Novant Health integrated the SCOUT® Radar Breast Localization System into their breast care program in July 2016 and recently they became a SCOUTCare™ certified wire-free provider. Breast surgeon, Peter Turk, MD, shares his experiences with the wire-free radar technology.
What was the key decision factor for choosing SCOUT?
Novant Health is a leader in our region for breast cancer care. As we reviewed our options, we felt that that a Radioactive Seed Localization (RSL) program seemed too cumbersome to maintain in a high-volume setting. The SCOUT system made perfect sense and freed us of many of the logistical issues. It also addressed patient comfort concerns that we had with standard needle localization.
The limited startup costs, the excellent support from Cianna Medical, and the intuitive nature of the system all played a big part in our decision-making process.
Do you consider SCOUT to be the new standard of care at Novant for localizing breast lesions?
The SCOUT radar localization system is our standard in Charlotte for localization and has been embraced by all of the radiologists and surgeons involved in the program.
Can you comment on your overall clinical experience with SCOUT? What do you see as the key benefits?
We were not sure what to expect transitioning from the wire localization system (which has been standard of practice for 30 years). We were pleasantly surprised by the low margin involvement rate, the success in localization in each of our first 127 cases (excepting one). This one case was early in our experience, and the cautery unit appeared to short-out the reflector upon contact intraoperatively. We were able to identify the SCOUT clip with ultrasound intraoperatively and successfully remove the lesion. With the new SCOUT system we have not had any further similar episodes. Also, with the distance monitoring we are able to dissect using cautery without making contact with the clip.
One of the most pleasant changes is the much more efficient patient care flow on the day of surgery. By uncoupling the localization process and the surgical date, we eliminated the delays in radiology and streamlined OR scheduling. We also improved the patient experience with ease of reflector placement and a less traumatic day of surgery.
How important is pre-operative MRI in your practice?
We perform preoperative MRI scans generally in patients with invasive lobular carcinoma, young patients with disease difficult to examine with standard mammography, and those with genetic predisposition. The SCOUT system has allowed these MRI scans without significant artifact, and this transition has been seamless.
Can you comment on the significant findings in your poster presented at ASBrS (May 2018) entitled: Is SAVI SCOUT localization as accurate as needle-localization in obtaining negative margins at time of breast conservation?: A single- institution Experience.
We reviewed our initial experience with SCOUT to help identify the relative success in transitioning the wire-free radar system in a large volume private practice setting. One of the most important factors of success of a localization system is achieving negative margins. With all the other variables constant, the data showed a 10% positive margin rate with SCOUT vs. a 17% rate using wire localization. This is an improved clear margin rate both with invasive cancer and ductal carcinoma in situ with SCOUT relative to standard needle localization. The SCOUT distance system allowing distance measurements from the skin to reflector should improve our success rate even more. Click here to view the full poster
Can you comment on placing the SCOUT reflector prior to neoadjuvant therapy? What benefits would you see?
We have used SCOUT prior to neoadjuvant therapy without problem. Two things to keep in mind, first the need to remember to place the clip at that juncture, rather than waiting for the pre-op time-frame. Secondly, very occasionally a patient who originally wanted breast conservation prior to chemotherapy decides for bilateral mastectomy. For use prior to neoadjuvant therapy the benefit of the SCOUT system is that the reflector does not interfere with MRI studies so patients are not restricted in the types of imaging modalities they may need during or after therapy.
Do you see other uses for SCOUT in your practice?
We have found the SCOUT system much easier to use than wire localization in the clipped node, and it is more accurate than using other methods of intraoperative localization of the lymph node.