Radioguided Occult Lesion Localization Technique Research Articles

Radioguided Occult Lesion Localization Technique for Biopsy of Nonpalpable Subcutaneous Lesions in Suspected Metastatic Melanoma.

In patients with a history of melanoma, the risk of recurrence depends on the stage at diagnosis. Patients who present with more advanced disease are more likely to experience recurrence; patients with less advanced disease at presentation have slower progression and lower likelihood of recurrence. The aim of this study was to evaluate the use of a minimally invasive and targeted technique as a diagnostic and therapeutic tool for the excision of nonpalpable lesions suspected to be melanoma metastases. The authors evaluated 21 patients with stage IIB, IIC, or III melanoma and subcutaneous nonpalpable lesions with a high risk of malignancy on positron emission tomography/computed tomography scan during oncologic follow-up. To guide biopsy, the authors used the radioguided occult lesion localization technique, using intralesional injection of technetium-99m albumin macroaggregates the day before surgery. During surgery, a handheld gamma probe was used to locate the lesions. Surgical localization of radiolabeled lesions was achieved in all cases. Relapsed melanoma was histologically confirmed in 13 patients. This technique proved to be a simple, safe, and effective method to detect and biopsy nonpalpable or difficult-to-locate lesions in suspected metastatic melanoma. The main advantage was disease restaging (eg, from stage II to III), allowing patients to access adjuvant therapies not approved as early-stage melanoma treatment. Therapeutic, IV.

Targeted axillary dissection using Radioguided Occult Lesion Localization technique in the clinically negative marked lymph node after neoadjuvant treatment in breast cancer patients

PurposeTo be aware of the feasibility of targeted axillary dissection (TAD) injecting 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA) preoperatively into the clipped lymph node of patients with axillary complete clinical response (ycN0), after neoadjuvant chemotherapy (NAC) for breast cancer. Patients and methodsA retrospective observational study was performed on N1 patients with a clipped positive node and a clinically negative axilla (ycN0) after NAC in one center. The pretreatment positive lymph node was injected with 99mTc-MAA the day before surgery and identified intraoperatively with a radioguided occult lesion localization (ROLL) technique. Patients were subjected to a TAD with the intent of identifying the clipped node and other/s sentinel nodes through a standard sentinel lymph node biopsy (SLNB). Results54 patients and 55 axillary clipped nodes were included. The clip was intraoperatively encountered in every patient, accomplishing a 100% detection rate, although in one case no lymphatic tissue could be found in the intraoperative frozen section. An axillary lymph node dissection (ALND) was avoided in 62.9% of the cases (34/54). ConclusionThe use of the ROLL technique is a highly valuable tool since it allows a 100% success rate in retrieving the marker (and a 98.1% rate in detecting the clipped lymph node) in ycN0 breast cancer patients.

Role of a portable gamma-camera with optical view for margins assessment of pulmonary nodules resected by radioguided surgery.

Radioguided occult lesion localization (ROLL) of pulmonary nodules is an alternative to hook-wire. Both required of a histological margin assessment. The activity emerging from the radiotracer allows to obtain an intraoperative scintigraphic image of the surgical specimen by a portable gamma-camera (PGC) fitted with an optical view, which provides information about the localization of the nodule in relation to the margins. The aim of this study was to evaluate the intraoperative use of a PGC for margin assessment of pulmonary nodules. ROLL technique was used in 38 nodules (36 pulmonary, 1 chest wall, and 1 pleural nodules). A PGC intraoperative image of the surgical specimen was obtained in 32. Scintigraphic results were compared to the histological assessment. Other factors, such as nodule size, distance from the pleural surface, or distance covered by the needle, were considered as possible factors for non-centered lesions. PGC images showed that the lesion was in contact with the margins in 8/32 cases and centered in 24. In all cases in which the lesion was considered as centered by the PGC, the margins were free of involvement (NPV 100%), although the PPV is low. The use of a PGC for margin assessment after pulmonary nodule resection is feasible and provides a high NPV in our series. In addition, the short intraoperative time required for its use makes the PGC a useful tool for providing supplementary information to histopathologic results. Further studies from different surgical teams are required for an external validation.

Application of the ROLL technique as a method of excisional biopsy in oncological pathology

ObjectiveTo evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. Material and methods33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. ResultsIn 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. ConclusionThe ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management.

Radioguided occult lesion localization for minimally-invasive parathyroidectomy without quick PTH monitoring and frozen section: impact of the learning curve.

