Simplified technique of radioguided occult lesion localization (ROLL) plus sentinel lymph node biopsy (SNOLL) in breast carcinoma.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, 12 Rue Leblanc, 75015, Paris, France.
Vincent
V
Lavoué
Claude
C
Nos
Krishna B
KB
Clough
Forouhar
F
Baghaie
Eric
E
Zerbib
Bruno
B
Poulet
Marie-Aude
MA
Lefrère Belda
Anne
A
Ducellier
Fabrice
F
Lecuru
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D016217:Ultrasonography, Mammary
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals