Radioguided localisation of non-palpable breast lesions and simultaneous sentinel lymph node mapping

The authors report their experience with a new strategy for radioguided breast surgery that combines radioguided occult lesion localisation (ROLL) and sentinel lymph node (SLN) mapping. The study population comprised 38 women with non-palpable breast lesions suspicious for breast cancer (BI-RADS 4-5). On the day before surgery, 0.2 ml solution containing particles of dextran labelled with approximately 15 MBq of technetium-99m was injected under stereotaxic guidance by mammography. All patients underwent open surgical biopsy guided by gamma probe, radiographic control of the surgical specimen and frozen section analysis. The rate of confirmation of lesion removal was 100% and the rate of simultaneous SLN mapping was 97.3% (37/38). Eleven cases of infiltrating carcinoma and eight of ductal carcinoma in situ (DCIS) were diagnosed intraoperatively. In the first eight invasive lesions, the SLN was biopsied and complete axillary lymph node dissection was performed; in the three other invasive lesions and in two aggressive cases of DCIS, only the SLN was dissected. The intraoperative results of SLN analysis and the definitive histopathological examinations of the SLN were always negative. It is concluded that ROLL and SLN can be employed simultaneously when dextran is used as a tracer; this technique allows frozen section diagnosis and intra-operative node analysis, and has many advantages over the conventional two-step procedure.