Comparable Tumor Removal, Re-Excision Rates for Radioguided and Wire-Guided Excision of Nonpalpable Breast Cancer
“ROLL, however leads to excision of larger tissue volumes,” added Emily Postma, MD, Department of Surgery, University Medical Center Utrecht, The Netherlands, and her coauthors.
Therefore, ROLL cannot replace WGL, the authors concluded.
ROLL involves intratumoral injection of 120 Mbq technetium-99m radiotracer to identify sentinel lymph nodes and guide tumor excision. ROLL avoids the “moderately painful procedure” of wire placement, the authors noted.
The authors enrolled 314 women with histologically-confirmed nonpalpable breast cancer, randomly assigning patients to a ROLL (n=162) or traditional wire-guided localization (WGL) arm (n=152).
“Complete tumour removal with negative margins was achieved in 140/162 (86%) of patients in the ROLL group versus 134/152 (88%) of patients in the WGL group (P=0.644),” the authors reported. Re-excision was necessary in 19 ROLL-arm patients (12%) versus 15 (10%) of patients in the WGL group (P=0.587).
Although ROLL was not associated with higher rates of negative surgical margins, ROLL excised-tissue volumes were significantly larger than WGL specimen volumes (71 cm3 vs 64 cm3; P=0.017), the authors reported.
“A straightforward explanation for excision of larger tissue volumes in the ROLL group is difficult to find,” the authors noted. “Potentially, a hooked wire is more helpful for a surgeon to exactly pinpoint the center of the lesion, while the maximal amount of counts (used as guidance during the ROLL procedure) is often more diffuse. In addition, surgeons may have the tendency to continue removing additional tissue when radioactivity is still traceable within the breast.”
Despite larger excised-tissue volumes among patients undergoing ROLL, ROLL and WGL yield similar cosmetic outcomes, the authors reported.