Randomized controlled clinical trial comparing radioguided occult lesion localization with wire-guided lesion localization to evaluate their efficacy and accuracy in the localization of nonpalpable breast lesions.

PURPOSE: The aim of this study was to compare the radioguided occult lesion localization (ROLL) technique with the wire-guided lesion localization (WGLL) technique to assess their efficacy and accuracy in the localization of nonpalpable breast lesions in patients at a unique reference medical center. These patients' reports were negative for malignancy but included highly suspicious imaging findings. METHODS: A controlled clinical trial was designed to compare the WGLL and ROLL techniques in women presenting with breast lesions diagnosed by mammography or ultrasonography at the Instituto Nacional de Cancerología in Bogotá, Colombia, from March 2006 to June 2011. RESULTS: This study examined 129 patients; 64 (49.6%) patients were treated with ROLL, and 65 (51.4%) were treated with WGLL. The ROLL technique achieved better median lesion centricity (ROLL = 11.7 and WGLL = 15.4; P = .038). No significant differences were found regarding demographic variables, operative specimen characteristics, the need to extend margins, operative complications, the degree of difficulty, or patient or surgeon satisfaction. CONCLUSION: The ROLL technique is as effective as WGLL for the localization of nonpalpable breast lesions. In our study, ROLL achieved better lesion centricity. Therefore, we propose that this technique could be used as a standard procedure in the detection of nonpalpable breast lesions at experienced centers.

Localización radioguiada de las lesiones ocultas de la mama / Roll for non palpable breast lesions

Los estudios de imágenes en patología mamaria han permitido detectar lesiones que clínicamente no son palpables y que requieren estudio con biopsia percutánea. Si el informe del estudio histopatológico es insuficiente, sospechoso o confirmatorio de malignidad, es necesario recurrir a su resección quirúrgica. Este procedimiento plantea un reto para el cirujano oncólogo, quien dispone de varias técnicas, dentro de las cuales la más utilizada es la marcación por arpón. Otra alternativa utilizada desde hace más de diez años es la Técnica de ROLL (por sus siglas del inglés radioguided occult lesion localization), que además de ser un arma adecuada para enfrentar a las pacientes con lesiones no palpables, ofrece ventajas como menores volúmenes de resección y baja incidencia de márgenes positivos. El presente artículo describe la técnica de ROLL para la localización de lesiones no palpables de la mama.

Imaging studies in mammary pathology now provide detection of clinically non palpable lesions whose study requires percutaneous biopsy. If histopathological study is insufficient, suspect or confirms malignancy, surgical resection is necessary. This procedure poses a challenge for the oncology surgeon who has at his/her disposal several techniques, the most widely used being spiral harpoon marking. Another alternative, in use for more than ten years, is ROLL (radio guided occult lesion localization) which not only serves as an adequate weapon to be used against non palpable lesions, but also provides advantages over other, resulting in lower resection volume and lower positive margin incidence. This article describes the ROLL technique used for the localization of non palpable breast lesions.

Resección de recaídas de cáncer diferenciado de tiroides mediante cirugía radioguiada / Resection for recurrent differentiated thyroid cancer with radioguided surgery

Durante el seguimiento a los pacientes con cáncer diferenciado de tiroides se pueden encontrar recaídas en el cuello entre el 10% y el 60% de los casos. Durante el seguimiento se hace obligatoria la detección de enfermedad en dicha localización. Consecuentemente, se hace búsqueda estricta con ecografías de alta resolución, las cuales son las que más a menudo detectan tempranamente nodos linfáticos metastásicos de escasos milímetros. Cuando tales nódulos están presentes, se realizan disecciones de cuello, pero con cirugía previa se dificulta mucho su extirpación, por la fibrosis y las adherencias. Con el fin de facilitar estos procedimientos se ha planteado el uso de la técnica ROLL (radioguided occult lesion localization) para resecar de forma precisa y segura estos ganglios enfermos. Recientemente, se usó dicha técnica por primera vez en Colombia, y en el Instituto Nacional de Cancerología (INC), hasta donde el equipo a cargo del presente trabajo tiene conocimiento, para intervenir a una paciente con recaída en el cuello por cáncer papilar de tiroides.

During follow up of patients with differentiated thyroid cancer it is possible to find recurrence in the neck in 10% to 60% of cases. During follow up it is requisite to seek out the disease in said location. Consequently, a rigorous search is made with high resolution sonogram, which can most frequently detect early lymphatic node metastasis of scant length in millimeters. If such nodes are detected, neck dissections are performed; but where surgery has previously been carried out, extirpation is difficult due to adherence and fibrosis. In order to facilitate these procedures, the ROLL technique (radio-guided-occult-lesion-localization) is recommended as a means for achieving precise and safe resection of these diseased ganglia. This technique was recently put to use for the first time in Colombia at the National Cancer Institute (NCI) by the authors of this paper whose knowledge of the technique allowed them to perform surgery on a patient with papillary thyroid cancer recurrence in the neck.