title: Radioguided occult lesion localisation (ROLL) in breast-conserving surgery after neoadjuvant chemotherapy.
abstract: BACKGROUND
  An important benefit of neoadjuvant chemotherapy, as compared to adjuvant chemotherapy, in breast cancer patients is down staging of the primary tumour, which allows for more breast-conserving surgery. When a tumour becomes non-palpable after this down staging, precise localisation of the original tumour bed is crucial to be able to perform breast-conserving surgery. Radioguided Occult Lesion Localisation with (99m)Technetium (ROLL-(99m)Tc) is commonly used to perform breast-conserving surgery in patients with non-palpable breast tumours. We modified this technique to use it in the neoadjuvant setting. The present analysis was performed to assess its feasibility and analyse the number of patients in which a mastectomy was correctly withheld using this technique.
  
  
  METHODS
  A retrospective analysis was performed for all patients who were treated with neoadjuvant chemotherapy between 2007 and 2010 in our institute and underwent breast-conserving surgery with the ROLL-(99m)Tc technique afterwards. The status of the margins and the weight of the resected specimen were assessed.
  
  
  RESULTS
  The median weight of the resected specimen in these 83 patients was 53 g (range: 11-204 g). Eleven of the 58 patients with residual disease revealed positive margins at pathological examination. However, in only 5 of those 11 patients a secondary mastectomy was indicated. This means that in 94% of all included patients a mastectomy was correctly withheld.
  
  
  CONCLUSIONS
  The ROLL-(99m)Tc technique is a feasible technique that can be used to perform breast-conserving surgery after neoadjuvant chemotherapy in a carefully selected group of patients.
authors.affiliation: Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. m.donker@nki.nl
authors.forename: M
authors.initials: M
authors.lastname: Donker
authors.forename: M E
authors.initials: ME
authors.lastname: Straver
authors.forename: E J Th
authors.initials: EJ
authors.lastname: Rutgers
authors.forename: R A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.forename: C E
authors.initials: CE
authors.lastname: Loo
authors.forename: G S
authors.initials: GS
authors.lastname: Sonke
authors.forename: J
authors.initials: J
authors.lastname: Wesseling
authors.forename: M-J T F D
authors.initials: MJ
authors.lastname: Vrancken Peeters
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin