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Breast Imaging

E3252. Radiologist as Operator: Early Facility With Novel Radar Reflector for Preop Breast Localization

Lee J,  Pysarenko K. New York University School of Medicine, New York, NY

Address correspondence to J. Lee (JIYON_L@hotmail.com)

Objective: The objective of this study was to report our early radiologists’ experience implementing a novel radar reflector alternative to preoperative wire localization for nonpalpable breast lesions. We measure our breast radiologists’ facility, technical satisfaction, and critical design feedback. This serves to complement the technical efficacy, and surgeon and patient satisfaction, which are rarely reported.

Materials and Methods: The Food and Drug Administration–approved SAVI SCOUT system (Cianna Medical) uses no wires or radioactive materials to guide surgical excision of nonpalpable lesions. Once placed percutaneously, the radar reflector may be heard through skin using a handle and console. In this study, 11 dedicated breast radiologists (range of experience, 6–27 years) who we term, “operators” used the SCOUT system in 15 selected cases (10 mammography-guided cases and five ultrasound-guided cases) of preoperative localization for nonpalpable lesions (mass, calcifications, clip, or combination). These operators responded to eight questions using a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral or unsure, 4 = agree, and 5 = strongly agree). Questions included: having company representative on site during case was useful; reflector placement was straightforward and easy to master; deployment needle is comfortable to use; procedure is faster than wire localization; my reflector placement was as precise as my usual wire localization and I am satisfied; I think the deployment needle design is fine; and I think the needle design could use improvement. The last question pertained to who should perform the immediate sound check to confirm SCOUT functionality and mark the skin site where best heard: is the best plan for the radiologist to perform the sound check rather than surgeon staff? Free text comments were also invited. Subsequent to this abstract, we plan to administer these questions to all our radiologists for both imaging guidance and satisfaction reporting after 10 cases for each radiologist.

Results: Responses to each question are reported as means for cases as (mammography; ultrasound): representative on site was useful (4.9; 4.6); reflector placement was straightforward and easy to master (4.3; 4.6); deployment needle is comfortable to use (3.5; 3.6); procedure is faster than wire localization (2.7; 3); placement was as precise as my usual wire localization, I am satisfied (3.6; 3.4); needle design is fine (3.3; 2.6); design could use improvement (3.8; 3.8); and best for radiologist to perform the sound check rather than surgeon staff (4.7; 4.2). Comments included constructive criticism regarding handle size and needle gauge, potential obscuring of lesion target, and rough handling of deployment mechanism that might require both hands.

Conclusion: Our radiologists reported easy facility with image-guided reflector placement due to prior procedural experience with wire localization and biopsy clip. Satisfaction is high for both mammography and ultrasound-guided reflector placement, in parallel with a published report of high patient and surgeon satisfaction. As the operator in this preoperative step, radiologists’ design assessment and early facility enable successful implementation in replacing some wire localization procedures with the SCOUT system.