Particles labeled with 0.1 mCi 99Tc (technetium-99) can be injected into breast lesions under mammography or ultrasound control, said Heriberto Medina-Franco, MD, associate professor of surgery, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico. The radioactive signal can then help surgeons remove the lesion while maintaining adequate disease-negative margins.

The traditional standard of care for lumpectomy used wires to indicate the lesion's location. This method causes significant patient discomfort and can cause errors if the wire becomes dislodged during surgery.

Recently, a computer-assisted, mammography-based localisation procedure called Mammotome has become available in the United States, but Dr. Medina-Franco said it was not available in his institution.

In an oral presentation on March 16th, Dr. Medina-Franco reported on a 100-patient randomised trial in which patients were assigned to either conventional wire-guided localisation or radio-guided occult lesion localisation (ROLL) using 99Tc. A handheld gamma radiation detector was used in the operating room to locate the isotope-labeled particles.

Rates of treatment success and complications were similar for the 2 methods, Dr. Medina-Franco said.

The wire became dislodged in 1 patient in the wire-guided group. Fewer lesions in the ROLL group showed positive margins, he said, with clear margins achieved in 95% of ROLL patients versus 65% with the wire-guided method (P < .01), which decreased the need for re-excision.

The wire-guided procedure was less expensive, at $132 USD versus $209 for ROLL, Dr. Medina-Franco said. There was evidence that ROLL produced more cosmetically pleasing results, and that surgeons and radiologists rated it as easier to use, he added.

Objectively, time spent in the operating room in localising lesions was several minutes shorter with ROLL, achieving statistical significance (P < .001), he said.

The results were consistent with phase 3 studies conducted in the U.S., he said.


[Presentation title: Radioguided Occult Lesion Localisation(ROLL) vs. Wire-Guided Lumpectomy (WL) for Non-Palpable Breast Lesions: A Randomised Prospective Evaluation. Abstract 16]

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