Minimally-invasive parathyroidectomy (MIP) is a surgical procedure that reduces the duration of operation, hospital costs, and hypocalcemia, and shortens the length of hospital stay. This study addressed the important procedural details of the radioguided occult lesion localization (ROLL)-MIP technique and evaluated the consequences of the learning curve from a series of patients. A total of 80 patients who underwent ROLL-MIP for a single parathyroid adenoma were included into this retrospective study. In order to analyze the effect of the learning curve, these subjects were then divided into 2 groups per time period and the operative times were compared. Group A consisted of 22 previously reported patients who served as the control group. Group B consisted of 58 consecutive patients. Serum calcium and parathyroid hormone (PTH) levels were normalized in all of the patients within 2 days and remained normal during the follow-up period (31 ± 18.5 months). None of the patients who underwent ROLL-guided parathyroidectomy suffered temporary or permanent recurrent laryngeal nerve injuries. Mean operation time (time from incision to excision of the adenoma) was 23 ± 6 min in Group A and 18 ± 7 min in Group B. Mean operative times were significantly shorter in group B. The success of MIP administered with the ROLL technique in a single adenomatous patient was quite high. This method seems especially valuable in patients with atypically located or small adenomas.

Diagnosis and radio-guided surgery of lung nodules

The detection of pulmonary nodules has increased in recent decades due to the introduction of lung cancer screening programs and the massive use of routine chest computed tomography in patients with malignant neoplasms. Percutaneous biopsy cannot always characterize these nodules, making surgical biopsy sometimes necessary, often requiring presurgical localization. Radioguided occult lesion localization (ROLL) described for breast lesions was first applied in the resection of pulmonary nodules in 2000, becoming an alternative to other presurgical localization techniques such as hook-wire. The technique provides a high detection rate with minimal morbidity, enhancing multidisciplinary work with specialists in Radiology and Chest Surgery. The present paper describes the different pre-surgical localization techniques currently available, the methodological procedure of the ROLL technique and the results collected over 20 years of experience.

Diagnóstico y cirugía radioguiada de nódulos pulmonares

The detection of pulmonary nodules has increased in recent decades due to the introduction of lung cancer screening programs and the massively use of routine chest computed tomography in patients with malignant neoplasms. Percutaneous biopsy of these nodules does not always characterize them, so sometimes a surgical biopsy is necessary, which often requires a presurgical localization. The radioguided occult lesion localization (ROLL) described for breast lesions was first applied in the resection of pulmonary nodules in 2000, becoming an alternative to other presurgical localization techniques such as hook-wire. The technique provides high detection rate with minimal morbidity, enhancing multidisciplinary work with specialists in Radiology and Chest Surgery. The present paper describes the different pre-surgical localization techniques currently available, the methodological procedure of the ROLL technique and the collected results in 20 years of experience.

Aplicación de la técnica ROLL como método de biopsia excisional en patología oncológica

ObjectiveTo evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. Material and methods33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. ResultsIn 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. ConclusionThe ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management.

Use of radioguided surgery technique for the treatment of thyroid cancer recurrence: clinical, surgical and anatomopathological aspects

Introduction: Surgery is the treatment of choice in locoregional thyroid neoplasia recurrence. The intense tissue healing process observed after surgery changes the neck anatomy, makes reoperation difficult, and interferes with surgical success. The use of the Radioguided Occult Lesion Localization (ROLL) technique has become a viable option to localize thyroid tumors. Objective: To analyze the use of the ROLL technique for the treatment of thyroid cancer recurrence with respect to its clinical, surgical and anatomopathological aspects. Methods: A descriptive cross-sectional study that analyzed 56 medical records and anatomopathological examinations of patients of both sexes who had thyroid neoplasms, underwent previous surgeries on this topography, and were submitted to the ROLL technique for recurrence removal from March 2011 to March 2019. Results: Most patients were women aged 46.05 years, on average. Papillary thyroid neoplasm was the most prevalent histological finding. In 100% of the cases, application of the ROLL technique identified and removed the lesions marked with suspicion for malignancy. Conclusion: Radioguided surgery has proved to be a very effective and safe tool to assist with lesion localization for the treatment of thyroid cancer recurrence. This technique has brought no additional side effects to patients, required minimal radiation and made surgery less invasive, reducing postoperative complication rates.

Surgical Treatment of Completely Endophytic Renal Tumor: a Systematic Review.

