Simplified Technique of Radioguided Occult Lesion Localization (ROLL) Plus Sentinel Lymph Node Biopsy (SNOLL) in Breast Carcinoma

Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, 12 Rue Leblanc, 75015, Paris, France.
Annals of Surgical Oncology (Impact Factor: 3.93). 07/2008; 15(9):2556-61. DOI: 10.1245/s10434-008-9994-y
Source: PubMed


Radioguided occult lesion localization (ROLL) is a new technique to detect nonpalpable breast tumors. We report our experience using injection of a single radiotracer to localize occult lesions together with sentinel lymph node (SLN) biopsy (SNOLL). The aim of this series was to evaluate the feasibility of the technique, its efficacy, and the rate of reoperation.
Under sonographic guidance, a nanocolloidal tracer was injected peritumorally above and below the lesion. A handheld gamma probe detector was used to locate and to guide its surgical removal. An intraoperative (IO) macroscopic examination of the specimen with margins evaluation and IO imprint cytology of SLN was always performed.
The targeted lesion was localized and removed in all cases. Final pathological diagnosis identified invasive in 70 patients and ductal carcinoma in situ (DCIS) in 2 patients. The average size of the resected lesion was 11 mm (4-50 mm). In 61 out of the 72 patients (85%), the breast specimen had clear and large margins. Sentinel lymph node (SLN) biopsy was performed in 70 patients with an identification rate of 90%. Final pathological SLN metastasis rate approached 25% (pN1 14%, pN1(mi) 11%). Despite intraoperative examination of the specimen, a total of 29% (21 out of 72) patients had to be reoperated (8 patients for involved margins, 10 patients for an involved SLN, and 3 for both).
This technique with a single nanocolloid tracer used both for ROLL and SLN detection is reliable for removing nonpalpable lesions. The use of this technique may have implications for further reducing reoperation rates.

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    • "Radiographic or sonographic guidance is used to inject a 99mTc labelled nanocolloidal tracer peritumorally in the case of ROLL or implant an 125I brachytherapy seed at the center of the nonpalpable tumour in the case of RSL. The surgeon then uses a hand-held gamma-ray-detecting probe (GDP), to guide the excision of the tumour [7–11]. Ultrasonography has been explored as an alternative approach; however, patients with tumours having extensive intraductal disease or a predominantly infiltrative growth pattern are not candidates for ultrasound-guided excision [12–14]. "
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    ABSTRACT: Breast-conserving surgery involves completely excising the tumour while limiting the amount of normal tissue removed, which is technically challenging to achieve, especially given the limited intraoperative guidance available to the surgeon. This study evaluates the feasibility of radioimmunoguided surgery (RIGS) to guide the detection and delineation of tumours intraoperatively. The 3D point-response function of a commercial gamma-ray-detecting probe (GDP) was determined as a function of radionuclide ((131)I, (111)In,( 99m)Tc), energy-window threshold, and collimator length (0.0-3.0-cm). This function was used to calculate the minimum detectable tumour volumes (MDTVs) and the minimum tumour-to-background activity concentration ratio (T:B) for effective delineation of a breast tumour model. The GDP had larger MDTVs and a higher minimum required T:B for tumour delineation with (131)I than with (111)In or (99m)Tc. It was shown that for (111)In there was a benefit to using a collimator length of 0.5-cm. For the model used, the minimum required T:B required for effective tumour delineation was 5.2 ± 0.4. RIGS has the potential to significantly improve the accuracy of breast-conserving surgery; however, before these benefits can be realized, novel radiopharmaceuticals need to be developed that have a higher specificity for cancerous tissue in vivo than what is currently available.
    02/2012; 2012:545034. DOI:10.1155/2012/545034
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    • ". Other techniques, including ultrasound guided hematoma localization [20] [21], seed localization [16] [19] [22] [23], radioguided localization [24] [25] [26], intraoperative specimen mammography [27] [28], and intraoperative pathologic margin assessment [29] [30] have also been utilized to ensure complete tumor removal. While success with these approaches has been reported, they universally require additional equipment and they may increase operative time. "
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    ABSTRACT: Introduction. Breast conserving surgery (BCS) requires tumor excision with negative margins. Reexcision rates of 30-50% are reported. Ultrasound localization, intraoperative margin pathology, and specimen mammography have reduced reexcisions, but require new equipment. Cavity shave margin (CSM) is a technique, utilizing existing equipment, that potentially reduces reexcision. This study evaluates CSM reexcision impact. Methods. 522 cancers treated with BCS were reviewed. Patients underwent standard partial mastectomy (SPM) or CSM. Data collected included demographics, pathology, and treatments. Results. 455 SPMs were compared to 67 CSMs. Analysis revealed no differences in pathology, intraductal component, or neoadjuvant chemotherapy. Overall reexcision rate = 43%. Most reexcisions were performed for DCIS at margin. SPMs underwent 213 reexcisions (46.8%), versus 16/67 (23.9%) CSMs (P = 0.0003). Total mastectomy as definitive procedure was performed after more SPMs (P = 0.009). Multivariate analysis revealed CSM, % DCIS, tumor size, and race to influence reexcisions. Conclusions. CSM is a technique that reduces reexcisions and mastectomy rates.
    International Journal of Surgical Oncology 01/2012; 2012(8):725121. DOI:10.1155/2012/725121
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