSL and 381 minutes (range 232‐711) for SSR (P ≤ .001). For the ambulatory setting, although there was no difference in operating time among the groups (median 50 minutes, range 18‐127, P = .715), only the RSL showed a decreased perioperative time compared to WL (WL 356 vs RSL 275, P < .001; SSR 279, p = NS). A total of 131 patients (44.7%) had same day localizations. Among operations with delayed start times, there was a longer average delay of 85 minutes (range 1‐304) for WL group compared with 69 minutes (range 13‐219) in RSL and 53 minutes (range 0‐228) in SSR (P < .001). There was no difference among the three groups in positive margin rate, volume of tissue excised, and 30‐day complications. Conclusion Nonwire localization devices are associated with reduced overall perioperative time compared to wire localization, with few complications.

Adequacy of invasive and in situ breast carcinoma margins in radioactive seed and wire‐guided localization lumpectomies

“…Since we obtained operative times from anesthesia records, it was difficult to compare to other studies that collected excision times prospectively or using a different method. Our results align with most studies that found similar or longer operative times 11,17,33,34 whereas Lovrics et al reported shorter operative times for RSL lumpectomies than WGL 21 . Most surgeons at our institution anecdotally reported excisions with RSL were more intuitive and technically easier.…”

Reflector-Guided Localisation of Non-Palpable Breast Lesions: A Prospective Evaluation of the SAVI SCOUT® System

“…Our study provides further evidence supporting the reliability of the SAVI SCOUT ® system in guiding breast conserving surgery and confirms the benefits of the technology in advancing patient care. Our findings by and large coincide with the findings of Srour et al, with no observed device-specific complications, migration of device, and favourable deployment and retrieval rates and durations [ 23 ]. We observed a margin positivity rate of 7%, which is significantly lower than the 22% re-excision rate observed in the UK NHS Breast Screening Programme [ 24 ].…”

“…Our study also found that reflectors were placed at the target tissue site at a mean interval of 15.3 days before surgery. Srour et al compared SAVI SCOUT ® with WGL across a range of time-specific variables [ 23 ]. Their results showed that WGL is associated with significantly longer delays in surgical operation starting times, as well as longer preoperative times on the day of surgery.…”

Savi Scout Radar Localization Versus Wire Localization for Breast Biopsy Regarding Positive Margin, Complication, and Reoperation Rates

“…This study showed no difference in the positive margin or 30-day complication rates. 10 Our study is the largest comparison of these localization techniques for positive margin, complication, and reoperation rates and results show Savi Scout being superior in all comparisons.…”