Intraoperative Localization Using an Implanted Radar Reflector Facilitates Resection of Non-Palpable Trunk and Extremity
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ORIGINAL ARTICLE – SARCOMA
Intraoperative Localization Using an Implanted Radar Reflector Facilitates Resection of Non-Palpable Trunk and Extremity Sarcoma Kristy Kummerow Broman, MD, MPH1, David Joyce, MD1, Odion Binitie, MD1, G. Douglas Letson, MD1, Ricardo J. Gonzalez, MD1, Junsung Choi, MD2, and John E. Mullinax, MD1 1
Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL; 2Radiology Department, H. Lee Moffitt Cancer Center, Tampa, FL
ABSTRACT Background. Resecting non-palpable soft tissue tumors presents a unique challenge, particularly with recurrent disease in which surrounding tissue has been surgically manipulated and often irradiated. SAVI SCOUTÒ is a radar-based localization device that was developed for breast tumor localization and was recently FDA-approved for localization of soft tissue tumors. Application of this technology to soft tissue sarcoma has not been previously reported. Methods. We assembled a single-institution retrospective case series of patients with trunk and extremity sarcomas resected by five sarcoma surgeons using SAVI SCOUTÒ from December 2018 to May 2020. Reflectors were placed preoperatively using image-guidance, and the radar detector was used intraoperatively to localize the target lesion. Clinical variables were abstracted from the electronic medical record including treatment history, pathology, and early oncologic outcomes. Using a focused review, we compared margin status and recurrence rates with previously published cohorts. Results. Ten SAVI SCOUTÒ-localized sarcoma resections were performed. Eight were for locally recurrent disease, of which seven (83%) had prior radiation. The remaining lesions became non-palpable after neoadjuvant chemotherapy. SAVI SCOUTÒ facilitated resection in all
Ó Society of Surgical Oncology 2020 First Received: 13 July 2020 Accepted: 23 September 2020 J. E. Mullinax, MD e-mail: [email protected]
cases with a margin-negative resection rate (77%) comparable to prior cohorts. In this high-risk population with a median follow-up of 14 months, only one patient recurred locally 7.5 months after SAVI SCOUTÒ-localized resection, requiring re-resection. Conclusion. SAVI SCOUTÒ technology facilitated resection of non-palpable recurrent sarcoma of the trunk and extremities in all ten cases attempted. In a high-risk patient population, the pattern of recurrence has been primarily distant with one instance of local tumor recurrence.
For soft tissue sarcomas, including recurrent tumors, surgical margin status is one of the most critical factors in predicting local recurrence.1–3 While the majority of primary soft tissue sarcomas can be delineated for adequate surgical resection using manual palpation and anatomic landmarks, achieving margin-negative resection of tumors that are ill-defined or non-palpable represents a distinct challenge. Particularly in the setting of recurrent disease, the tissue surrounding a recurrent tumor is often abnormal as a result of previous surgery and radiation, and it can be more challenging to delineate th
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