52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement41st Annual Miami Breast Cancer Conference® - Abstracts
Volume 38
Issue 4
Pages: 66

Background

The standard treatment for early breast cancer with node-negative axilla is wide local excision (WLE) and sentinel lymph node biopsy (SNB). Guide-wire WLE for impalpable cancers poses various challenges. The use of magnetic seeds has been adopted as an alternative solution. Difficult detectability, magnetic interference with metallic instruments/MRI, and recalibration remain open issues. The common technique for SNB is radioisotope with or without blue dye. The radioisotope poses various problems including handling and disposal of isotopes. The short half-life of the isotope restricts the scheduling of surgery and hinders patients’ flow into the operating theater. Finally, concerns have previously been raised regarding the efficacy of ICG in patients with high body mass index (BMI). We present our experience in WLE plus SNB using a non-wire, non-magnetic breast localization method plus non-radioisotope technique for sentinel node identification. A comparison with the magnetic breast localization method is provided. The aims of the study are:

  1. Compare oncological clearance of cancer between magnetic and nonmagnetic localization seeds.
  2. Demonstrate a good identification rate of SNB using a
    non-radioisotope fluorescent dye.
  3. Confirm good node detection rate with the ICG regardless of patients’ BMI.

Methods

Patient and Tumor Characteristics of Patients Having WLE With SAVI SCOUT and Magseed

Patient and Tumor Characteristics of Patients Having WLE With SAVI SCOUT and Magseed

We compared 50 patients with WLE and SNB using SAVI SCOUT plus ICG with 50 cases using Magseed plus ICG in 2022/2023. The SAVI SCOUT clip was placed 1 to 5 days before surgery. Additionally, 2 mL of ICG and 2 mL of blue dye were injected intradermally in the periareolar area.

Results

The identification rate of SNB with ICG dye was 100% despite high BMI. Also, BMI has not affected the number of nodes retrieved (average number of SNB was 2, similar to other case series). A total of 5 of the patients localized with SAVI SCOUT had positive margins (10%) compared with 6 localized with magnetic seed (12%). The re-excision rate using SAVI SCOUT/Magseed is not statistically significant. Compared with guide wire, the use of SAVI SCOUT reduced the re-excision rate by 50% in our case series (15% vs 10%).

Conclusions

Non-magnetic localization of impalpable breast cancers showed a good detection rate with adequate margins clearance (10% re-excision rate, compared with 17.2% UK average). The use of ICG in SNB (with blue dye) is associated with an identification rate of 100% regardless of high BMI. Preoperative admission and preparation for surgery are streamlined by avoiding the need for wire localization and radioisotope injection.

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36 MONARCH 3: Final Overall Survival Results of Abemaciclib Plus a Nonsteroidal Aromatase Inhibitor as First-Line Therapy for HR+/HER2– Advanced Breast Cancer
37 Estimating the Direct and Indirect Resource Burden of Treatment Management With Current Standard of Care or Elacestrant for ER+, HER2–, ESR1-Mutated Advanced or Metastatic Breast Cancer Patients: A Population- Level Provider Model
37 Estimating the Direct and Indirect Resource Burden of Treatment Management With Current Standard of Care or Elacestrant for ER+, HER2–, ESR1-Mutated Advanced or Metastatic Breast Cancer Patients: A Population- Level Provider Model
38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer
38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer
39 The Influence of Reconstruction Type on Outcomes in Women Undergoing Mastectomy With Immediate Reconstruction:  A Nationwide Study
39 The Influence of Reconstruction Type on Outcomes in Women Undergoing Mastectomy With Immediate Reconstruction: A Nationwide Study
40 Ethnic Disparities in Complication Rates and Outcomes  of Nipple-Sparing Mastectomy:  A Comprehensive Analysis
40 Ethnic Disparities in Complication Rates and Outcomes of Nipple-Sparing Mastectomy: A Comprehensive Analysis
41 A Case Series of Sarcomas
41 A Case Series of Sarcomas
42 Transitional Lymphedema: Understanding the Temporal Dynamics Post-Axillary Surgery
42 Transitional Lymphedema: Understanding the Temporal Dynamics Post-Axillary Surgery
43 Impact of Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) on Postoperative Complication Rates in Mastectomy With Immediate Prosthetic-Based Breast Reconstruction
43 Impact of Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) on Postoperative Complication Rates in Mastectomy With Immediate Prosthetic-Based Breast Reconstruction
44 Variant of Uncertain Significance (VUS) Genetic Testing Results and Mastectomy Choice in Lumpectomy-Eligible Patients
44 Variant of Uncertain Significance (VUS) Genetic Testing Results and Mastectomy Choice in Lumpectomy-Eligible Patients
45 Application of the 7-Gene Biosignature in Palpable Versus Nonpalpable Ductal Carcinoma In Situ in a Black Patient Population: Does Palpability Suggest a More Aggressive Genomic Risk?
45 Application of the 7-Gene Biosignature in Palpable Versus Nonpalpable Ductal Carcinoma In Situ in a Black Patient Population: Does Palpability Suggest a More Aggressive Genomic Risk?
46 Comparative Analysis of Breast Conserving Therapy vs Mastectomy in Multifocal and Multicentric Breast Cancer: A Review of the Literature
46 Comparative Analysis of Breast Conserving Therapy vs Mastectomy in Multifocal and Multicentric Breast Cancer: A Review of the Literature
47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
48 The Era ‘or Error’ of Second Localization Procedures
48 The Era ‘or Error’ of Second Localization Procedures
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
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