Localization for Breast Surgery: The Next Generation

Abstract

Context.— Preoperative localization of nonpalpable breast lesions using image-guided wire placement has been a standard of breast imaging, diagnosis, and treatment since its development in the 1970s. With this technique, coordinated, same-day wire placement by the radiologist and surgery are required, which can lead to significant inefficiencies in workflow. Other disadvantages of wire localization (WL) include limitations in surgical incision and dissection route and protruding wires that can be both bothersome for the patient and have risk of displacement. Objective.— To outline several recently developed techniques that could replace traditional WL and eliminate its disadvantages. The first developed was radioactive seed localization (RSL) using I-125, a technique adopted by many institutions during the last few years. The challenge to this method, however, is the strict nuclear regulatory requirements, which can be a significant burden and limitation. The disadvantages of WL and RSL have provided incentive for the development of other types of preoperative localization procedures. Two of these are recently US Food and Drug Administration–cleared, nonradioactive, non-wire location technologies emerging as alternatives to WL and RSL; SAVI SCOUT (Cianna Medical Inc, Aliso Viejo, California), which uses infrared light and a microimpulse radar reflector, and Magseed (Endomagnetics Inc, Austin, Texas), which uses a magnetic seed for localization. Data Sources.— We review the published literature on non-wire location technologies for breast tissue resection. Conclusions.— Non-wire location techniques are beneficial, allowing image-guided placement before the day of surgery and resulting in improved workflows. These techniques also eliminate bothersome protruding wires, risk of dislodging, and allow the incision site to be independent from the localization site.

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

“…Advantages of the seed include that there is no risk of displacement of a protruding wire, and the seed can be placed days prior to surgery, reducing delays in operating room start times ii . Disadvantages to the seed include requirements for strict adherence to nuclear regulations, training of all personnel who handle the seed in radiation safety, obtaining proper licensing, and meticulous tracking and disposal of the seed …”

“…Disadvantages to the seed include requirements for strict adherence to nuclear regulations, training of all personnel who handle the seed in radiation safety, obtaining proper licensing, and meticulous tracking and disposal of the seed. 4 In 2014, the FDA approved the first nonradioactive nonwire localization device, the Savi Scout ® Radar (Cianna Medical, Inc). This system uses radar reflector activated with infrared light, which is detected by a console which generates a signal that is detectable by a radar detector probe.…”

Magnetic seed localisation for non-palpable lesions in patients undergoing breast conservative surgery

“…Moreover, several studies have shown better cosmetic results, no significant difference for negative margin rates and schedule improvement compared to the WGL [3][4][5][6]. However the RSL is radioactive; therefore the manipulation of radioactive material requires a specialized structure and organization, from localization to excision, including transport, storage and elimination, increasing costs, and bringing constraints to diffusion of this technique [7][8][9].…”

“…In 2016, the FDA approved SAVI SCOUT radar localization system [8][9][10], a 12-mm non-radioactive seed detected by an infrared light probe. The device could be placed 30 days before surgery.…”

Sewing needles in the breasts localized intraoperatively with sentimag probe

“…The Magseed system received FDA approval in 2016 and has been shown to be an effective alternative to traditional wire‐guided localization. A nonradioactive paramagnetic seed is placed at the site of a breast lesion with either sonographic or mammographic guidance prior to surgery . The Sentimag probe is then used intraoperatively to detect the magnetic marker.…”