An endophytic renal tumor represents a special surgical challenge in terms of location and safe removal. For this reason we wanted to review the existing literature on this subject. In high-activity robotic centers, robot-assisted partial nephrectomy (RAPN) is a safe and efficacious surgical approach for completely endophytic renal tumors. As research innovation, the application of the radio-guided occult lesion localization technique (ROLL) facilitates the location and complete excision of the tumor during surgery. There are few studies that specifically report the experience with completely endophytic renal tumors. The endophytic tumor is usually smaller than exophytic. Frequently it represents a high complexity value in the different Score systems reported in the last decade. This surgery should be performed by experienced urologists regardless of the surgical approach they prefer (open, laparoscopic, or robotic). It is necessary to develop new techniques for intraoperative easy localization and intraoperative evaluation of surgical margins.

Computed tomography-guided preoperative localization of musculoskeletal lesions using the ROLL technique.

ObjectiveTo describe the preoperative localization of musculoskeletal lesions with the radioguided occult lesion localization (ROLL) technique.Materials and MethodsIn all cases, computed tomography-guided injection of technetium-99m sulfur colloid was performed, directly into or near the suspicious lesion, up to 36 hours before the surgical procedure. Lesions were detected intraoperatively with a gamma probe.ResultsWe report the cases of six patients submitted to radioguided surgery, including three patients with bone lesions suspicious for metastasis, two patients suspected of recurrent sarcoma, and one patient with no previous diagnosis who had a nodular lesion on the left leg. Patients tolerated the procedure well, and no complications were associated with the puncture. All marked lesions were easily identified intraoperatively and were excised with clear margins.ConclusionThe ROLL technique was effective in the intraoperative localization of occult musculoskeletal lesions, demonstrating that it is a feasible and promising technique for the surgical exploration of selected cases.

Radioguided Occult Lesion Localization Techniques for Nonpalpable Breast Cancer Identification

Background: The main goal of successful management of nonpalpable breast tumors is accurate preoperative localization. A hooked wire inserted under radiographic guidance has been the technique used most often to remove occult breast lesions. Because of several disadvantages of wire-guided localization (WGL), new modalities have been investigated. These include radioguided occult lesion localization (ROLL) and radioguided seed localization (RSL). Objective: The aim of this review is to elucidate the diagnostic efficacy of ROLL and RSL techniques and to evaluate the results of subsequent surgical procedures in cases of nonpalpable breast lesions, with special reference to the extent of histologic spread and adequate excision. Methods: A comparison with the standard of care, WGL, as well as an assessment of the recent literature was performed in order to provide an update on the current concepts of diagnostic approach of early breast cancer. Results: The ROLL technique is as effective as WGL for excision of nonpalpable breast lesions, reduces localization time, and probably reduces the incidence of pathologically involved margins of excision. Therefore, ROLL is an attractive alternative to WGL. Moreover, a statistically significant benefit for RSL versus WGL in the form of involved surgical margin status, reoperation rates, and operative time has been documented. Conclusions: This systematic review provides evidence that both ROLL and RSL techniques are not only useful methods for three-dimensional localization of impalpable breast tumors but also are superior in terms of surgical-margin status, reoperation need, and operative duration, compared to WGL. (J GYNECOL SURG 20XX:000)

Radioguided Occult Lesion Localization in Deep Schwannomas of the Peripheral Nerves: Results of a Preliminary Case Series.

The detection of small deep schwannomas of the peripheral nerves has been increasing since the the use of precise neuroimaging techniques has become more widespread; however, although nonpalpable lesions can be well defined by images, it is often difficult to identify them during the surgical procedure. The authors report seven cases of nonpalpable small deep schwannomas surgically treated after their identification using the radioguided occult lesion localization (ROLL) technique. Seven men, whose ages ranged from 34 to 70 years (mean 52 years), presented with symptomatic nonpalpable peripheral nerve lesions; two cases involved the sciatic nerve, two the femoral nerve, two the radial nerve, and one the tibial nerve. Before the operation, all the patients were studied by ultrasonography and magnetic resonance imaging (MRI); 1 h before the surgery 3-5 MBq of 99mTc labeled with human albumin macroaggregates was injected into the lesion. A gamma detection probe permitted the preoperative and intraoperative detection of the nonpalpable schwannomas. The ROLL technique provides good support for identifying small lesions of the peripheral nerves both preoperatively and intraoperatively. This technique permits the use of minimally invasive approaches performed with local anesthesia, with good cosmetic results and acceptance by the patients.

First Case of ROLL Technique for Mesorectal Recurrence Excision

The radio-guided occult lesion localization (ROLL) technique has been in use since the mid-1990s, mainly in breast surgery. Today, ROLL is used for numerous oncologic pathologies, including parathyroid lesions, melanomas, and colorectal tumors. We report a patient with an 11-mm left mesorectal solitary recurrence of a primary ovarian cancer in whom the ROLL technique was used to identify the implant. A radioisotope was introduced through a 22-gauge needle with endoscopic ultrasound technique using an linear echo endoscope. On the day of surgery, the patient's perianal region was scanned with a gamma probe to identify the area of maximal radioactivity, to determine the optimal placement of the incision over the lesion. After macroscopic excision of the lesion, radioactivity was measured in the lesion bed to ensure complete removal of affected tissues. In our case, the ROLL technique was performed safely for the detection and excision of a recurrent lesion of difficult identification. To our knowledge, this is the first reported case involving use of the ROLL technique to aid the excision of a mesorectal lesion.

Localization techniques for guided surgical excision of non-palpable breast lesions.

Localization techniques for guided surgical excision of non-palpable breast lesions.

Randomized controlled clinical trial comparing radioguided occult lesion localization with wire-guided lesion localization to evaluate their efficacy and accuracy in the localization of nonpalpable breast lesions

The aim of this study was to compare the radioguided occult lesion localization (ROLL) technique with the wire-guided lesion localization (WGLL) technique to assess their efficacy and accuracy in the localization of nonpalpable breast lesions in patients at a unique reference medical center. These patients' reports were negative for malignancy but included highly suspicious imaging findings. A controlled clinical trial was designed to compare the WGLL and ROLL techniques in women presenting with breast lesions diagnosed by mammography or ultrasonography at the Instituto Nacional de Cancerología in Bogotá, Colombia, from March 2006 to June 2011. This study examined 129 patients; 64 (49.6%) patients were treated with ROLL, and 65 (51.4%) were treated with WGLL. The ROLL technique achieved better median lesion centricity (ROLL = 11.7 and WGLL = 15.4; P = .038). No significant differences were found regarding demographic variables, operative specimen characteristics, the need to extend margins, operative complications, the degree of difficulty, or patient or surgeon satisfaction. The ROLL technique is as effective as WGLL for the localization of nonpalpable breast lesions. In our study, ROLL achieved better lesion centricity. Therefore, we propose that this technique could be used as a standard procedure in the detection of nonpalpable breast lesions at experienced centers.

Abstract P2-13-05: Radioguided occult lesion localization (ROLL). A 12-year single institution experience of 942 ROLL excisions

Abstract Introduction Despite widespread adoption for the localization of impalpable breast lesions the wire guided localization (WGL) technique has a range of disadvantages including high re-operation rates. Radio-guided occult lesion localization (ROLL) has been proposed as an alternative technique, which may have superior clinical outcomes and be more flexible in its clinical application. A retrospective study of outcomes following ROLL therapeutic wide local excisions (WLE) and diagnostic excision biopsies (DEB) was performed. This documented 12 years experience of the ROLL technique at a single institution to provide a comprehensive analysis of the largest UK based series of ROLL excisions and sentinel node occult lesion localisations (SNOLL). Methods 942 patients were identified who had been referred with non-palpable breast lesions from 2000-2012. 576 patients underwent WLE following a biopsy proven diagnosis of breast cancer. 366 patients underwent DEB. Prospective data collection was performed using bespoke proformas by the operating clinician. These data were supplemented with a retrospective analysis of prospectively collected data held on patient electronic records including evidence of radiological excision on specimen radiographs and histopathological characteristics including excision margin status. Sub-group analysis was performed to examine the outcomes from "same day" and "next day" protocols for ROLL/SNOLL procedures and to examine the effect of residual radioactivity levels in the excision bed on margin status. Results 99.0% of ROLL WLE returned histological diagnoses of invasive cancer or DCIS and 98.4% of radiological abnormalities were identified on post-excision specimen radiographs. 97.5% of radiological abnormalities were identified on post-excision radiographs following DEB. Surgical localisation was rated as easy in 92.3% of excisions and 29 adverse events were recorded as a result of the localisation procedure (3.1%). Complete histological excision was recorded in 77.8% of the WLE sub-group based on defined margin criteria with a median specimen weight of 50g. 31.7% of DEB were pathologically upgraded to a diagnosis of breast cancer. No significant difference was seen in complete excisions rates between "next day" (76.4%, n=250) and "same day" (78.8%, n=326) ROLL protocols (p= NS). No significant difference was seen when levels of residual excision bed radioactivity and complete excision rates were compared (p=NS). Sentinel Lymph Node (SLN) localisation was successful in 97.6% of cases (n=205) with an SLN positivity rate of 12.7%. No significant difference was identified between SLN localisation rates for "next day" vs. "same day" SNOLL protocols (p=NS). The presence of microcalcification as the radiological abnormality (p=0.0005), underestimation of lesion size on pre-operative imaging (p=0.0005) and symptomatic referral (p=0.001) were factors that predisposed to incomplete excision margin status. Conclusions ROLL/SNOLL can be safely and effectively used to accurately localize impalpable breast lesions in agreement with current evidence. In addition to highly accurate localization, ROLL also has technical and logistical advantages that may make it more acceptable than WGL for clinicians and patients. Citation Format: Simon C Hawkins, Iain M Brown, Kirsten Stepp, Sue Widdison, Donna Christensen, Mohsen El-Gammal, Alistair Paterson, Philip Drew. Radioguided occult lesion localization (ROLL). A 12-year single institution experience of 942 ROLL excisions [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-05.

