• Barros Alfredo C S D AC Mastology Department, Hospital Sírio Libanês, Rua Adma Jafet, 91, Bela Vista, 01308-000, São Paulo, SP, Brazil. clinab@terra.com.br, Maria A C Barros, Felipe E Andrade, Lincon J Mori, Paulo A Costa, Peng Y Sheng, and Christina H T Pelizon.
• Mastology Department, Hospital Sírio Libanês, Rua Adma Jafet, 91, Bela Vista, 01308-000, São Paulo, SP, Brazil. clinab@terra.com.br
• Ann. Surg. Oncol. 2007 Apr 1; 14 (4): 1472-7.

BackgroundThe aim of this study was to test a new strategy for radioguided management of malignant or suspicious nonpalpable breast lesions, with a combination of radioguided occult lesion localization (ROLL), sentinel lymph node (SLN) mapping, and, if necessary, immediate local surgery and SLN biopsy with a single injection of (99m)Tc-labeled dextran for the whole procedure.MethodsA total of 115 nonpalpable lesions were studied: 101 with high suspicion of malignancy from which frozen sections had been produced, and 14 carcinomas diagnosed by mammotomy. On the day before surgery, 0.2 mL of solution of dextran labeled with 15 MBq of (99m)Tc was injected into the center of the lesions under imaging guidance. All patients underwent lymphoscintigraphy and open-surgery biopsy guided by gamma probe, followed by radiographic verification of the specimen. If malignancy was detected, in cases of infiltrating or ductal carcinoma-in-situ with comedonecrosis or high nuclear grade, breast-conserving surgery and SLN biopsy were performed during the same operation.ResultsThe combination of ROLL and SLN biopsy was feasible and practical. The rate of simultaneous SLN mapping by lymphoscintigraphy was 97.4% (112 of 115), and the confirmation rate for breast lesion removal by specimen radiography was 100%. It was known that 57 cases were malignant at the time of surgery. After segmental breast resection, SLN immediately underwent biopsy in 50 cases (34 infiltrating carcinomas and 16 ductal carcinoma-in-situ) with probe monitoring. Three were cytologically positive for metastasis and required full axillary dissection.ConclusionsROLL and SLN biopsy are emerging procedures that can be used simultaneously. They permit exact breast lesion excision, immediate local breast surgery, and intraoperative SLN biopsy in a single procedure. The combination of radioguided nonpalpable lesion localization and SLN biopsy is a suitable alternative to working up subclinical imaging-detected breast carcinomas.

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