Lavoué Vincent, Nos Claude, Clough Krishna B, Baghaie Forouhar, Zerbib Eric, Poulet Bruno, Lefrère Belda Marie-Aude, Ducellier Anne, Lecuru Fabrice
Department of Gynecologic and Oncologic Surgery, Hôpital Européen Georges Pompidou, 12 Rue Leblanc, 75015, Paris, France.
Ann Surg Oncol. 2008 Sep;15(9):2556-61. doi: 10.1245/s10434-008-9994-y. Epub 2008 Jun 24.
Radioguided occult lesion localization (ROLL) is a new technique to detect nonpalpable breast tumors. We report our experience using injection of a single radiotracer to localize occult lesions together with sentinel lymph node (SLN) biopsy (SNOLL). The aim of this series was to evaluate the feasibility of the technique, its efficacy, and the rate of reoperation.
Under sonographic guidance, a nanocolloidal tracer was injected peritumorally above and below the lesion. A handheld gamma probe detector was used to locate and to guide its surgical removal. An intraoperative (IO) macroscopic examination of the specimen with margins evaluation and IO imprint cytology of SLN was always performed.
The targeted lesion was localized and removed in all cases. Final pathological diagnosis identified invasive in 70 patients and ductal carcinoma in situ (DCIS) in 2 patients. The average size of the resected lesion was 11 mm (4-50 mm). In 61 out of the 72 patients (85%), the breast specimen had clear and large margins. Sentinel lymph node (SLN) biopsy was performed in 70 patients with an identification rate of 90%. Final pathological SLN metastasis rate approached 25% (pN1 14%, pN1(mi) 11%). Despite intraoperative examination of the specimen, a total of 29% (21 out of 72) patients had to be reoperated (8 patients for involved margins, 10 patients for an involved SLN, and 3 for both).
This technique with a single nanocolloid tracer used both for ROLL and SLN detection is reliable for removing nonpalpable lesions. The use of this technique may have implications for further reducing reoperation rates.
放射性引导隐匿性病变定位（ROLL）是一种检测不可触及乳腺肿瘤的新技术。我们报告了使用单一放射性示踪剂注射来定位隐匿性病变并同时进行前哨淋巴结（SLN）活检（SNOLL）的经验。本系列研究的目的是评估该技术的可行性、有效性及再次手术率。
在超声引导下，于病变上下方瘤周注射纳米胶体示踪剂。使用手持式γ探头探测器定位并引导手术切除。术中始终对标本进行大体检查并评估切缘，同时对前哨淋巴结进行术中印片细胞学检查。
所有病例中目标病变均被定位并切除。最终病理诊断显示70例为浸润性癌，2例为导管原位癌（DCIS）。切除病变的平均大小为11毫米（4 - 50毫米）。72例患者中有61例（85%）乳腺标本切缘清晰且宽大。70例患者进行了前哨淋巴结活检，识别率为90%。最终病理前哨淋巴结转移率接近25%（pN1为14%，pN1(mi)为11%）。尽管术中对标本进行了检查，但共有29%（72例中的21例）患者需要再次手术（8例因切缘受累，10例因前哨淋巴结受累，3例两者均受累）。
这种使用单一纳米胶体示踪剂同时用于ROLL和SLN检测的技术对于切除不可触及病变是可靠的。该技术的应用可能对进一步降低再次手术率有意义。
