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

Abstract

Radioactive seed localization (RSL) and the Savi scout® radar (SSR) are newer alternatives to wire-guided localization (WL) for nonpalpable breast lesions. To compare three types of localization devices used in breast conserving surgery. 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. 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 19minutes, compared with 15minutes for WL and 14minutes 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 233minutes (range 56-486), 130minutes (range 64-294) in RSL, and 108minutes (range 59-240) for SSR (P<.001). There was no difference in operative time among the groups with a median of 51minutes (range 17-122) (P=.108). There was, however, significantly longer perioperative time of 469minutes (range 210-926) in the WL group compared with 399minutes (range 240-871) for RSL and 381minutes (range 232-711) for SSR (P≤.001). For the ambulatory setting, although there was no difference in operating time among the groups (median 50minutes, 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 85minutes (range 1-304) for WL group compared with 69minutes (range 13-219) in RSL and 53minutes (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. Nonwire localization devices are associated with reduced overall perioperative time compared to wire localization, with few complications.