Radioguided Surgery for Nonpalpable Breast Tumors Following Neo Adjuvant Systemic Therapy | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 44, Issue 2, April 2025, Page 595-602 PDF (597.8 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2024.326321.1224 | ||||
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| Authors | ||||
Mohamed F. Ahmed  1; Sherif F. Naguib1; Maha Helal2; Magdy Kotb3; Maher H. Ibraheem4
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| 1Department of Surgical Oncology, National Cancer Institute, Cairo University, Giza, Egypt | ||||
| 2Department of Radio Diagnosis, National Cancer Institute, Cairo University, Giza, Egypt | ||||
| 3Department of Nuclear Medicine, National Cancer Institute, Cairo University, Giza, Egypt | ||||
| 4Department of Surgical Oncology, National Cancer Institute, Cairo University, Giza, Egypt | ||||
| Abstract | ||||
| Background: The tumor burden in the breast can be markedly decreased following Neoadjuvant chemotherapy (NAC). Nevertheless, surgical excision of the residual tumor, or the tumor bed in cases of complete response is required. Accurate intraoperative tumor localization is essential. Wire-guided localization is currently being the most commonly used, yet, with several drawbacks. As a result, localization techniques using radio-isotopes were developed, including radio guided occult lesion localization (ROLL) and sentinel-node and occult-lesion localization (SNOLL). Over the past decade, ROLL has become popular due to its numerous benefits. Aim: To verify the efficiency of radio guided surgical management of breast cancer patients with nonpalpable residual breast lesions post-NAC. Patients and Methods: This is a prospective cohort study undertaken at the National Cancer Institute (NCI), Cairo University between April 2021 and 2023 on female breast cancer patients with clinically nonpalpable breast lesions post- NAC. Results: Our study included 52 female patients with breast cancer post-NAC. The highest pathological complete response rate was observed in triple-negative patients. The median scar length was 4.5 cm. The largest volume of breast tissue excised was 8˟6 cm and the smallest was 3˟2 cm with a median excision size of 6˟4 cm. Thirty three patients were submitted to sentinel lymph node biopsy and 19 patients underwent axillary lymph node dissection. The maximum number of positive lymph nodes (LN)s in patients who underwent sentinel lymph node biopsy was 2LNs. All pretreatment clips were retrieved successfully with no major complications. ROLL positive margin rate was (3.8%). Conclusion: ROLL is superior to wire-guided localization for nonpalpable breast lesion localization, with many advantages as reaching a higher percentage of clear margins in spite of smaller specimen size and scar length with less complications. SNOLL can be performed during the same procedure. Therefore, we recommend ROLL in nonpalpable breast lesion localization. | ||||
| Keywords | ||||
| Breast-conserving surgery; neoadjuvant chemotherapy; radio-guided occult lesion localization; sentinel lymph node and occult lesion localization | ||||
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