27 Radar Reflector Localization of Peripheral Nonpalpable Lesions During Skin-Sparing and Nipple-Sparing Mastectomy: A Novel Application Using the IDEAL Framework

Joshua Feinberg, DO¹

¹NYU Langone Health, New York, NY.

Background

Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) utilize smaller incisions that may pose a challenge for the surgeon in an effort to completely extirpate the breast tissue, including peripherally located breast lesions, with clear margins. Positive margins following mastectomy are associated with increased rates of local recurrence and necessitate postmastectomy radiation therapy (PMRT). Utilization of radar reflectors to localize nonpalpable lesions during partial mastectomy is well documented. However, this technique has not been applied to patients undergoing SSM or NSM. This IDEAL stage 1 study is intended to evaluate the feasibility and effectiveness of reflector radar localization during SSM and NSM.

Materials and Methods

Our institutional review board–approved breast cancer database was queried for patients who underwent preoperative placement of a radar reflector prior to undergoing mastectomy between October 2016 and September 2020. In accordance with the IDEAL Framework for Stage 1 studies, we sought to evaluate proof of concept and technical achievement.

TABLE. Clinicopathologic Data

Results

Five patients were identified who underwent preoperative placement of a radar reflector; 3 patients underwent NSM while 2 patients underwent SSM. Clinicopathologic data are displayed in the Table. In all 5 patients, localized lesions were nonpalpable and located peripherally. Radar reflectors were successfully removed in all patients. There were no adverse events. Final margins were greater than 5 mm in 4 patients. In 1 patient, there was a focally positive margin for ductal carcinoma in situ at a site separate from the radar localized index lesion. No patient required PMRT.

Conclusions

Placement of a radar reflector into peripheral nonpalpable lesions prior to SSM and NSM appears to be a safe and technically feasible procedure that helps ensure complete excision. To the best of our knowledge, this is the first application of this technique during SSM and NSM. Further evaluation should proceed with larger sample sizes in an IDEAL stage 2a study.

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