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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    Full-text · Article · Feb 2012
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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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