ARRS 2022 Abstracts

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1156. Single-Step: 5-Year Clinical Experience Using Preoperative SCOUT Localization at Biopsy of Suspicious Breast and Axillary Lymph Node Lesions
Authors * Denotes Presenting Author
  1. Stephanie Salgueiro *; Florida Atlantic University, Charles E. Schmidt College of Medicine
  2. Samantha Matott; Florida Atlantic University, Charles E. Schmidt College of Medicine
  3. Nikita Rao; Florida Atlantic University, Charles E. Schmidt College of Medicine
  4. Quan Ta; Florida Atlantic University, Charles E. Schmidt College of Medicine
  5. Simarsukh Dhillon; Florida Atlantic University, Charles E. Schmidt College of Medicine
  6. Mary Hayes; Memorial Regional Hospital Department of Radiology
Objective:
Breast imaging plays a pivotal role in the diagnosis, treatment, follow-up, and long-term surveillance of patients with breast cancer and high-risk lesions. Patients presenting with suspicious breast or axillary lymph node lesions, known or strongly predicted to require both needle biopsy (Bx) and Localization (Loc) to guide surgery, may benefit from an evolving single-step approach: a same-day image-guided Biopsy with SCOUT localization (Bx-Loc). The SCOUT device serves a dual function as a Bx tissue clip marker and Wire-free Loc (WFL), is inert until activated, and allows for diagnostic assessment of the target and adjacent tissue via US, MG, PET/CT, and MRI. This single-step Bx-Loc may decrease redundant downstream needle procedures while maintaining flexible oncoplastic treatment options. In our multi-hospital institution, SCOUT WFL has been performed in over 1,200 patients, including a longer-term 33 patient pilot in whom SCOUT WFL was placed 31-516 days prior to surgery. To date, no device complication, migration, or obscuring MRI artifact was identified in any SCOUT WFL up to 1239 days in-vivo. Building on this successful pilot data, we now report our 5-year clinical experience with over 200 same-day single-step SCOUT Bx-Loc of breast and axillary lesions.

Materials and Methods:
Institutional Review Board waived consent for this retrospective review of our breast database for patients who had same-day image-guided SCOUT Bx-Loc of a suspicious breast or axillary lesion between August 29, 2016 – May 19, 2021. Patient age, image-guidance, location, device related complication, time to surgery, and surgical outcome were recorded. Descriptive statistics were calculated using spreadsheet software (Microsoft, Excel 2013).

Results:
Of the 160 female patients age 20-89 (mean 53.9), who underwent 210 single-step image-guided Bx-WFL with SCOUT (105 breast, 104 axilla, 1 chest wall), using US (207), MG (2), or CT (1) guidance, surgery has been completed 1-417 (mean 128) days after Bx-Loc in 122/160 patients. All SCOUTs were excised without device-related complications. All standard of care preoperative surgical planning and surveillance imaging, including 111 MRI exams, depicted the SCOUT, target lesion, and adjacent tissue with no significant signal void artifact. No additional localization was required, but supplementary wire localization with successful surgery was performed per surgeon preference/learning curve for 5 lesions (2 breast, 2 axilla, 1 chest wall). Of the remaining 38/160 patients, 17 are pending surgery and 21 are not expected to proceed to surgery [stage IV (7), benign (7), refused (5), myeloma (1), high risk (1)].

Conclusion:
Patients with suspicious lesions, who are known or strongly predicted to require both needle biopsy and localization to guide surgery, may benefit from single-step Bx-WFL where SCOUT serves a dual function as a tissue clip marker and wire-free localization device. This preserves breast surgical oncology options, allows for flexible preoperative planning, permits surveillance with MRI, and may eliminate downstream redundant needle localization procedures.