Efficacy of Radioguided Occult Lesion Localisation: How Well are We Doing?

Full Article

AKY Au, AYH Wan, BST Leung, SSW Lo, WWC Wong, JLS Khoo

Hong Kong J Radiol 2016;19:269-78

DOI: 10.12809/hkjr1615317

Objective: To assess the radiological, scintigraphic, surgical, and histological success rates of radioguided occult lesion localisation (ROLL).

Methods: We retrospectively reviewed 94 consecutive patients who underwent stereotactic-guided ROLL for radiologically indeterminate to highly suspicious microcalcifications from September 2002 to May 2014. Mammograms, scintigraphic records, surgical records, pathology results, and consultation notes of patients were reviewed. Fisher’s exact test was used to assess the association between ductal carcinoma in-situ (DCIS), invasive carcinoma, and surgical success.

Results: Radiological success was achieved in 88 (93.6%) of 94 patients. There were four cases of inadvertent intraductal injection of iodinated contrast and two cases of contrast staining away from the suspicious microcalcifications. Scintigraphic success was achieved in 93 (98.9%) of 94 patients. There was one failure related to insufficient radio-isotope. Among the 87 cases of successful stereotactic-guided ROLL, 50 (57.5%) tumours were benign and 37 (42.5%) were malignant, including 24 (64.9%) cases of DCIS. There were five (20.8%) low-grade, 15 (62.5%) intermediate-grade, and four (16.7%) high-grade DCIS. Surgical success was achieved in 71 (81.6%) of 87 patients. Margin involvement by DCIS accounted for 14 (16.1%) failures, in which 10 (71.4%) patients had re-excision of margin. Subsequent modified radical mastectomy was performed in six (37.5%) patients and included two patients in whom there was failed re-excision of margin. Histological success was achieved in 82 (94.3%) of 87 patients, in whom ‘microcalcifications present’ was mentioned in the pathology report. All patients survived with no recurrence on follow-up breast imaging for 12 years except one patient who died from carcinoma of the ovary. There was a significant association between DCIS and lower surgical success (p = 0.017).

Conclusion: ROLL is effective in localising non-palpable breast lesions with high radiological, scintigraphic, surgical, and histological success. There was a significant association between DCIS and lower surgical success. A wider resection margin may improve surgical success.


Authors’ affiliation:
Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong