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Nonpalpable breast lesions: preoperative radiological guidance in radioguided occult lesion localisation (ROLL)

Lesioni mammarie non palpabili: la guida radiologica preoperatoria nella ROLL (radioguided occult lesion localisation)

  • Breast Radiology / Senologia
  • Published:
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Abstract

Purpose

This study evaluated the methods, technical aspects and impact of preoperative radiological guidance in radioguided occult lesion localisation (ROLL) for single nonpalpable breast lesions.

Materials and methods

A total of 288 patients underwent ROLL before surgery. Human serum albumin macroaggregates labelled with 3.7–7.4 MBq of technetium99 were injected into the lesion. In the case of ultrasonographic guidance (221/288 patients), inoculum positioning resulted in a change of echogenicity at the lesion site. In the case of mammographic guidance (67/288 patients), iodinated contrast medium was injected following the radiotracer for subsequent mammographic evaluation. Patients underwent surgery within 24 h from ROLL. A gamma-detecting probe was used to locate the lesion during surgery and guide its removal. After excision, the specimen was examined by either ultrasonography or mammography to verify complete lesion removal before histological evaluation.

Results

The lesion was correctly localised in 281/288 patients (97.5%). One ROLL procedure failed because surgery could not be performed within 24 h and the radioactivity decayed. Of the six incorrect localisations, 2 were due to the radiological guidance and 4 to technetium99 dispersion.

Conclusions

Radiological guidance in ROLL ensured the outcome of the procedure of localisation and removal of single, nonpalpable breast lesions in the majority of cases.

Riassunto

Obiettivo

Scopo del presente lavoro è stato quello di valutare metodi, aspetti tecnici ed impatto della guida radiologica preoperatoria nella radioguided occult lesion localisation (ROLL) per lesioni mammarie singole non palpabili.

Materiali e metodi

Duecentottantotto pazienti sono state sottoposte a ROLL prima dell’intervento. All’interno della lesione sono stati iniettati macro-aggregati di albumina umana marcata con tecnezio99; nel caso di guida ecografica (221/288 soggetti), l’inoculo ha prodotto iperecogenicità in corrispondenza della lesione; nel caso di guida mammografica (67/288 soggetti), dopo il radiotracciante è stato inoculato mezzo di contrasto iodato per il successivo controllo mammografico. Le pazienti sono state sottoposte ad intervento chirurgico entro 24 ore dalla ROLL. Per localizzare la lesione e guidarne la rimozione chirurgica, è stata utilizzata una sonda per la rilevazione dei raggi gamma. Dopo l’escissione, il pezzo operatorio è stato esaminato con ecografia o mammografia per verificare la completa rimozione della lesione.

Risultati

La lesione è stata localizzata correttamente in 281/288 pazienti (97,5%). Una ROLL non ha avuto successo poiché non è stato possibile effettuare l’intervento chirurgico entro 24 ore. Delle 6 localizzazioni non riuscite, 2 sono da mettere in relazione alla guida radiologica e 4 alla dispersione del tecnezio99.

Conclusioni

La guida radiologica nella ROLL ha garantito l’esito della localizzazione e rimozione di lesioni mammarie singole non palpabili nella maggioranza dei casi.

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Belloni, E., Canevari, C., Panizza, P. et al. Nonpalpable breast lesions: preoperative radiological guidance in radioguided occult lesion localisation (ROLL). Radiol med 116, 564–574 (2011). https://doi.org/10.1007/s11547-011-0654-0

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  • DOI: https://doi.org/10.1007/s11547-011-0654-0

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