• Gianpiero Manca, Sara Mazzarri, Domenico Rubello, Elisa Tardelli, Roberto C Delgado-Bolton, Francesco Giammarile, Manuela Roncella, Duccio Volterrani, and Patrick M Colletti.
• From the *Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa; †Department of Nuclear Medicine, Radiology and Clinical Pathology, "S. Maria della Misericordia" Hospital, Rovigo, Italy; ‡Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, Spain; §Unit of Senology Hospital University of Pisa, Pisa, Italy; ∥Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria; and ¶Department of Radiology, University of Southern California, Los Angeles, CA.
• Clin Nucl Med. 2017 Dec 1; 42 (12): e498-e503.

PurposeRegarding radioguided surgery, the concept of "radioguided occult lesion localization" (ROLL) is based on both preoperative interventional imaging and intraoperative radioguided detection of a clinically occult neoplastic lesion.MethodsThis methodology consists in the direct administration into the lesion of Tc-macroaggregated human albumin formed by relatively large particles retained at the injection site, which direct radioguided excisional biopsy.ResultsThis modality has expanded from the classic application of ROLL for nonpalpable breast lesions to other tumors, such as solitary pulmonary nodules or recurrences from differentiated thyroid carcinoma. In 2011, in order to improve the classification of different radioguided surgical procedures, ROLL applications were included in the more complete concept of GOSTT (Guided intraOperative Scintigraphic Tumor Targeting). This concept was introduced to include the entire range of basic and advanced radioguided procedures necessary to supply a "road map" for the surgeon.ConclusionsThe terms ROLL and GOSTT have further developed by incorporating novel modalities such as hybrid tracers for simultaneous fluorescence and radioactive signal detection and innovative navigation systems based on mixed-reality protocols.

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