Radar reflector guided axillary surgery in node positive breast cancer patients

Feinberg, Joshua A; Axelrod, Deborah; Guth, Amber; Maldonado, Leonel; Darvishian, Farbod; Pourkey, Nakisa; Goodgal, Jenny; Schnabel, Freya

doi:10.1080/17434440.2022.2139177

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…After inspecting all the articles retrieved using the relevant keywords and search terms, six articles were initially identified. However, upon further analysis, two articles were deemed ineligible due to having less than 10 cases of RRL-guided TAD [15,16]. As a result, four articles met the criteria for analysis (Figure 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

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Evaluating Radar Reflector Localisation in Targeted Axillary Dissection in Patients Undergoing Neoadjuvant Systemic Therapy for Node-Positive Early Breast Cancer: A Systematic Review and Pooled Analysis

Wazir,

Michell,

Alamoodi

et al. 2024

Cancers

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SAVI SCOUT® or radar reflector localisation (RRL) has proven accurate in localising non-palpable breast and axillary lesions, with minimal interference with MRI. Targeted axillary dissection (TAD), combining marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), is becoming a standard post-neoadjuvant systemic therapy (NST) for node-positive early breast cancer. Compared to SLNB alone, TAD reduces the false negative rate (FNR) to below 6%, enabling safer axillary surgery de-escalation. This systematic review evaluates RRL’s performance during TAD, assessing localisation and retrieval rates, the concordance between MLNB and SLNB, and the pathological complete response (pCR) in clinically node-positive patients post-NST. Four studies (252 TAD procedures) met the inclusion criteria, with a 99.6% (95% confidence [CI]: 98.9–100) successful localisation rate, 100% retrieval rate, and 81% (95% CI: 76–86) concordance rate between SLNB and MLNB. The average duration from RRL deployment to surgery was 52 days (range:1–202). pCR was observed in 42% (95% CI: 36–48) of cases, with no significant migration or complications reported. Omitting MLNB or SLNB would have under-staged the axilla in 9.7% or 3.4% (p = 0.03) of cases, respectively, underscoring the importance of incorporating MLNB in axillary staging post-NST in initially node-positive patients in line with the updated National Comprehensive Cancer Network (NCCN) guidelines. These findings underscore the excellent efficacy of RRL in TAD for NST-treated patients with positive nodes, aiding in accurate axillary pCR identification and the safe omission of axillary dissection in strong responders.

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Section: Literature Search Resultsmentioning

confidence: 99%

“…As a result, four articles met the criteria for analysis (Figure 1). analysis, two articles were deemed ineligible due to having less than 10 cases of RRLguided TAD [15,16]. As a result, four articles met the criteria for analysis (Figure 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

Evaluating Radar Reflector Localisation in Targeted Axillary Dissection in Patients Undergoing Neoadjuvant Systemic Therapy for Node-Positive Early Breast Cancer: A Systematic Review and Pooled Analysis

Wazir,

Michell,

Alamoodi

et al. 2024

Cancers

View full text Add to dashboard Cite

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“…The initial search yielded 385 articles, with 21 appearing relevant [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] ( Supplementary Figure S1 ). Further inspection narrowed down 17 articles meeting the inclusion criteria, covering 1358 procedures in 1355 patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Further inspection narrowed down 17 articles meeting the inclusion criteria, covering 1358 procedures in 1355 patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] ( Table 1 ). Three studies on 5 [ 30 ] and 10 patients were excluded [ 31 , 32 ], along with a fourth study on the feasibility and accuracy of RRL–MLNB in 86 patients, as all patients had ALND with no SLNB data [ 33 ]. Twelve of the studies that fulfilled the eligibility criteria were retrospective [ 1 , 13 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 28 , 29 ] and five were prospective [ 14 , 15 , 16 , 19 , 27 ], two of which were multicentre [ 14 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in Node-Positive Early Breast Cancer

Varghese,

Patani,

Wazir

et al. 2024

Cancers

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Recent advances in neoadjuvant systemic therapy (NST) have significantly improved pathologic complete response rates in early breast cancer, challenging the role of axillary lymph node dissection in nose-positive patients. Targeted axillary dissection (TAD) integrates marked lymph node biopsy (MLNB) and tracer-guided sentinel lymph node biopsy (SLNB). The introduction of new wire-free localisation markers (LMs) has streamlined TAD and increased its adoption. The primary endpoints include the successful localisation and retrieval rates of LMs. The secondary endpoints include the pathological complete response (pCR), SLNB, and MLNB concordance, as well as false-negative rates. Seventeen studies encompassing 1358 TAD procedures in 1355 met the inclusion criteria. The localisation and retrieval rate of LMs were 97% and 99%. A concordance rate of 67% (95% CI: 64–70) between SLNB and MLNB was demonstrated. Notably, 49 days (range: 0–272) was the average LM deployment time to surgery. pCR was observed in 46% (95% CI: 43–49) of cases, with no significant procedure-related complications. Omitting MLNB or SLNB would have under-staged the axilla in 15.2% or 5.4% (p = 0.0001) of cases, respectively. MLNB inclusion in axillary staging post-NST for initially node-positive patients is crucial. The radiation-free Savi Scout, with its minimal MRI artefacts, is the preferred technology for TAD.

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Pre-operative localisation of axillary lymph nodes using radiofrequency identification (RFID) tags: a feasibility assessment in 75 cases

et al. 2023

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Radar reflector guided axillary surgery in node positive breast cancer patients

Cited by 3 publications

References 19 publications

Evaluating Radar Reflector Localisation in Targeted Axillary Dissection in Patients Undergoing Neoadjuvant Systemic Therapy for Node-Positive Early Breast Cancer: A Systematic Review and Pooled Analysis

Evaluating Radar Reflector Localisation in Targeted Axillary Dissection in Patients Undergoing Neoadjuvant Systemic Therapy for Node-Positive Early Breast Cancer: A Systematic Review and Pooled Analysis

Wire-Free Targeted Axillary Dissection: A Pooled Analysis of 1300+ Cases Post-Neoadjuvant Systemic Therapy in Node-Positive Early Breast Cancer

Pre-operative localisation of axillary lymph nodes using radiofrequency identification (RFID) tags: a feasibility assessment in 75 cases

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