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

Area of Science:

• Oncology
• Radiology
• Surgical Oncology

Background:

• Accurate axillary lymph node localization is critical for breast cancer management, especially after neoadjuvant chemotherapy (NACT).
• Existing localization methods present limitations in scheduling, patient comfort, and implantable device issues.
• Ultrasound-guided Radioguided Occult Lesion Localisation (ROLL) is a novel approach for axillary lymph node localization.

Purpose of the Study:

• To evaluate the effectiveness and feasibility of ultrasound-guided ROLL for axillary lymph node localization in breast cancer patients.
• To share the experience of implementing ROLL in a single tertiary care center.

Main Methods:

• A retrospective study included 41 suspicious axillary nodes from 30 patients undergoing ultrasound-guided ROLL between March 2020 and December 2024.
• Radioisotope was injected for localization, with post-injection scintigraphy and intra-operative localization confirming success.

Main Results:

• The technical success rate for ROLL was 95.1% (39/41 nodes).
• For patients who received NACT, mean lymph node size decreased from 2.1 cm to 1.2 cm.
• Challenges included localizing small, deep, or clipped/unclipped lymph nodes with limited sonographic visibility.

Conclusions:

• Ultrasound-guided ROLL is a highly effective method for localizing axillary lymph nodes, even those that are small, deep, or difficult to identify.
• The technique enhances patient comfort and offers logistical flexibility.
• High accuracy supports ROLL's significant role in targeted axillary dissection (TAD).