PURPOSE: Radioguided occult lesion localization (ROLL) was developed in the European Institute of Oncology in 1998, where it is used routinely.
We describe our experience using ROLL with sonographic guidance for non-palpable breast cancer.
MATERIALS AND METHODS: Since August 2012 we have performed ROLL procedure for 15 occult lesions in 13 patients; one patient had bilateral carcinoma and one patient had multifocal carcinoma. There were 11 lesions of invasive duct carcinoma and 4 cases of DCIS. Mean size of lesions was 10 mm. All the lesions were non-palpable and were previously diagnosed on biopsy with ultrasonographic guidance. ROLLprocedures were done in the department of nuclear medicine to avoid radioactive hazards. The localization of breast lesions was performed by two experienced radiologists with ultrasound guidance using a portable ultrasound unit. Under local anesthesia a 22-gauge spinal needle was placed with its tip in the lesion or just near the border of the lesion, depending on solidity of the tumor, and 0.1-0.2 millicurie (mCi) of Technetium 99m with macroaggregates of albumin (Tc-MAA) was injected, followed by 1 cc of saline solution. In the cases of invasive carcinoma, ROLL was followed by sentinel node detection using intradermal injection of 0.5 mCi of Tc-nanocolloid. On the same day surgical excisions were done guided by a gamma-detecting probe. After excision of the specimen, the probe was used to check for residual radioactivity at the excision site to confirm that the radioactive area was removed. Specimen margins were assessed
by frozen sections.
RESULTS: Breast lesions were correctly localized by the radiotracer in all the cases. ROLL procedure allowed rapid, easy and accurate surgical removal with reduced specimen volume and good cosmetic results. Sentinel node identification and removal was successful in all the cases. Positive margins were diagnosed by frozen sections in two cases and additional tissue removal was performed.
Conclusions: ROLL technique can be successfully integrated into practice with coordinated effort radiologist, nuclear medicine specialist, surgeon and pathologist.
