Radioguided localisation of impalpable breast lesions using 99m-Technetium macroaggregated albumin: Lessons learnt during introduction of a new technique to guide preoperative localisation

Application of the ROLL technique as a method of excisional biopsy in oncological pathology

OBJECTIVE

To evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [¹⁸F]Fluordeoxiglucose PET/CT scans.

MATERIAL AND METHODS

33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure.

RESULTS

In 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process.

CONCLUSION

The ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management.

A Review of Options for Localization of Axillary Lymph Nodes in the Treatment of Invasive Breast Cancer

Invasive breast cancer is a common disease, and the most common initial site of metastatic disease are the axillary lymph nodes. As the standard of care shifts towards less invasive surgery in the axilla for patients with invasive breast cancer, techniques have been developed for axillary node localization that allow targeted dissection of specific lymph nodes without requiring full axillary lymph node dissection. Many of these techniques have been adapted from technologies developed for localization of lesions within the breast and include marker clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive seeds, magnetic seeds, radar reflectors, and radiofrequency identification devices.The purpose of this article is to summarize these methods and describe benefits and drawbacks of each method for performing localization of lymph nodes in the axilla.

Use of the ROLL technique for lumpectomy in non-palpable breast lesions

OBJECTIVE

To evaluate the efficiency of radioguided occult lesion localising in non-palpable breast lesions (NPBL) compared to the surgical wire technique.

METHOD

A prospective study was conducted on 161 women with NPBL, of whom 80 marked with the wire (group 1), whereas 81 women were marked with an intratumour injection of ^99mTc-nanocoloid (group 2). The NPBL were located by ultrasound or stereotactic guidance. The lumpectomies were performed following the wire direction in group 1, and with the aid of a gamma-probe in group 2. Surgical margins were then checked, determining the need of extension if the margin was less than 5mm in the intra-surgical study, and less than 2mm in the deferred study. Data were collected on the mean number detected by surgery, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, as well as total resected volume, volume/tumour ratio, and complications.

RESULTS

No significant differences were observed between the two groups in the mean number detected, surgical margins, number of extensions, presence of residual tumour in the extension, second surgeries, lumpectomy volume, total resected volume, volume/tumour ratio or complications. The multivariate analysis showed the determining factors of the resected volume were the radiological guidance technique, as well as the surgeon.

CONCLUSIONS

The radioguided occult lesion localising technique helps in the detection and resection of NPBL with the same efficiency as the surgical wire, and adds the possibility of sentinel node detection in the same surgery. The determining factors of the resected volume were the radiological guidance technique and the surgeon.