Radio guided occult lesion localization (ROLL) for non-palpable invasive breast cancer

Background: Wire guided localization (WGL) for non-palpable breast cancer is technically difficult and patient unfriendly. Radio guided occult lesion localization (ROLL) takes advantage of the possibility to detect the tumor through the nuclear tracer that is injected directly into the tumor for the sentinel node procedure. Methods: Forty patients with 41 invasive breast carcinomas were treated using ROLL. Patients received a dose of 120Mbq 99mTc Nanocolloid intra-tumorally on the day of surgery or a dose of 370Mbq 99mTc Nanocolloïd intra-tumorally the prior day. The sentinel node (SN) was located using patent blue and a gamma ray detection probe that was also employed to guide the tumor excision. Results: In 31 patients (78%) the invasive tumor was adequately excised. In two cases (5%) a re-excision was required due to inadequately excised carcinoma in situ and in three patients (7.5%) both the invasive and the in situ tumor were inadequately excised. In 35 patients (88%) the SN was found and removed. Conclusions: The ROLL procedure seems to be an alternative to WGL in patients with non-palpable breast carcinoma. To determine the place of ROLL versus WGL in the treatment of non-palpable breast cancer, a randomized clinical trial is needed.