Assessment of Ultrasound / Radio-guided Occult Lesion Localization in Non-palpable Breast Lesions

Document Type : Original Article


1 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Endoscopic and minimally invasive surgery research center, Mashhad University of Medical Sciences, Mashhad, Iran


Objective(s): Controversy exists about the localization of non-palpable breast lesions. In many countries, the gold standard for the diagnosis of these lesions is needle localization due to its accuracy. This study sought to compare the ultrasoundand radio-guided occult lesion localization (ROLL) as a simple method with the conventional procedures in terms of their diagnostic power. Methods: This study was conducted on 94 patients with non-palpable breast lesions detected by ultrasonography and localized by the combination of ultrasonography and using radiopharmaceuticals. One to ten hours prior to surgery, 0.1-0.2 ml (equivalent to 0.5-1 mCi) of Tc-99m-phytate was injected to the lesion under the guidance of ultrasonography. Then, the lesion was localized using a hand-held gamma probe, and excision of the lesion was performed according to its radioactivity signal. Data analysis was performed using SPSS, version 16. Results: Benign and malignant pathologic results were observed in 77 (81.9%) and 17(18.1%) of the patients, respectively, and the mean volume of the excised tissue was 26.29±27 mm³. 79 patients had a solitary lesion (84%), 55 in the left breast (58.5%) and 39 in superolateral quadrant (41.5%). The mean size of the lesions was 15.7 mm in diameter (ranging from 4 to 34 mm). Additionally, there was a need to secondary surgery in 3 (3.2%) patients and inappropriate localization in 6 (6.4%) patients (subcutaneous or intra-ductal spread of radiodrug). Conclusion: Combination of ultrasound- and radio-guided localization methods for localizing non-palpable breast lesions is a simple and acceptable method for localization with no significant complications. For radio-drug spread and subsequent excessive excised tissue volume, subcutaneous and intra-ductal lesions are not suitable indication for ROLL.


