Radioguided localisation of non-palpable lesions of the breast in Costa Rica: Review of results of our first 800 patients in private practice

Abstract

BackgroundSurgical treatment of non-palpable breast lesions is controversial. At the European Institute of Oncology in Milan, Italy, Prof Umberto Veronesi introduced a new technique called the radioguided occult lesion localisation (ROLL) in 1996 to replace conventional methods and their disadvantages (Zurrida S, Galimberti V, and Monti S et al (1998) Radioguided localization of occult breast lesions Breast 7 11–13 https://doi.org/10.1016/S0960-9776(98)90044-3). Given the success experienced in that institution, the method became the technique of choice for the early diagnosis of breast cancer. In this paper, we will examine the technical aspects of ROLL and the results from a large series of patients treated in our private practice in Costa Rica.MethodsWe analysed the first 816 patients with different non-palpable breast lesions detected by ultrasound or mammography within our private practice in Costa Rica. In 774 patients, technetium 99m labelled with human serum albumin (7–10 MBq) in 0.2 ml of saline solution was injected into the lesion under mammographic or ultrasound guidance. The excisional biopsy was done by means of a gamma-probe and complete excision of the lesion was verified by X-ray on the specimen in lesions that were visible by mammography and ultrasound 4 months after surgery. In the remaining 42 patients, the localisation of the lesion was carried out by wire.ResultsThe tracer was correctly positioned in the first attempt in 772/816 (94.6%) of cases and in the second attempt in two other cases. In 42/816 (5.1%) cases, the localisation of the lesion had to be performed with the traditional method. X-rays showed that the lesion was entirely removed in 770/772 (99.74%) of cases.ConclusionThe ROLL is a simple and excellent option for the removal of hidden breast lesions in clinical practice. It offers the advantage of making resections safer and with tumour-free margins, in addition to reducing the number of reinterventions. Since it makes it possible to specify to the pathologist the exact site where the lesion is located, we can guarantee a better diagnosis. The rate of success with the use of this technique corresponds to the available scientific data, so we conclude that it is a procedure that we can routinely perform in private practice in Costa Rica.

Intraoperative sonography for nonpalpable breast lesions: Additional indications for a consolidate technique

“…Initial studies evaluating ROLL suggested its superiority to wire localization and the large experience reported by the European Institute of Oncology in Milan supported its role in breast surgery . However, recently, Aguilar et al analyzed 816 patients with nonpalpable breast lesions undergoing ROLL, but in 42/816 (5.1%) it was not successful because of the following reasons: The radiotracer was not injected sufficiently close to the lesion (n = 22), the radiotracer was administered inside the ducts or in a lymphatic vessel, diffusing in the breast (n = 20), the scintigraphy revealed no radioactivity, and the procedure had to be repeated (n = 2); in particular, because of radiopharmaceutical spreading and subsequent larger excised tissue volume, subcutaneous and intraductal lesions were not “recommended” for ROLL: Our experience regarding mainly ductal/intraductal breast carcinomas permits to state that IUSS technique can be preferred in such cases, overcoming these ROLL limitations and establishing additional indications for IUSS in breast surgery. Namely, since ROLL technique is performed using radiopharmaceutical administration, IUSS approach can be preferred when ROLL is contraindicated or when patients refuse to undergo wire/tag/seed placement.…”

Útilidad de la ecografía intraoperatoria en la exéresis de las lesiones no palpables de la mama. Experiencia y revisión de conjunto

“…Los inconvenientes que presenta y que pueden condicionar fallos en la técnica son: lesiones menores de 5 mm, lesiones localizadas en el cuadrante central de la mama, que el radiotrazador pueda difundirse cuando éste se inyecta dentro de los ductos o en los vasos linfáticos, dificultando la exéresis de la lesión. Otros inconvenientes son la contaminación de la piel (0,5%) y del trayecto de la aguja (19%) [20][21] .…”