Review of Variables Associated With Positive Surgical Margins Using Scout Reflector Localizations for Breast Conservation Therapy



      To evaluate factors contributing to positive surgical margins associated with reflector guidance for patients undergoing breast conserving therapy for malignancy.

      Materials and Methods

      A retrospective IRB-approved review of our institutional database was performed for malignant breast lesions preoperatively localized from January 1, 2018 to December 31, 2020. The following data was recorded using electronic medical records: lesion type and grade, lesion location, reflector and wire placement modality, use of intraoperative ultrasound, margin status, patient age, family history, BMI, and final pathology. Statistical analysis was performed with univariate summary statistics and logistic regression. P < .05 was significant.


      A total of 606 image-guided pre-surgical localizations were performed for lumpectomies of breast malignancies. A total of 352 of 606 (58%) wire localizations and 254 of 606 (42%) SCOUT reflector localizations were performed. Sixty out of 352 (17%) of wire-localized patients had positive surgical margins, whereas forty-eight out of 254 (19%) of reflector-localized patients had positive surgical margins. (OR = 1.12, P value: .59). For reflector guided cases, the use of intraoperative ultrasound (IOUS) was associated with decreased positive margin status (OR = 0 .28, 95% CI = [0.14, 0.58]) while in situ disease was associated with increased positive margin status (OR = 1.99, 95% CI = [1.05, 3.75]). No association between modality used for localization (mammography vs. ultrasound) and positive margin status was observed (OR = 0.63, 95% CI = [0.33, 1.19]). No association between positive margins and age, family history, tumor location and BMI was observed.


      For reflector guided surgeries, the use of IOUS was associated with decreased positive margins, by contrast the presence of ductal carcinoma in situ was associated with increased positive margins. There was no statistically significant difference in surgical outcomes for reflector-guided localization compared to wire localizations of the breast.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • DeSantis CR
        • Ma J
        • Gaudet MM
        • et al.
        Breast cancer statistics, 2019.
        CA Cancer J Clin. 2019; 69: 438-451
        • Houssami N
        • Macaskill P
        • Marinovich ML
        • Morrow M
        The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis.
        Ann Surg Oncol. 2014; 21: 717-730
        • Kapoor MM
        • Patel MM
        • Scoggins ME
        • et al.
        The wire and beyond: recent advances in breast imaging preoperative needle localization.
        Radiographics. 2019; 39: 1886-1906
        • Kopans DB
        Breast Imaging.
        3rd ed. Lippincott Williams & Wilkins, Baltimore, MD2007
        • Zagouri F
        • Sergentanis TN
        • Gounaris A
        • et al.
        Pain in different methods of breast biopsy: Emphasis on vacuum-assisted breast biopsy.
        The Breast. 2008; 17: 71-75
        • Slijkhuis WA
        • Noorda EM
        • van der Zaag-Loonen H
        • et al.
        Ultrasound-guided breast-conserving surgery for early-stage palpable and nonpalpable invasive breast cancer: decreased excision volume at unchanged tumor-free resection margin.
        Breast Cancer Res Treat. 2016; 158: 535-541
        • Tigen JS
        • McKinely BP
        • Rinkliff JM
        • et al.
        Savi scout radar localization versus wire localization for breast biopsy regarding positive margin, complication, and reoperation rates.
        Am Surg. 2020; 86: 1029-1031
        • Kuzmiak CM
        • Kim SJ
        • Lee SS
        • et al.
        Reflector localization of breast lesions and parameters associated with positive surgical margins in women undergoing breast conservation surgery.
        J Bioeth Inq. 2020; 2: 462-470
        • Schwartz GF
        • Goldberg BB
        • Rifkin MD
        • D'Orazio SE
        Ultrasonography: an alternative to x-ray-guided needle localization of nonpalpable breast masses.
        Surgery. 1988; 104: 870e873
        • Krekel NM
        • Haloua MH
        • Lopes Cardozo AMF
        • et al.
        Intraoperative ultrasound guidance for palpable breast cancer excision. (COBALT trial): a multicenter, randomized controlled trial.
        Lancet Oncol. 2013; 14: 48-54
        • Pan H
        • Wu N
        • Ding H
        • et al.
        Intraoperative ultrasound guidance is associated with clear lumpectomy margins for breast cancer: a systematic review and meta-analysis.
        PLoS ONE. 2013; 8: e74028
        • Colakovic N
        • Zdravkovic D
        • Skuric Z
        • Mrda D
        • Gacic J
        • Ivanovic N
        Intraoperative ultrasound in breast cancer surgery-from localization of non-palpable tumors to objectively measurable excision.
        World J Surg Oncol. 2018; 16: 184
        • Karanlik H
        • Ozgur I
        • Sahin MF
        • et al.
        Intraoperative ultrasound reduces the need for re-excision in breast-conserving surgery.
        World J Surg Oncol. 2015; 13: 321
        • Mango V
        • Ha R
        • Gomberawalla A
        • Wynn R
        • Feldman S
        Evaluation of the SAVI SCOUT surgical guidance system for localization and excision of nonpalpable breast lesions: a feasibility study.
        AJR. 2016; 207: W69-W72
        • Ngo C
        • Poller AG
        • Laperrelle J
        • Ackerman G
        • Gomme S
        • Thibault F
        • et al.
        Intraoperative ultrasound localization of nonpalpable breast cancers.
        Ann Surg Oncol. 2007; 14: 2485e9
        • Park CC
        • Mitsumori M
        • Nixon A
        • et al.
        Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence.
        J Clin Oncol. 2000; 18: 1668-1675
      1. Rahman RL, Puckett Y, Habrawi Z, et al. A decade of intraoperative ultrasound guided breast conservation for margin negative resection – Radioactive, and Magnetic, and Infrared Oh My…Am J Surg 220, 2020, p1410–1416

