Radioguided Occult Lesion Localization Techniques for Nonpalpable Breast Cancer Identification

Abstract Background: The main goal of successful management of nonpalpable breast tumors is accurate preoperative localization. A hooked wire inserted under radiographic guidance has been the technique used most often to remove occult breast lesions. Because of several disadvantages of wire-guided localization (WGL), new modalities have been investigated. These include radioguided occult lesion localization (ROLL) and radioguided seed localization (RSL). Objective: The aim of this review is to elucidate the diagnostic efficacy of ROLL and RSL techniques and to evaluate the results of subsequent surgical procedures in cases of nonpalpable breast lesions, with special reference to the extent of histologic spread and adequate excision. Methods: A comparison with the standard of care, WGL, as well as an assessment of the recent literature was performed in order to provide an update on the current concepts of diagnostic approach of early breast cancer. Results: The ROLL technique is as effective as WGL for excision of nonpalpable breast lesions, reduces localization time, and probably reduces the incidence of pathologically involved margins of excision. Therefore, ROLL is an attractive alternative to WGL. Moreover, a statistically significant benefit for RSL versus WGL in the form of involved surgical margin status, reoperation rates, and operative time has been documented. Conclusions: This systematic review provides evidence that both ROLL and RSL techniques are not only useful methods for three-dimensional localization of impalpable breast tumors but also are superior in terms of surgical-margin status, reoperation need, and operative duration, compared to WGL. (J GYNECOL SURG 20XX:000)