Umar Wazir

Background and Objective: Wire-free localisation technologies have transformed the management of non-palpable breast lesions and pathological axillary lymph nodes. Radar-based localisation using the SAVI SCOUT^® system is supported by extensive prospective clinical validation. SCOUT MD™ represents a next-generation radar platform incorporating miniaturised reflectors with unique signal identification designed to address recognised limitations of single-reflector systems. This narrative review aimed to examine the technical characteristics, regulatory status, clinical rationale and available evidence relating to SCOUT MD™, and to contextualise the platform within the broader landscape of wireless localisation technologies. Methods: A narrative review of literature published between January 2016 and January 2026 was undertaken using PubMed-indexed articles, regulatory documentation, manufacturer technical reports and reference lists from key studies of radar-based localisation systems. Key Content and Findings: SCOUT MD™ incorporates miniaturised 5-mm reflectors with up to four uniquely identifiable radar signatures enabling multi-target localisation. The reflectors can be discriminated individually by their unique signal signatures, without signal overlap. The system supports ultrasound, stereotactic mammography, magnetic resonance imaging (MRI) and computed tomography (CT)-guided deployment. Clinical evidence currently consists primarily of early technical reports and a single case report. Conclusions: SCOUT MD™ addresses recognised technical limitations of single-reflector radar localisation systems, particularly in multi-target localisation and tight bracketing scenarios. However, independent clinical evidence remains limited and prospective clinical studies are required to establish its comparative effectiveness.

Methodological considerations in evaluating reconstructive strategies following postmastectomy radiotherapy

Oncoplastic breast-conserving surgery: advancing oncological outcomes and aesthetic standards in breast cancer treatment

Dear Editor

Recent advances in neoadjuvant systemic therapy (NST) have significantly improved pathologic complete response rates in early breast cancer, challenging the role of axillary lymph node dissection in nose-positive patients. Targeted axillary dissection (TAD) integrates marked lymph node biopsy (MLNB) and tracer-guided sentinel lymph node biopsy (SLNB). The introduction of new wire-free localisation markers (LMs) has streamlined TAD and increased its adoption. The primary endpoints include the successful localisation and retrieval rates of LMs. The secondary endpoints include the pathological complete response (pCR), SLNB, and MLNB concordance, as well as false-negative rates. Seventeen studies encompassing 1358 TAD procedures in 1355 met the inclusion criteria. The localisation and retrieval rate of LMs were 97% and 99%. A concordance rate of 67% (95% CI: 64–70) between SLNB and MLNB was demonstrated. Notably, 49 days (range: 0–272) was the average LM deployment time to surgery. pCR was observed in 46% (95% CI: 43–49) of cases, with no significant procedure-related complications. Omitting MLNB or SLNB would have under-staged the axilla in 15.2% or 5.4% (p = 0.0001) of cases, respectively. MLNB inclusion in axillary staging post-NST for initially node-positive patients is crucial. The radiation-free Savi Scout, with its minimal MRI artefacts, is the preferred technology for TAD.

Targeted axillary dissection (TAD), employing marked lymph node biopsy (MLNB) alongside sentinel lymph node biopsy (SLNB), is increasingly recognised for its efficacy in reducing false negative rates (FNRs) in node-positive early breast cancer patients receiving neoadjuvant systemic therapy (NST). One such method, ¹²⁵I radioactive seed localisation (RSL), involves implanting a seed into a biopsy-proven lymph node either pre- or post-NST. This systematic review and pooled analysis aimed to assess the performance of RSL in TAD among node-positive patients undergoing NST. Six studies, encompassing 574 TAD procedures, met the inclusion criteria. Results showed a 100% successful deployment rate, with a 97.6% successful localisation rate and a 99.8% retrieval rate. Additionally, there was a 60.0% concordance rate between SLNB and MLNB. The FNR of SLNB alone was significantly higher than it was for MLNB (18.8% versus 5.3%, respectively; p = 0.001). Pathological complete response (pCR) was observed in 44% of cases (248/564). On average, the interval from ¹²⁵I seed deployment to surgery was 75.8 days (range: 0–272). These findings underscore the efficacy of RSL in TAD for node-positive patients undergoing NST, enabling precise axillary pCR identification and facilitating the safe omission of axillary lymph node dissection.

Navigating axillary staging post-neoadjuvant systemic therapy: innovations, efficacy, and oncologic safety

Background/Objectives: De-escalation of axillary surgery is made possible by advancements in both neoadjuvant systemic therapy (NST) and in localisation technology for breast lesions. Magseed^®, developed in 2013 by Dr. Michael Douk of Cambridge, United Kingdom, is a wire-free localisation technology that facilitates the localisation and retrieval of lymph nodes for staging. Targeted axillary dissection (TAD), which entails marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), has emerged as the preferred method to assess residual disease in post-NST node-positive patients. This systematic review and pooled analysis evaluate the performance of Magseed^® in TAD. Methods: The search was carried out in PubMed and Google Scholar. An assessment of localisation, retrieval rates, concordance between MLNB and SLNB, and pathological complete response (pCR) in clinically node-positive patients post NST was undertaken. Results: Nine studies spanning 494 patients and 497 procedures were identified, with a 100% successful deployment rate, a 94.2% (468/497) [95% confidence interval (CI), 93.7–94.7] localisation rate, a 98.8% (491/497) retrieval rate, and a 68.8% (247/359) [95% CI 65.6–72.0] concordance rate. pCR was observed in 47.9% (220/459) ) [95% CI 43.3–52.6] of cases. Subgroup analysis of studies reporting the pathological status of MLNB and SLNB separately revealed an FNR of 4.2% for MLNB and 17.6% for SLNB (p = 0.0013). Mean duration of implantation was 37 days (range: 0–188). Conclusions: These findings highlight magnetic seed localisation’s efficacy in TAD for NST-treated node-positive patients, aiding in accurate axillary pCR identification and safe de-escalation of axillary surgery in excellent responders.

SAVI SCOUT^® or radar reflector localisation (RRL) has proven accurate in localising non-palpable breast and axillary lesions, with minimal interference with MRI. Targeted axillary dissection (TAD), combining marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB), is becoming a standard post-neoadjuvant systemic therapy (NST) for node-positive early breast cancer. Compared to SLNB alone, TAD reduces the false negative rate (FNR) to below 6%, enabling safer axillary surgery de-escalation. This systematic review evaluates RRL’s performance during TAD, assessing localisation and retrieval rates, the concordance between MLNB and SLNB, and the pathological complete response (pCR) in clinically node-positive patients post-NST. Four studies (252 TAD procedures) met the inclusion criteria, with a 99.6% (95% confidence [CI]: 98.9–100) successful localisation rate, 100% retrieval rate, and 81% (95% CI: 76–86) concordance rate between SLNB and MLNB. The average duration from RRL deployment to surgery was 52 days (range:1–202). pCR was observed in 42% (95% CI: 36–48) of cases, with no significant migration or complications reported. Omitting MLNB or SLNB would have under-staged the axilla in 9.7% or 3.4% (p = 0.03) of cases, respectively, underscoring the importance of incorporating MLNB in axillary staging post-NST in initially node-positive patients in line with the updated National Comprehensive Cancer Network (NCCN) guidelines. These findings underscore the excellent efficacy of RRL in TAD for NST-treated patients with positive nodes, aiding in accurate axillary pCR identification and the safe omission of axillary dissection in strong responders.