        • Moore MM
        • Whitney LA
        • Cerilli L
        • et al.
        Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer.
        Ann Sur. 2001; 233: 761-768
        • Krekel NM
        • Lopes Cardozo AM
        • Muller S
        • et al.
        Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound–feasibility and surgeons’ learning curve.
        Eur J Surg Oncol. 2011; 37: 1044-1050
        • Murphy ML
        • Boughey JC
        • Keeney MG
        Factors associated with positive margins in women undergoing breast conservation surgery.
        Mayo Clinic Proc. 2018; 93: 429-435
        • Langhans L
        • Jensen MB
        • Talman MM
        • Vejborg I
        • Kroman N
        • Tvedskov TF
        Reoperation rates in ductal carcinoma in situ vs invasive breast cancer after wire-guided breast-conserving surgery.
        JAMA Surg. 2017; 152: 378-384
        • Lee CH
        • Carter D
        Detecting residual tumor after excisional biopsy of impalpable breast carcinoma: efficacy of comparing preoperative mammograms with radiographs of the biopsy specimen.
        AJR. 1995; 164: 81-86
        • Cox CE
        • Garcia-Henriquez N
        • Glancy MJ
        • et al.
        Pilot study of a new nonradioactive surgical guidance technology for locating nonpalpable breast lesions.
        Ann Surg Oncol. 2016; 23: 1824-1830
        • Cox CE
        • Russell S
        • Prowler V
        • et al.
        A Prospective, Single Arm, Multi-site, Clinical Evaluation of a Nonradioactive Surgical Guidance Technology for the Location of Nonpalpable Breast Lesions during Excision.
        Ann Surg Oncol. 2016; 23: 3168-3174
        • Mango VL
        • Wynn RT
        • Feldman S
        • et al.
        Beyond wires and seeds: reflector-guided breast lesion localization and excision.
        Radiology. 2017; 284: 365-371
        • Patel SN
        • Mango VL
        • Jadeja P
        • et al.
        Reflector-guided breast tumor localization versus wire localization for lumpectomies: a comparison of surgical outcomes.
        Clin Imaging. 2018; 47: 14-17
        • Jadeja PH
        • Mango V
        • Patel S
        • et al.
        Utilization of multiple SAVI SCOUT surgical guidance system reflectors in the same breast: A single-institution feasibility study.
        Breast J. 2018; 24: 531-534
        • Racz JM
        • Glasgow AE
        • Keeney GL
        • et al.
        Intraoperative pathologic margin analysis and re-excision to minimize reoperation for patients undergoing breast- conserving surgery.
        Ann Surg Oncol. 2020; 27: 5303-5311
        • Maes-Carballo M
        • Munoz-Nunez I
        • Martin-Diaz M
        • et al.
        Shared decision making in breast cancer treatment guidelines: Development of a quality assessment tool and a systematic review.
        Health Expect. 2020; 23: 1045-1064
        • Cardoso F
        • Kyriakides S
        • Ohno S
        • et al.
        Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2019; 30: 1674