Augusto Lombardi1, Giuseppe Nigri2, Francesco Scopinaro3, Stefano Maggi1, Mauro Mattei4, Adriana Bonifacino5, Maria Parisella3, Alessandro Soluri6, Claudio Amanti1. 1. Breast Surgery Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. 2. Department of Surgery, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy. Electronic address: giuseppe.nigri@uniroma1.it. 3. Nuclear Medicine Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. 4. Breast Radiology Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. 5. Breast Diagnosis and Treatment Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy. 6. Biomedical Engineering Unit, National Research Council (CNR), Rome, Italy.
Abstract
BACKGROUND: Sentinel node and occult lesion localization (SNOLL) calls for a combination of two specific procedures: intraoperative detection of sentinel lymph node (SLN) via gamma probe and radioguided occult lesion localization (ROLL). This applies to nonpalpable invasive breast cancer or high-grade in situ carcinoma. As opposed to standard techniques, today's handheld gamma cameras enable intraoperative scintigraphic images. METHODS: A cohort (N = 186) of consecutive patients with breast cancer was subjected to radioguided conservative surgery (quadrantectomy and SLN biopsy), using a standard gamma probe and a high-resolution handheld camera. Intraoperative SLN frozen section was also performed. RESULTS: Neoplastic lesions were removed in 99.4% of all patients, and SLN biopsy was achieved in 99%. Of the 137 patients with invasive cancer, SLN metastasis was confirmed in 21. In 12% of patients, a second operation was required for close or tumor-positive surgical margins. DISCUSSION: This combination of procedures represents an improvement in the surgical management of occult breast carcinomas and is the method of choice for accurate tumor localization and SLN biopsy. Handheld cameras have the potential to become highly useful intraoperative aids.
BACKGROUND: Sentinel node and occult lesion localization (SNOLL) calls for a combination of two specific procedures: intraoperative detection of sentinel lymph node (SLN) via gamma probe and radioguided occult lesion localization (ROLL). This applies to nonpalpable invasive breast cancer or high-grade in situ carcinoma. As opposed to standard techniques, today's handheld gamma cameras enable intraoperative scintigraphic images. METHODS: A cohort (N = 186) of consecutive patients with breast cancer was subjected to radioguided conservative surgery (quadrantectomy and SLN biopsy), using a standard gamma probe and a high-resolution handheld camera. Intraoperative SLN frozen section was also performed. RESULTS:Neoplastic lesions were removed in 99.4% of all patients, and SLN biopsy was achieved in 99%. Of the 137 patients with invasive cancer, SLN metastasis was confirmed in 21. In 12% of patients, a second operation was required for close or tumor-positive surgical margins. DISCUSSION: This combination of procedures represents an improvement in the surgical management of occult breast carcinomas and is the method of choice for accurate tumor localization and SLN biopsy. Handheld cameras have the potential to become highly useful intraoperative aids.
Authors: Christina Bluemel; Andreas Cramer; Christoph Grossmann; Georg W Kajdi; Uwe Malzahn; Nora Lamp; Heinz-Jakob Langen; Jan Schmid; Andreas K Buck; Hanns-Jörg Grimminger; Ken Herrmann Journal: Eur J Nucl Med Mol Imaging Date: 2015-07-09 Impact factor: 9.236
Authors: Thijs Engelen; Beatrice Mf Winkel; Daphne Dd Rietbergen; Gijs H KleinJan; Sergi Vidal-Sicart; Renato A Valdés Olmos; Nynke S van den Berg; Fijs Wb van Leeuwen Journal: Am J Nucl Med Mol Imaging Date: 2015-02-15
Authors: Giulia Anna Follacchio; Francesco Monteleone; Paolo Anibaldi; Giuseppe De Vincentis; Silvia Iacobelli; Raffaele Merola; Valerio D'Orazi; Massimo Monti; Vittorio Pasta Journal: J Exp Clin Cancer Res Date: 2015-10-06