Original Research

Radioguided occult lesion localisation: A retrospective audit at a single tertiary academic breast unit

Sumaya Ismail, Francois Malherbe, Eugenio Panieri, Lydia Cairncross, Gaseeda Boltman, Florence E. Davidson
South African Journal of Oncology | Vol 7 | a233 | DOI: https://doi.org/10.4102/sajo.v7i0.233 | © 2023 Sumaya Ismail, Francois Malherbe, Eugenio Panieri, Lydia Cairncross, Gaseeda Boltman, Florence E. Davidson | This work is licensed under CC Attribution 4.0
Submitted: 07 March 2022 | Published: 22 February 2023

About the author(s)

Sumaya Ismail, Department of Medical Imaging and Therapeutic Sciences, Faculty Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
Francois Malherbe, Division of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Eugenio Panieri, Division of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Lydia Cairncross, Division of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Gaseeda Boltman, Nuclear Medicine Division, Groote Schuur Hospital, Cape Town, South Africa
Florence E. Davidson, Department of Medical Imaging and Therapeutic Sciences, Faculty Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa

Abstract

Background: The radioguided occult lesion localisation (ROLL) technique was introduced at Groote Schuur Hospital in 2003 replacing the wire-guided localisation (WGL) technique. In the case of preoperative histologically proven impalpable breast cancers, a sentinel lymph node (SLN) biopsy was done simultaneously (sentinel node [SN] with occult lesion localisation or SNOLL).

Aim: To assess the efficacy of the ROLL and SNOLL techniques for diagnostic and therapeutic excisions.

Setting: A retrospective record analysis of 190 patients who underwent a ROLL procedure for diagnostic or therapeutic excision of occult breast lesions was performed at a large tertiary hospital in the Western Cape.

Methods: Data were collected on patient and tumour characteristics, successful localisation rates, the volume of tissue removed, complete tumour resection rates, the number of re-operations performed and the proportion of SLN detection. The Pearson’s chi-squared test was used to test for significance between variables at α = 0.05.

Results: Correct radiopharmaceutical placement was achieved in 177/190 (93.2%) lesions. Histologic examination of excised specimens confirmed 115/190 (61.0%) malignant and 75/190 (39.0%) benign lesions. Involved margins were found in 37/115 (32.2%). Complete excision with adequate margins occurred in 50/70 (71.4%) of cases of invasive cancer and in 11/45 (24.4%) of ductal carcinoma in situ (DCIS). The SN was successfully identified in 30/37 (81.1%) of SNOLL cases.

Conclusion: Radioguided occult lesion localisation is an effective tool in the preoperative localisation of occult lesions for surgical biopsy as well as the removal of impalpable breast cancers. A single intratumoural injection with 99mTc nanocolloid combined with lymphoscintigraphy is a reliable method of localising the SN.

 


Keywords

nonpalpable breast lesion; radioguided surgery; radioguided occult lesion localisation; wire-guided localisation; WGL; sentinel node biopsy

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