SAVI Scout® System for Excision of Non-Palpable Breast Lesions

Abstract

Background The standard localization of non-palpable breast masses is wire/needle localization (WL). Newer technologies have evolved, allowing more efficient scheduling and improving surgeon and patient experiences. These include Radioactive Seed, MagSeed®, and SAVI Scout® (SS). We adopted SS at our program in July of 2017. We are reporting our experience comparing SAVI Scout® with needle localization. Study Design This is a retrospective study comparing SS and wire localization techniques for the excision of both benign and malignant lesions. Chart reviews of localized patients between 7/1/2017 and 6/30/2019, recording the age of the patient, date of procedure, localization method, pathology of lesion postexcision, number and status of margins, guidance method (mammogram vs. ultrasound), specimen size, and distance of reflector from biopsy clip, were completed to compare these localization methods with the aim of asserting their equality. Results There were 48 wire and 64 SS localized excisions. Successful lesion excision was achieved in 100% of cases for both techniques. There were 1 SS and 4 WL re-excisions for margin clearance not reaching statistical significance. 51 additional margins were obtained in the SS cases compared to 36 margins in the WL cases without a statistically significant difference. Conclusions 1- Both SS and WL achieved 100% excision of targeted lesions 2- SS localization was successfully implemented, offering more convenience for patients and providers 3- More re-excisions in the WL group as compared to the SS group did not reach statistical significance and requires further investigation 4- A prospective controlled trial comparing the different localization techniques can address questions related to effectiveness, cost, patient and provider experiences.

Cost-Effectiveness of Radar Localisation Versus Wire Localisation for Wide Local Excision of Non-palpable Breast Cancer

“… 25 The results support previous findings that there was no significant difference in surgical outcomes between RL and WL techniques. 2 , 3 , 8 – 11 It also demonstrated that WLE using RL was a cost-effective technique for reducing delays in surgery related to preoperative localisation with WL.…”

“…RL has been shown to be a potential alternative to WL in small cohort studies, but data on the costs associated with it are lacking. 2 , 3 , 8 – 11 This study compared the cost-effectiveness of RL to WL for wide local excision (WLE) of non-palpable breast tumours, in terms of margin status, re-excision rates, and surgery delays associated with preoperative localisation.…”

Evolution of localization methods for non-palpable breast lesions: a literature review from a translational medicine perspective

“…Furthermore, surgical flexibility could be considered a disadvantage for ROLL since it is necessary to inject the tracer hours or even days before the surgery. Damage of the seed could potentially release radioactive material, with the half life of iodine-125 being 60 days ( 62 , 63 ). Any delay in surgery could put up constructional and logistical challenges, hence, the adoption has been limited ( 64 ).…”

“…The detection range can be up to 6 cm deep from the skin surface ( Figure 7 ) ( 83 ). Due to its safety profile, the FDA approved it for implantation for an unrestricted length of time ( 62 , 84 ).…”

“…A recent literature review with pooled analysis showed that SSL has superior outcomes in terms of lower proportion of positive margins and lower re-operation rate compared to WGL, ROLL, RSL, and MSL ( 5 ). Furthermore, this innovation is associated with high patient satisfaction ( 10 ), minimizing patient discomfort and reducing time delay ( 62 , 90 ). Hence, there is emerging evidence that SSL is a good alternative to WGL that warrants further exploration in our institute.…”