title: iROLL: does 3-D radioguided occult lesion localization improve surgical management in early-stage breast cancer?
abstract: OBJECTIVE
  To prospectively evaluate the feasibility of 3-D radioguided occult lesion localization (iROLL) and to compare iROLL with wire-guided localization (WGL) in patients with early-stage breast cancer undergoing breast-conserving surgery and sentinel lymph node biopsy (SLNB).
  
  
  METHODS
  WGL (standard procedure) and iROLL in combination with SLNB were performed in 31 women (mean age 65.1 ± 11.2 years) with early-stage breast cancer and clinically negative axillae. Patient comfort in respect of both methods was assessed using a ten point scale. SLNB and iROLL were guided by freehand SPECT (fhSPECT). The results of the novel 3-D image-based method were compared with those of WGL, ultrasound-based lesion localization, and histopathology.
  
  
  RESULTS
  iROLL successfully detected the malignant primary and at least one sentinel lymph node in 97% of patients. In a single patient (3%), only iROLL, and not WGL, enabled lesion localization. The variability between fhSPECT and ultrasound-based depth localization of breast lesions was low (1.2 ± 1.4 mm). Clear margins were achieved in 81% of the patients; however, precise prediction of clear histopathological surgical margins was not feasible using iROLL. Patients rated iROLL as less painful than WGL with a pain score 0.8 ± 1.2 points (p < 0.01) lower than the score for iROLL.
  
  
  CONCLUSIONS
  iROLL is a well-tolerated and feasible technique for localizing early-stage breast cancer in the course of breast-conserving surgery, and is a suitable replacement for WGL. As a single image-based procedure for localization of breast lesions and sentinel nodes, iROLL may improve the entire surgical procedure. However, no advantages of the image-guided procedure were found with regard to prediction of complete tumour resection.
authors.affiliation: Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany. Bluemel_c@ukw.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Bluemel
authors.affiliation: Department of Obstetrics and Gynecology, Missionsärztliches Klinikum Würzburg, Würzburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Cramer
authors.affiliation: Department of Obstetrics and Gynecology, Missionsärztliches Klinikum Würzburg, Würzburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Grossmann
authors.affiliation: Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
authors.forename: Georg W
authors.initials: GW
authors.lastname: Kajdi
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Malzahn
authors.affiliation: Institute of Pathology, University of Würzburg, Würzburg, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Lamp
authors.affiliation: Department of Radiology, Missionsärztliches Klinikum Würzburg, Würzburg, Germany.
authors.forename: Heinz-Jakob
authors.initials: HJ
authors.lastname: Langen
authors.affiliation: Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Schmid
authors.affiliation: Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Buck
authors.affiliation: Department of Obstetrics and Gynecology, Missionsärztliches Klinikum Würzburg, Würzburg, Germany.
authors.forename: Hanns-Jörg
authors.initials: HJ
authors.lastname: Grimminger
authors.affiliation: Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
authors.forename: Ken
authors.initials: K
authors.lastname: Herrmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome