Magnetic resonance imaging-radioguided occult lesion localization (ROLL) in breast cancer using Tc-99m macro-aggregated albumin and distilled water control

Abstract

BackgroundMagnetic resonance imaging (MRI) guided wire localization presents several challenges apart from the technical difficulties. An alternative to this conventional localization method using a wire is the radio-guided occult lesion localization (ROLL), more related to safe surgical margins and reductions in excision volume. The purpose of this study was to establish a safe and reliable magnetic resonance imaging-radioguided occult lesion localization (MRI-ROLL) technique and to report our initial experience with the localization of nonpalpable breast lesions only observed on MRI.MethodsSixteen women (mean age 53.2 years) with 17 occult breast lesions underwent radio-guided localization in a 1.5-T MR system using a grid-localizing system. All patients had a diagnostic MRI performed prior to the procedure. An intralesional injection of Technetium-99m macro-aggregated albumin followed by distilled water was performed. After the procedure, scintigraphy was obtained. Surgical resection was performed with the help of a gamma detector probe. The lesion histopathology and imaging concordance; the procedure’s positive predictive value (PPV), duration time, complications, and accuracy; and the rate of exactly excised lesions evaluated with MRI six months after the surgery were assessed.ResultsOne lesion in one patient had to be excluded because the radioactive substance came back after the injection, requiring a wire placement. Of the remaining cases, there were four malignant lesions, nine benign lesions, and three high-risk lesions. Surgical histopathology and imaging findings were considered concordant in all benign and high-risk cases. The PPV of MRI-ROLL was greater if the indication for the initial MR examination was active breast cancer. The median procedure duration time was 26 minutes, and all included procedures were defined as accurate. The exact and complete lesion removal was confirmed in all (100%) patients who underwent six-month postoperative MRI (50%).ConclusionsMRI-ROLL offers a precise, technically feasible, safe, and rapid means for performing preoperative MRI localizations in the breast.

Magnetic resonance imaging-guided occult breast lesion localization and simultaneous sentinel lymph node mapping

“…Pereira and colleagues [ 19 ] also described a technique that successfully marked suspicious NPLs with technetium, but we did not need to use a titanium needle to inject the radio-pharmaceuticals. We developed this new low-cost alternative at a time when there was no access in Brazil to titanium needles.…”

Localization Techniques for Non-Palpable Breast Lesions: Current Status, Knowledge Gaps, and Rationale for the MELODY Study (EUBREAST-4/iBRA-NET, NCT 05559411)

“…In two RCTs comparing costs, ROLL (mean cost: EUR 182) was found to be slightly more expensive than WGL (mean cost: EUR 163) [10]. The technique is MRI compatible: It does not cause MRI artifacts and allows localization of lesions observed only on MRI [55]. Localization failures are rare [9].…”

Recent Progress for the Techniques of MRI-Guided Breast Interventions and their applications on Surgical Strategy

“…These new technologies can relieve the pressures of the number of same-day requests for diagnostic localization or biopsy of breast imaging centers, as well as increase patients' convenience and comfort. However, these newer techniques cannot be placed under MRI guidance, and to date only wire localizations can be performed under MRI guidance [75][76][77][78][79][80][81].…”