Cirugía guiada con radiotrazadores de lesiones de mama no palpables y del ganglio centinela

ObjectiveTo evaluate our experience with preoperative localization of non-palpable breast lesions (NPBL) with the injection of a radiotracer, or radioguided occult lesion localization technique, and with localization of NPBL and sentinel node (SN) with a single injection of radiotracer, or SN and occult lesion localization technique. Material and methodsWe included NPBL in which excision was indicated during the period from January 2001 to December 2011. The radiotracer was injected under stereotactic or ultrasound guidance. Scintigraphy was carried out in all patients before surgery. The surgeon in the operating room had a hand-held gamma probe to locate the lesions in the breast and in the axilla. Intraoperative pathological examination of the SN was done to avoid reinterventions if there were indications for axillary lymphadenectomy. ResultsWe included 881 patients: 226 benign lesions were localized in patients with indications for lumpectomy and 655 malignant lesions in patients scheduled for breast conserving treatment. The detection rate of NPBL was 99.4%. Reoperations were reduced to 7.4%. ConclusionIn our experience, radioguided surgery of NPBL with radioguided occult lesion localization-SN and occult lesion localization is a quick and simple technique that allows tumor excision with adequate surgical margins and optimal cosmetic results, as well as SN biopsy during the same operation.

Guiding Breast-Conserving Surgery in Patients After Neoadjuvant Systemic Therapy for Breast Cancer: A Comparison of Radioactive Seed Localization with the ROLL Technique

Radioguided occult lesion localization (ROLL) with technetium-99m colloid (ROLL-(99m)Tc) is commonly used to perform breast-conserving surgery in patients with nonpalpable breast tumors. Radioactive seed localization is a relatively new technique that localizes the tumor with a radioactive iodine-125 ((125)I) seed. The feasibility and outcome of these techniques after neoadjuvant systemic treatment has not been widely investigated. All patients treated with neoadjuvant systemic treatment between 2007 and 2010 in the Netherlands Cancer Institute who underwent breast-conserving surgery with the ROLL-(99m)Tc technique (n=83) or with (125)I seed localization (n=71) were analyzed. The weight of the resected specimen, the margins, and the percentage of patients requiring a second surgical intervention as a result of positive margins were assessed. Patient and tumor characteristics and systemic treatment regimens were comparable between both groups. The median weight of the resected specimen (53 vs. 48g), the median smallest margin (3.5 vs. 3.0mm), and the risk for additional surgery for incomplete resections (7 vs. 8%) did not differ significantly between patients treated with the ROLL-(99m)Tc technique and (125)I seed localization. The ROLL-(99m)Tc technique and (125)I seed localization demonstrate comparable results when used to perform breast-conserving surgery after neoadjuvant systemic treatment. Because (125)I seed localization does not require additional radiological localization shortly before surgery, it simplifies surgery scheduling. Therefore, we prefer (125)I seed localization to perform breast-conserving surgery after neoadjuvant systemic treatment.

Localización radioguiada de las lesiones ocultas de la mama

Imaging studies in mammary pathology now provide detection of clinically non palpable lesions whose study requires percutaneous biopsy. If histopathological study is insufficient, suspect or confirms malignancy, surgical resection is necessary. This procedure poses a challenge for the oncology surgeon who has at his/her disposal several techniques, the most widely used being spiral harpoon marking. Another alternative, in use for more than ten years, is ROLL (radio guided occult lesion localization) which not only serves as an adequate weapon to be used against non palpable lesions, but also provides advantages over other, resulting in lower resection volume and lower positive margin incidence. This article describes the ROLL technique used for the localization of non palpable breast lesions.