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When the clipped node goes missing, CT guided SAVI SCOUT placement: A novel approach for localizing soft tissue
Andrea Lifrieri1, Sarah Fuzesi2, Elise Desperito3
1Department of Surgery, Columbia University Medical Center, New York, NY, United States of America.
Abstract:
Axillary staging in breast cancer is performed with physical exam and axillary imaging. Suspicious lymph nodes are biopsied and clipped prior to surgery to identify the previously biopsied node during surgery. Conventional mapping techniques of blue dye and radioisotope do not always accurately identify the clipped lymph node and therefore many techniques have been described to improve the identification of the clipped lymph node. Most of these techniques rely on axillary ultrasound to identify the previously biopsied lymph node or previously placed clip. A marker such as a fiducial reflector is then placed percutaneously. In this case report we describe a novel technique of Computed tomography (CT) identification of a previously clipped lymph node with CT guided placement of a fiducial reflector (SAVI SCOUT). The SAVI SCOUT was then identified and successfully excised with the previously biopsied lymph node. A PRECIS: CT guided placement of SAVI SCOUT is a novel technique for the identification and retrieval of a previously biopsied axillary lymph node in breast cancer patients.
Insights
Accurate axillary lymph node identification in breast cancer surgery is crucial. Computed tomography (CT) guided placement of a SAVI SCOUT reflector offers a novel, precise method for retrieving previously biopsied nodes.
Area of Science:
- Oncology
- Radiology
- Surgical Navigation
Background:
- Accurate axillary lymph node staging is vital for breast cancer treatment planning and prognosis.
- Current methods for identifying previously biopsied axillary lymph nodes, such as blue dye and radioisotope, have limitations in precision.
- Ultrasound-guided techniques with percutaneous marker placement are used, but improved identification methods are continually sought.
Observation:
- This case report details a novel technique utilizing Computed Tomography (CT) for precise localization of a clipped axillary lymph node.
- A fiducial reflector, the SAVI SCOUT, was placed percutaneously under CT guidance to mark the biopsied lymph node.
- The SAVI SCOUT facilitated accurate identification and subsequent surgical excision of the target lymph node.
Findings:
- Computed Tomography (CT) guided placement of the SAVI SCOUT reflector successfully identified a previously biopsied axillary lymph node.
- The novel technique enabled precise retrieval of the clipped lymph node along with the placed fiducial marker.
- This method demonstrates high accuracy in re-identifying the specific lymph node targeted in prior biopsy.
Implications:
- CT-guided SAVI SCOUT placement presents a promising new approach for improving the accuracy of axillary lymph node retrieval in breast cancer surgery.
- This technique may enhance surgical efficiency and reduce the need for repeat procedures or broader axillary dissections.
- Further research could validate this method's broader applicability and impact on patient outcomes in breast cancer staging.
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