Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions

Rampaul, R.S.; Bagnall, Mark; Burrell, H.C.; Pinder, Sarah; Evans, Andrew; Macmillan, R. Douglas

doi:10.1002/bjs.4801

Cited by 129 publications

(99 citation statements)

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“…PEML'nın sayısının artması, bu lezyonların işaretlenmesinde güvenli, etkili, ideal bir yöntem arayışını gerekli kılmıştır (25). İdeal yöntem lezyonun tamamen çıkarıl-masını sağlayan ve gereksiz sağlam meme dokusu eksizyonunu en aza indiren bir yöntem olmalıdır (9,10,(28)(29)(30). PEML'nın lokalizasyonu için birkaç yöntem tanımlanmıştır.…”

Section: Tartışma Ve Sonuçlarunclassified

“…Yapılan çalışmaların çoğunda radyonüklid madde ile işaretlemenin güvenilir ve etkili olduğu kanıtlanmıştır (17,26,28,29,(35)(36)(37)(38)(39). Radyonüklid madde ile işaretlemede başarı oranları literatürde %92 ile %100 arasında değişmektedir (17,25,36,39,40).…”

Section: Tartışma Ve Sonuçlarunclassified

“…Literatürde ROLL ile işaretleme süreleri USG ile ortalama 6 dk, MG ile 10-14dk arasında bildirilmiştir (15,25,28,29). Bizim çalışmamız-da işaretleme süresi USG ile 16,5 dk, MG ile 21 dk olarak bulundu.…”

Section: Tartışma Ve Sonuçlarunclassified

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Total Excision Accompanied by Roll in Non-Palpable Breast Lesion

Sarı¹,

Hot²,

Bender³

et al. 2013

J Breasth Health

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Objective: The development and extensive use of methods of breast imaging has increased the diagnosis of non-palpable breast lesions (NPBL). Although several methods have been applied in the localization of NPBL throughout the world, the technique of wire-guided localization is used as a standard. The aim of this study is to present the results of ROLL (Radioguided occult lesion localization), which is a new technique in our clinic for localization of NPBL. Materials and Methods:We included 44 patients who had NPBL in the study. The lesions were localized preoperatively with TC-99m labelled human serum albumin. A gamma probe was used to determine the place of lesion and to guide the excisional biopsy. We assessed the duration of the localization, the excisional biopsy and hospital stay, the volume of the excised piece, the surgical margin in the malign facts, complication, cost calculation, and the comfort of the procedure from the points of view of the surgeon, radiologist and patient for every case. Anahtar sözcükler: Radyo-nüklid rehberliğinde okült lezyon lokalizasyonu, palpe edilemeyen meme lezyonları, meme kanseri

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Section: Tartışma Ve Sonuçlarunclassified

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Total Excision Accompanied by Roll in Non-Palpable Breast Lesion

Sarı¹,

Hot²,

Bender³

et al. 2013

J Breasth Health

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“…Most importantly, the resemblance of RSL and ROLL to the performance of SLNB which is a standard practice means that breast surgeons who have never performed either technique formally will still be familiar with the principles and possess the necessary skills to learn both techniques rapidly. Certainly studies comparing RSL and ROLL to WGL have suggested that surgeons favoured the radio-guided techniques over WGL in terms of ease of performance [17,46].…”

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confidence: 99%

“…It can be demonstrated from what has been presented from the published evidence that it is not possible to identify any differences in clinical outcomes including complications between ROLL and RSL to suggest the superiority of one over the other. Both techniques have proven to be competitively priced in comparison with WGL [7,10,11] and to have no significant learning curves for surgeons [7,8,17,46]. The single area where a difference can be identified currently is in terms of the flexibility and timing of RSL over ROLL.…”

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confidence: 99%

ROLL versus RSL: toss of a coin?

Ahmed

Douek

2013

Breast Cancer Res Treat

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The safety and benefits of radio-guided localization (RGL) versus wire-guided localization (WGL) surgery in the treatment of non-palpable breast cancers have been confirmed through several meta-analyses. RGL has become the standard of care in several institutions, although overall uptake has been slow. In view of this evidence supporting RGL, we believe that the future discussion is not of RGL versus WGL, but rather of what form of RGL will constitute best practice of care going forward. We therefore discuss the case for radio-guided occult lesion localization versus radioactive seed localization in the treatment of non-palpable breast cancers, is it really a toss of a coin?Keywords Wire-guided localization Á Radio-guided occult lesion localization Á ROLL Á Radioactive seed localization Á RSL Á Radio-guided localization Á Non-palpable breast cancer Non-palpable breast cancers constitute approximately onethird of all diagnosed breast cancers, [1] therefore creating a heavy burden upon health care systems. The current accepted standard of treatment for non-palpable breast cancers of wire-guided localization (WGL) has been increasingly challenged by radio-guided localization (RGL) techniques in the form of radio-guided occult lesion localization (ROLL) and radio-guided seed localization (RSL). In the four meta-analyses of RGL versus WGL, [2][3][4][5] three have demonstrated the superiority of RGL [2,4,5] with the remaining study demonstrating shorter operating times but also greater volume excisions for RGL [3]. However, the clinical relevance of this greater volume of excision remains questionable [6]. The two largest cohort series [7-9] each composed of approximately 1,000 patients supports the excellent outcomes achievable with RGL. The economical assessment has also demonstrated no disadvantage for RGL [7,[9][10][11]. In view of the mounting evidence supporting RGL, the question no longer remains that of the previous decade in terms of deciding between RGL and WGL, but rather the clinically relevant issue has now progressed to deciding between ROLL and RSL in the treatment of non-palpable breast cancers.Both techniques depend upon the presence of a skilled radiologist to perform either ultrasound or stereotactically guided localization, with the administration of between 0.2 and 0.5 mL of 99m Tc-radiolabelled albumin-based colloid for ROLL or a single 8 9 0.4 mm titanium seed radiolabelled with 125 I in RSL. Great variation exists in the radiation dose administered for ROLL, with the literature quoting anywhere between 5 and 123 MBq, [12,13] whilst for RSL it is between 3.7 and 10.7 MBq [14,15]. ROLL requires localization to be performed within 24 h of surgery due to the short 6 h half-life of 99m Tc-labelled colloid and RSL typically is performed 0-5 days prior to surgery [7,[14][15][16][17]. In the primary systemic therapy (PST) setting RSL can be undertaken several months before surgery because the half-life of 125 I is 60 days [18]. This flexibility in the timing of seed insertion provides a clear ...

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