Use of 125iodine seeds (ROLLIS) for intra-operative localization of nonpalpable breast lesions: analysis of the implant of 338 seeds in 284 patients

Abstract

To analyze the feasibility, efficacy and results of the use of 125Iodine seeds for intra-operative localization of nonpalpable breast lesions. Method: Retrospective review of 284 patients, referred by various breast specialist surgeons, with radiologically detected but clinically nonpalpable microcalcifications or nodules, submitted to pre-operatory 125Iodine seed implant, between July 2012 and September 2016. A total of 338 seeds were implanted in ordinary radiologic departments, supported by ultrasonography or mammography exams, chosen according to the morphologic aspect of the lesion. Radioguided surgical procedure took place on the same day or few days after the implant of the seeds, with the help of a radiation detector called Gamaprobe, which directs the surgeons towards the radioactive seeds and to the lesion to be resected. Results: All implants were performed as outpatient procedures, with patients immediately returning to their daily activities. No complications such as pain, bleeding, infeccion and haematoma were recorded. Pathologists had no difficulty in preparing the surgical specimens for histopathologic analysis. Surgical safety margins were considered adequate in all pathologic reports, with no need for re-operations. The healing process was not jeopardized by radiation, and the surgeons were pleased with the improvement on intraoperative lesions localizations and shortening on operatory time. Cosmetic results were well accepted by the patients. Conclusion: The 125Iodine seed implant is an effective alternative method for intraoperative localization of radiologically detectable and clinically nonpalpable breast lesions.

Iodine‐125 seed versus hook‐wire guided breast conserving surgery: do post operative complication rates differ?

“…Several other studies have looked at the differences in terms of other outcomes between the two techniques. Most have reported favourable outcomes for ROLLIS in terms of reduced excision margins required, reduced re‐excision rates and better cosmetic outcomes 6,11,12 With the introduction of ROLLIS, some centres have also reported more efficient utilization of radiology resources. Sharek et al 2 .…”

“…Several other studies have looked at the differences in terms of other outcomes between the two techniques. Most have reported favourable outcomes for ROLLIS in terms of reduced excision margins required, reduced re-excision rates and better cosmetic outcomes 6,11,12 With the introduction of ROLLIS, some centres have also reported more efficient utilization of radiology resources. Sharek et al 2 reported that patients had reduced wait times for percutaneous breast biopsies by 3.4 days (45% improvement) as the seeds can be placed in any interventional appointment, thus freeing up timeslots which would have been allocated to hook-wire placements.…”

Radioactive Seed Localization for Nonpalpable Breast Lesions: Systematic Review and Meta-Analysis

“…The ROLL technique consists of the use of a radiotracer, where about 0.2 to 0.5 mL of 99m-technetium-labeled colloidal albumin ( 99m Tc-MAA) is injected directly into the breast [9], under ultrasound or stereotactic mammography guidance. As technetium is a gamma-type radiation emitter [11], a gamma detector device is needed to identify the marker during surgery [12]. It is possible to perform ROLL in conjunction with sentinel lymph node biopsy (SLNB) using the same radioactive tracer.…”

“…After the procedure, mammography is performed to confirm the seed location [14]. The use of a gamma detector device, such as a gamma probe, is necessary during surgery to identify the seed location [12][13][14].…”

“…Iodine-125 has a half-life of approximately 60 days [11], emitting gamma radiation with an average energy of 29 KeV [9], and the activity per seed is between 2 and 13 MBq [15]. Thus, the iodine-125's physical characteristics permit the surgery to be performed within 2 months, on average, after implantation [12]. In addition, seed insertion can be performed before the initiation of neoadjuvant chemotherapy, and patients can avoid a new procedure the day of the surgery [19,20].…”