'Radioguided occult lesion localisation' (ROLL) for non-palpable breast lesions: a review of the relevant literature.

BACKGROUND: 'Radioguided occult lesion localisation' (ROLL) is a possible alternative to the commonly used 'wire-guided localisation' (WGL) of non-palpable breast lesions. Intratumoural injection of a radiotracer identifies both the primary tumour and the sentinel lymph nodes for intraoperative gamma probe guided dissection.
METHOD: A broad literature search was conducted, using the Pubmed, Embase and The Cochrane Library databases. Five clinically controlled trials and one randomised controlled trial, all of modest size, were selected which describe both ROLL and WGL. Four articles were found that describe the combined use of the ROLL technique with the sentinel node procedure.
RESULTS: In the ROLL group between 69% and 84% of the lesions were radically excised, compared with 44-60% of the lesions in the WGL group. The studies that combined ROLL and the sentinel node procedure mentioned even higher percentages of radically excised specimens ranging from 90% to 95% and an identification rate of sentinel nodes up to 100%. One randomised controlled trial mentioned that the ROLL procedure had a faster localisation time, was easier to perform, was less painful and gave a better cosmetic result than WGL.
CONCLUSION: ROLL seems a promising technique, which appears to be more radical than WGL. Localisation tends to be more accurate and faster, the excision procedure is more elegant and simple to perform, and the cosmetic result seems to be better. Further research is necessary to establish the exact role of ROLL in the management of non-palpable breast lesions.