ROLL Is Successful at Localising Axillary Lymph Nodes: A Single Tertiary Centre Experience

In breast malignancy, localisation of axillary nodes is crucial for guiding targeted axillary dissection (TAD), particularly following neoadjuvant chemotherapy (NACT). While many localisation techniques exist, many have limitations with flexibility in scheduling, patient discomfort or issues with implantables (e.g., radioactive seeds, radar reflectors or magnetic markers). Ultrasound-guided Radioguided Occult Lesion Localisation (ROLL) was originally used for non-palpable breast lesions and relatively new in localisation of axillary lymph nodes. The authors aim to share the experience of ROLL in this single tertiary centre.

From March 2020 to December 2024, 41 suspicious axillary nodes from 30 patients who underwent ultrasound guided ROLL were included in this study.

The technical success rate was 95.1% (39/41 nodes) as confirmed by the appreciation of radioisotope in post-injection scintigraphy and subsequent intra-operative localisation. Among 21 patients (26 nodes) who underwent NACT, the mean size of lymph node pre- and post-NACT was 2.1 cm (1.0-4.3 cm) and 1.2 cm (0.7-3.2 cm), respectively. The distance from lymph node to skin was 1.5 cm (0.8-2.5 cm). The primary pathology was breast cancer in 26 patients (33 nodes). A tissue marker clip was inserted into 27 (65.9%) lymph nodes. Main technical challenges include small or deep lymph nodes and those that are either unclipped or marked with clips demonstrating limited sonographic visibility.

Ultrasound-guided ROLL is an effective method for localising axillary lymph nodes, including small, deep or clipped/unclipped nodes that are challenging to identify. This technique offers improved patient comfort and logistical flexibility, and its high accuracy provides a strong argument for its role in TAD.