Development of sentinel node localization and ROLL in breast cancer in Europe

Abstract

The concept of a precise region in which to find the lymph nodes that drain the lymph directly from the primary tumor site can be traced back to a century ago to the observations of Jamieson and Dobson who described how cancer cells spread from cancer of the stomach in a single lymph node, which they called the â\u80\u9cprimary glandâ\u80\u9d. However, Cabanas was the first in 1977 to realize the importance of this concept in clinical studies following lymphography performed in patients with penile cancer. Thanks to Mortonâ\u80\u99s studies on melanoma in 1992, we began to understand the potential impact of the sentinel lymph node (SN) on the surgical treatment of this type of cancer. The use of a vital dye (blue dye) administered subdermally in the region surrounding the melanoma lesion led to the identification of the sentinel node, and the vital dye technique was subsequently applied to other types of solid tumors, e.g. breast, vulva. However, difficulties in using this technique in anatomical regions with deep lymphatic vessels, e.g. axilla, led to the development of lymphoscintigraphy, started by Alex and Krag in 1993 on melanoma and breast cancer and optimized by our group at European Institute of Oncology (IEO) in Milan in 1996. Today, lymphoscintigraphy is still considered as the most reliable method for the detection of the SN. In 1996, a new method for the localization of non-palpable breast lesion called radioguided occult lesion localization (ROLL) was also developed at IEO. Retrospective and prospective studies have since shown that the ROLL procedure permits the easy and accurate surgical removal of non-palpable breast lesions, overcoming the limitations of previous techniques such as the wire-guided localization. The purpose of this paper is to describe the evolution of SN biopsy and radioguided surgery in the management of breast cancer. We also include a review of the literature on the clinical scenarios in which SN biopsy in breast cancer is currently used, with particular reference to controversies and future prospects

Sentinel Node Imaging and Radioguided Surgery in the Era of SPECT/CT and PET/CT

“…4 A second approach targets the resection of primary tumors or metastases with the use of direct intralesional administration of a radiotracer with relatively large particle size facilitating retention at the injection site and subsequently the resection of the lesion following a procedure known as ROLL ("radioguided occult lesion localization"). 5 In recent years, radioactive 125 I seeds have been introduced as an alternative for intralesional tracer injection principally in patients receiving neoadjuvant treatment. This approach is known as RSL ("radioguided seed localization").…”

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

“…This study used particle sizes in the region of 100 nm -600 nm because large colloid particle sizes of more than 100 nm do not drain easily and stay at the injection site. 19 In this study, ultrasound and stereotactic imaging alone were relied on to confirm accurate needle placement, unlike several other studies where radio-opaque contrast was administered at the time of injection to assess the accurate placement of the injection with mammography. 20,21,22,23…”