title: SNOLL. Sentinel node and occult (impalpable) lesion localization in breast cancer.
abstract: OBJECTIVE
  To evaluate the efficacy and safety for use of dual radioisotopes for localization of occult (impalpable) breast lesions and sentinel node biopsy as a combined technique (SNOLL) using a lower dose than previous studies.
  
  
  METHODS
  One hundred and twenty-seven SNOLL procedures were performed. The impalpable breast lesions were localized with an intra-lesion injection of 0.2 ml of (99m)Tc MAA (1 MBq) with a particle size of 10-90 μm (radio-guided occult lesion localization, or ROLL) 1 to 4 h before surgery. Sentinel node localization was performed using 0.2 mls of (99)Tc nanocolloid (20 MBq) particle size no greater than 80 nm injected subdermally in the periareolar region within the index quadrant, the night before or the morning of surgery.
  
  
  RESULTS
  Lesion localization was consistently achieved with a lower dose than that described in other studies without the need to use scintigraphy or additional imaging with radioopaque contrast medium. One hundred percent lesion localization with a negative clearance margin of 94.8% and 100% sentinel node localization was achieved. The use of dual radioisotopes with the lower dose used for ROLL did not compromise the localization of the impalpable lesion or the sentinel nodes.
  
  
  CONCLUSIONS
  The combined use of radioisotopes for lesion and sentinel node removal is feasible and reliable with the lower radioisotope dose suggested compared with previously published studies. This method should be recommended as a standard procedure for SNOLL.
authors.affiliation: Radiology Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescott, Liverpool, UK. thindr@aol.com
authors.forename: C R
authors.initials: CR
authors.lastname: Thind
authors.forename: S
authors.initials: S
authors.lastname: Tan
authors.forename: S
authors.initials: S
authors.lastname: Desmond
authors.forename: O
authors.initials: O
authors.lastname: Harris
authors.forename: H S J
authors.initials: HS
authors.lastname: Ramesh
authors.forename: L
authors.initials: L
authors.lastname: Chagla
authors.forename: A
authors.initials: A
authors.lastname: Ray
authors.forename: R
authors.initials: R
authors.lastname: Audisio
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016217:Ultrasonography, Mammary