Radioguided Surgery of Non-palpable Breast Lesions: Radio Occult Lesion Localization (ROLL)

Abstract

The incidence of non-palpable breast cancer is rising since national screening programs were introduced. More than 25 % of the radiological suspicious breast lesions are considered clinically occult or non-palpable. Surgical removal of non-palpable breast tumors requires a specific approach. The main challenge of resecting non-palpable lesions is to ensure clear margins while minimizing the resection of healthy tissue and cosmetic damage. Radioguided occult lesion localization (ROLL) using a radioactive tracer (e.g., technetium 99m; half-life of approximately 6 hours) was developed in 1996 and is nowadays used in several institutes as a reliable alternative for wire-guided localization. The commonly used radiotracer is technetium 99m (Tc 99m) macroaggregate albumin (MAA) with a particle size of 10–150 μm, which can be detected by the surgeon using a gamma probe. The tracer is administered by an intratumoral injection, and accordingly, this site is surgically excised at the operating room while using a gamma probe. At the moment more than 29 peer-reviewed articles have emerged about ROLL. The general consensus is that ROLL, using Tc 99m, is preferable over wire-guided localization with the main advantages: the patient comfort, positive margins, and localization time. Furthermore, the procedure can be combined with a sentinel lymph node biopsy.