title: High-resolution, handheld camera use for occult breast lesion localization plus sentinel node biopsy (SNOLL): a single-institution experience with 186 patients.
abstract: BACKGROUND
  Sentinel node and occult lesion localization (SNOLL) calls for a combination of two specific procedures: intraoperative detection of sentinel lymph node (SLN) via gamma probe and radioguided occult lesion localization (ROLL). This applies to nonpalpable invasive breast cancer or high-grade in situ carcinoma. As opposed to standard techniques, today's handheld gamma cameras enable intraoperative scintigraphic images.
  
  
  METHODS
  A cohort (N = 186) of consecutive patients with breast cancer was subjected to radioguided conservative surgery (quadrantectomy and SLN biopsy), using a standard gamma probe and a high-resolution handheld camera. Intraoperative SLN frozen section was also performed.
  
  
  RESULTS
  Neoplastic lesions were removed in 99.4% of all patients, and SLN biopsy was achieved in 99%. Of the 137 patients with invasive cancer, SLN metastasis was confirmed in 21. In 12% of patients, a second operation was required for close or tumor-positive surgical margins.
  
  
  CONCLUSIONS
  This combination of procedures represents an improvement in the surgical management of occult breast carcinomas and is the method of choice for accurate tumor localization and SLN biopsy. Handheld cameras have the potential to become highly useful intraoperative aids.
authors.affiliation: Breast Surgery Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Lombardi
authors.affiliation: Department of Surgery, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy. Electronic address: giuseppe.nigri@uniroma1.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.affiliation: Nuclear Medicine Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Scopinaro
authors.affiliation: Breast Surgery Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Maggi
authors.affiliation: Breast Radiology Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Mattei
authors.affiliation: Breast Diagnosis and Treatment Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Bonifacino
authors.affiliation: Nuclear Medicine Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Parisella
authors.affiliation: Biomedical Engineering Unit, National Research Council (CNR), Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Soluri
authors.affiliation: Breast Surgery Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Amanti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005629:Frozen Sections; D015902:Gamma Cameras; D006801:Humans; D007430:Intraoperative Care; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011877:Radionuclide Imaging; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation*
keywords: Imaging probe; Nonpalpable breast cancer; Radioguided surgery; Sentinel lymph node biopsy