Main Subjects


    1. Ocal K, Dag A, Turkmenoglu O, Gunay EC, Yucel E, Duce MN. Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial. Clinics (Sao Paulo). 2011;66(6):1003-7.
    2. Dodd GD, Fry K, Delany W. Preoperative localization of occult carcinoma in the breast. In: Nealon TF, editor. Management of the patient with cancer. Philadelphia: Saunders Co; 1966. P. 183.
    3. Czarnecki DJ, Feider HK, Splittgerber GF. Toluidine blue dye as a breast localization marker. AJR Am J Roentgenol. 1989;153:261-3.
    4. della Rovere GQ, Benson JR, Morgan M, Warren R, Patel A. Localization of impalpable breast lesions-a surgical approach. Eur J Surg Oncol. 1996;22(5):478-82.
    5. Jakub JW, Gray RJ, Degnim AC, Boughey JC, Gardner M, Cox CE. Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg. 2010;199(4):522-8.
    6. Sajid MS, Parampalli U, Haider Z, Bonomi R. Comparison of radioguided occult lesion localization (ROLL) and wire localization for non-palpable breast cancers: a meta-analysis. J Surg Oncol. 2012;105(8):852-8.
    7. Medina-Franco H, Abarca-Pérez L, Garcí􀆴a-Alvarez MN, Ulloa-Gómez JL, Romero-Trejo C, Sepúlveda- Méndez J. Radioguided occult lesion localization (ROLL) VERSUS wire guided lumpectomy for Non palpable breast lesion: a randomized prospective evaluation. J Surg Oncol. 2008;97(2):108-11.
    8. Luini A, Zurrida S, Galimberti V, Paganelli G. Radioguided surgery of occult breast lesions. Eur J Cancer. 1998;34(1):204-5.
    9. Luini A, Zurrida S, Paganelli G, Galimberti V, Sacchini V, Monti S, et al. Comparison of radioguided excision with wire localization of occult breast lesions. Br J Surg. 1999;86(4):522-5.
    10. Lovrics PJ, Cornacchi SD, Farrokhyar F, Garnett A, Chen V, Franic S, et al. The relationship between surgical factors and margin status after breast conservation surgery for early stage breast cancer. Am J Surg. 2008;197(6):740-6.
    11. Takács T, Paszt A, Simonka Z, Á􀆵 brahám S, Borda B, Ottlakán A, et al. Radioguided occult lesion localization versus wire guided lumpectomy in the treatment of non-palpable breast lesions. Pathol Oncol Res. 2013;19(2):267-73.
    12. Aydogan F, Ozben V, Celik V, Uras C, Tahan G, Gazioglu E, et al. Radioguided occult lesion localization (ROLL) for non-palpalable invasive breast cancer: a comparison between day-before and same-day protocols. Breast. 2010;19(3):226-30.
    13. Thind CR, Desmond S, Harris O, Nadeem R, Chagla LS, Audisio RA, et al. Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience. Clin Radiol. 2005;60(6):681-6.
    14. Nadeem R, Chagla LS, Harris O, Desmond S, Thind R, Titterrell C, et al. Occult breast lesions: a comparison between radioguided occult lesion localization (ROLL) vs. wire-guided lumpectomy (WGL). Breast. 2005;14(4):283-9.
    15. Bronstein AD, Kilcoyne RF, Moe RE. Complications of the needle localization of foreign bodies and nonpalpable breast lesions. Arch Surg. 1998;123(6):775-9.
    16. Mariscal Martinez AN, Sola M, Tudela AP, Julian JF, Fraile M, Vizcaya S, et al. Radioguided localization of Non palpable Breast cancer lesions: randomized comparison with wire localization in patients undergoing conservative surgery and sentinel node biopsy. Am J Roentgenol. 2009;193(4):1001-9.
    17. Rampul RS, MacMilan RD, Evans AJ. Intra-ductal of the breast: a potential pitfall of radioisotope occult lesion localization. Br J Radiol. 2003;76(906):425-6.
    18. Patel A, Pain SJ, Britton P, Sinnatamby R, Warren R, Bobrow L, et al. Radioguided occult lesion localization (ROLL) and sentinel node biopsy for impalpable invasive breast cancer. Eur J Surg Oncol. 2004;30(9):918-23.
    19. Kopans DB, Meyer JE. Versatile spring hookwire breast lesion localizer. AJR Am J Roentgenol. 1980;135(3):184-7.
    20. Lavoue V, Nos C, Clough KB, Baghaie F, Zerbib E, Poulet B, et al. Simplified technique of radioguided occult lesion localization (ROLL) plus sentinel lymph node biopsy (SNOLL) in breast carcinoma. Ann Surg Oncol. 2008;15(9):2556-61.
    21. Monti S, Galimberti V, Trifiro G, De Cicco C, Peradze N, Brenelli F, et al. Occult lesion localization plus sentinel node biopsy (SNOLL): experience with 959 patients at the European Institute of Oncology. Ann Surg Oncol. 2007;14(10):2928-31.
    22. Chu TY, Lui CY, Hung WK, Kei SK, Choi CL, Lam HS. Localization of occult breast lesions: A comparative analysis of hookwire and radioguided procedures. Hong Kong Med J. 2010;16(5):367-72.
    23. Moreno M, Wiltgen JE, Bodanese B, Schmitt RL, Gutfilen B, da Fonseca LM. Radioguided breast surgery for occult lesion localization - correlation between two methods. J Exp Clin Cancer Res. 2008;27:29.
    24. Audisio RA, Nadeem R, Harris O, Desmond S, Thind R, Chagla LS. Radioguided occult lesin localization (ROLL) is available in the UK for impalpable breast lesions. Ann R Coll Surg Engl. 2005;87(2):92-5.
    25. Van der Ploeg IM, Hobbelink M, Van Den Bosch MA. Radioguided occult lesion localization (ROLL) for non-palpable breast lesions, a review of the relevant literature. Eur J Sur Oncol. 2008;34(1):1-5.
    26. Rönkä R, Krogerus L, Leppänen E, von Smitten K, Leidenius M. Radio-guided occult lesion localization in patients undergoing breast conserving surgery and sentinel node biopsy. Am J Surg. 2004;187(4):491-6.
    27. Zgajnar J, Hocevar M, Frkovic-Grazio S, Hertl K, Schweiger E, Besic N. Radioguided occult lesion localization (ROLL) of the non palpable breast lesions. Neoplasma. 2004;51(5):385-9.
    28. Strnad P, Rob L, Halaska MG, Chod J, Zuntova A, Moravcova Z. Radioguided occult lesion localization in combination with detection of the sentinel lymph node in non-palpable breast cancer tumors. Eur J Gynecol Oncol. 2006;27(3):236-8.
    29. Hernandez JG, Tanis PJ, Deurloo EE, Nieweg OE, Rutgers ET, Kroon BB, et al. Radio-guided surgery improves outcome of therapeutic excision in non palpable invasive breast cancer. Nucl Med Commun. 2004;25(3):227-32.
    30. Hughes JH, Mason MC, Gray RJ, McLaughlin SA, Degnim AC, Fulmer JT, et al. A multi-site validation trial of radioactive seed localization as an alternative to wire localization. Breast J. 2008;14(2):153-7.
    31. Gray RJ, Pockaj BA, Karstaedt PJ, Roarke MC. Radioactive seed localization of nonpalpable breast lesions is better than wire localization. Am J Surg. 2004;188(4):377-80.
    32. Alamdaran SA, Modoodi E, Keshtgar M, Sadeghi R, Forghani MN, Sajjadi S. Assessment of radio-guided occult lesion localization associated with Sonography in non-palpable breast lesions. Breast J. 2016;23(3):367-9.