title: Magnetic resonance imaging-radioguided occult lesion localization (ROLL) in breast cancer using Tc-99m macro-aggregated albumin and distilled water control.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) guided wire localization presents several challenges apart from the technical difficulties. An alternative to this conventional localization method using a wire is the radio-guided occult lesion localization (ROLL), more related to safe surgical margins and reductions in excision volume. The purpose of this study was to establish a safe and reliable magnetic resonance imaging-radioguided occult lesion localization (MRI-ROLL) technique and to report our initial experience with the localization of nonpalpable breast lesions only observed on MRI.
  
  
  METHODS
  Sixteen women (mean age 53.2 years) with 17 occult breast lesions underwent radio-guided localization in a 1.5-T MR system using a grid-localizing system. All patients had a diagnostic MRI performed prior to the procedure. An intralesional injection of Technetium-99m macro-aggregated albumin followed by distilled water was performed. After the procedure, scintigraphy was obtained. Surgical resection was performed with the help of a gamma detector probe. The lesion histopathology and imaging concordance; the procedure's positive predictive value (PPV), duration time, complications, and accuracy; and the rate of exactly excised lesions evaluated with MRI six months after the surgery were assessed.
  
  
  RESULTS
  One lesion in one patient had to be excluded because the radioactive substance came back after the injection, requiring a wire placement. Of the remaining cases, there were four malignant lesions, nine benign lesions, and three high-risk lesions. Surgical histopathology and imaging findings were considered concordant in all benign and high-risk cases. The PPV of MRI-ROLL was greater if the indication for the initial MR examination was active breast cancer. The median procedure duration time was 26 minutes, and all included procedures were defined as accurate. The exact and complete lesion removal was confirmed in all (100%) patients who underwent six-month postoperative MRI (50%).
  
  
  CONCLUSIONS
  MRI-ROLL offers a precise, technically feasible, safe, and rapid means for performing preoperative MRI localizations in the breast.
authors.affiliation: Department of Radiology, Federal University of Rio de Janeiro, Rua Prof, Rodolpho Paulo Rocco 255, Cidade Universitária, Rio de Janeiro, RJ 21941-617, Brazil. fephila@gmail.com.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Philadelpho Arantes Pereira
authors.forename: Gabriela
authors.initials: G
authors.lastname: Martins
authors.forename: Maria Julia
authors.initials: MJ
authors.lastname: Gregorio Calas
authors.forename: Maria Veronica
authors.initials: MV
authors.lastname: Fonseca Torres de Oliveira
authors.forename: Emerson Leandro
authors.initials: EL
authors.lastname: Gasparetto
authors.forename: Lea Mirian
authors.initials: LM
authors.lastname: Barbosa da Fonseca
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D057168:Distillation; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012709:Serum Albumin; D013668:Technetium Tc 99m Aggregated Albumin; D017971:Tin Compounds; D014867:Water
chemical_list: D019275:Radiopharmaceuticals; D012709:Serum Albumin; D013668:Technetium Tc 99m Aggregated Albumin; D017971:Tin Compounds; C038216:technetium Tc 99m-Sn aggregated albumin; D014867:Water
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