Clinical Case Review: Long-term SCOUT® placement prior to surgery

By Mary K. Hayes, MD; Erica V. Bloomquist, MD; and Heather R. Wright, MD, Departments of Radiology and Breast Surgical Oncology, Memorial Healthcare System, Hollywood, FL

December 20, 2019 -- The SCOUT Radar Localization system by Merit Medical is used to mark breast lesions or lymph nodes prior to surgery, without many of the challenges associated with wire localization. But what happens if a SCOUT Reflector is placed in the breast, and the surgery is postponed? Find out in this case study from Memorial Healthcare System in Hollywood, FL.

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.
Figure 1: Breast and axillary node biopsy: January 2018.
Figure 2a: Ultrasound-guided SCOUT localization of the axillary lymph node: February 2018
Figures 2a and b: Ultrasound-guided SCOUT localization of the axillary lymph node and breast: February 2018.
Figure 2b: Ultrasound-guided SCOUT localization of the 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.

Surgery

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
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).

Figure 4a: Preoperative imaging PET/CT, June 2019
Figures 4a and b: Preoperative imaging PET/CT: June 2019.
Figures 4b: Preoperative imaging PET/CT, June 2019

Conclusion

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.

This case and other information are for the practitioner's convenience and for general information purposes only. This information does not constitute medical or legal advice, nor is it meant to endorse or guarantee the suitability of any of the referenced products or methods for any specific patient or procedure. Before using any product, refer to the instructions for use (IFU) for indications, contraindications, warnings, precautions, and directions for use.


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