title: Radioguided occult lesion localisation using iodine-125 seeds ('ROLLIS') for removal of impalpable breast lesions: First Australian experience.
abstract: BACKGROUND
  Approximately one-third of breast cancers are impalpable and require pre-operative image-guided localisation. Hook-wire localisation (HWL) is commonly used but has several disadvantages. Use of a low-activity radioactive iodine-125 seed is a promising alternative technique used in the USA and the Netherlands. This pilot study describes the first use of this in Australia.
  
  
  METHODS
  In this prospective pilot study, 21 participants with biopsy-proven breast cancer underwent radioguided occult lesion localisation using iodine-125 seed(s) (ROLLIS) with insertion of a hook-wire for back up. Sentinel node biopsy was performed where indicated. Ease of hook-wire and seed insertion, duration of the procedure, dependence on the seed versus hook-wire during surgery, lesion location within the specimen, histopathology including size of radial margins, the ease of seed retrieval in pathology, and safe return of seeds for disposal were documented. Radiation dosimetry of staff was performed.
  
  
  RESULTS
  All seeds were placed within 3.5 mm of the lesion. All lesions and seeds were removed. One participant needed re-excision for involved margins. Radiologists and surgeons both preferred ROLLIS. Surgeons were able to depend on the seed for localisation in all but one case. Sentinel node biopsy was successfully performed when required. Pathologists found seed retrieval quick and easy, with no detrimental effect on tissue processing. No radiation doses measurably above background were received by staff.
  
  
  CONCLUSIONS
  ROLLIS is an easily learnt, safe and effective alternative technique to standard HWL.
authors: School of Surgery, University of Western Australia, Perth, Western Australia, Australia.|Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Donna B
authors: DB
authors: Taylor
authors: School of Surgery, University of Western Australia, Perth, Western Australia, Australia.|Breast Centre, Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors: Anita G
authors: AG
authors: Bourke
authors: Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, QEII Medical Centre, Perth, Western Australia, Australia.|School of Physics, University of Western Australia, Perth, Western Australia, Australia.
authors: Eliza
authors: E
authors: Westcott
authors: Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: John
authors: J
authors: Burrage
authors: PathWest Laboratory Medicine, Royal Perth Hospitial, Perth, Western Australia, Australia.|School of Medicine, Notre Dame University, Fremantle, Western Australia, Australia.
authors: Bruce
authors: B
authors: Latham
authors: Breast Centre, Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors: Paul
authors: P
authors: Riley
authors: Breast Centre, Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors: Helen
authors: H
authors: Ballal
authors: Breast Centre, Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors: Roshi
authors: R
authors: Kamyab
authors: PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia.
authors: Felicity
authors: F
authors: Frost
authors: Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Deepthi
authors: D
authors: Dissanayake
authors: Department of Nuclear Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Joanne
authors: J
authors: Landman
authors: Harry Perkins Institute for Medical Research, University of Western Australia, Perth, Western Australia, Australia.
authors: Michael
authors: M
authors: Phillips
authors: School of Surgery, University of Western Australia, Perth, Western Australia, Australia.|Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Christobel
authors: C
authors: Saunders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D007457:Iodine Radioisotopes; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D010865:Pilot Projects; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals
keywords: breast conserving surgery; image-guided localisation; iodine-125; radioactive seed localisation