The following case is a 64-year-old female diagnosed with locally advanced invasive ductal carcinoma (IDC) in the left upper outer quadrant (UOQ) with left axillary metastasis. SCOUT localization of the left breast and left axillary lymph node was performed prior to neoadjuvant chemotherapy.
Patient had a complete response to chemotherapy, but breast surgery was then delayed for 516 days post SCOUT localization due to other health issues (stroke, rehabilitation, nutritional status).
Figure 1: Breast and axillary node biopsy: January 2018.
Figures 2a and b: Ultrasound-guided SCOUT localization of the axillary lymph node and breast: February 2018.
In January 2018, patient received an ultrasound-guided core biopsy of two masses:
- 16-mm left axilla lymph node marked with bar clip; metastatic carcinoma involving portions of lymph node tissue is histologically similar to breast
- 29-mm left breast 2 o'clock mass marked with U-shaped clip, invasive ductal carcinoma, poorly differentiated (ER/PR negative [0%]; HER2 positive)
In February 2018, SCOUT localization was placed in the breast lesion and axillary lymph node under ultrasound guidance.
In July 2019, the breast lesion and lymph node were excised -- 516 days after SCOUT placement.
Planned definitive surgery was delayed secondary to health issues (stroke, rehabilitation, insurance, and address changes). Patient stabilized and preoperative imaging confirmed complete radiologic response (Fig. 3).
Patient's postoperative course was uneventful.
Figure 3: Postplacement mammogram demonstrates SCOUT in the axillary lymph node and breast.
Definitive SCOUT-guided partial mastectomy and left axillary SCOUT-guided sentinel lymph node biopsy was performed without incident 516 days post-SCOUT placement (Figs. 4a and 4b).
Figures 4a and b: Preoperative imaging PET/CT: June 2019.
SCOUT localization in the breast and axillary lymph node lesions can be performed prior to neoadjuvant chemotherapy when the lesion(s) are well visualized. U.S. Food and Drug Administration-cleared long-term placement in the breast and axillary lymph node soft tissues allowed for 516-day interval between time of SCOUT localization and definitive breast surgery in order to accommodate the patient's concomitant health care needs.
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