SNOLL. Sentinel node and occult (impalpable) lesion localization in breast cancer.

AIM: To evaluate the efficacy and safety for use of dual radioisotopes for localization of occult (impalpable) breast lesions and sentinel node biopsy as a combined technique (SNOLL) using a lower dose than previous studies. MATERIALS AND METHODS: One hundred and twenty-seven SNOLL procedures were performed. The impalpable breast lesions were localized with an intra-lesion injection of 0.2 ml of (99m)Tc MAA (1 MBq) with a particle size of 10-90 µm (radio-guided occult lesion localization, or ROLL) 1 to 4 h before surgery. Sentinel node localization was performed using 0.2 mls of (99)Tc nanocolloid (20 MBq) particle size no greater than 80 nm injected subdermally in the periareolar region within the index quadrant, the night before or the morning of surgery. RESULTS: Lesion localization was consistently achieved with a lower dose than that described in other studies without the need to use scintigraphy or additional imaging with radioopaque contrast medium. One hundred percent lesion localization with a negative clearance margin of 94.8% and 100% sentinel node localization was achieved. The use of dual radioisotopes with the lower dose used for ROLL did not compromise the localization of the impalpable lesion or the sentinel nodes. CONCLUSION: The combined use of radioisotopes for lesion and sentinel node removal is feasible and reliable with the lower radioisotope dose suggested compared with previously published studies. This method should be recommended as a standard procedure for SNOLL.

Long-term outcomes after ROLL lumpectomy.

BACKGROUND: Occult breast lesions are being successfully targeted by means of Radioactive-guided Occult Lesion Localization (ROLL). Several reports demonstrate suitability of ROLL technique to excise non-palpable breast lesions with immediate advantages. AIM: Evaluation of long-term outcomes after ROLL guided lumpectomy for early breast cancer. MATERIALS AND METHODS A CONSECUTIVE SERIES OF NON PALPABLE EARLY INVASIVE BREAST CANCERS EXCISED WITH ROLL (151 PTS; DECEMBER 2002#ENTITYSTARTX02013;JUNE 2006) WERE FOLLOWED UP FOR LONG-TERM OUTCOMES, I.E. LOCAL AND/OR SYSTEMIC RECURRENCE. OUR FOLLOW-UP PROTOCOL INCLUDED 6 MONTHLY PHYSICIAN ADMINISTERED CLINICAL EXAMINATIONS AND 18 MONTHLY IMAGING, I.E. MAMMOGRAM. BONE SCAN, LIVER AND BRAIN IMAGING WERE REQUESTED ON CLINICAL NEED. CLINICAL AND/OR RADIOLOGICAL SUSPICIOUS LESIONS FOR LOCAL RECURRENCE WERE CONFIRMED PATHOLOGICALLY: RESULTS: The median follow-up was 46 months with all patients having a minimum 22 months follow-up. 3/151 local recurrences occurred (1.98%). CONCLUSIONS: Long-term outcomes, i.e. local recurrence of invasive breast cancer excised with ROLL guidance compares well with existing localization techniques.

Recurrence after ROLL lumpectomy for invasive breast cancer.

BACKGROUND: Impalpable breast lesions are being successfully targeted by means of radio-guided occult lesion localisation (ROLL). Although ROLL allows adequate removal of sub-clinical breast lesions within a smaller volume of glandular tissue no long-term outcomes have been reported. AIM: To evaluate the recurrence of invasive cancer after ROLL lumpectomy. METHODS: A consecutive series of impalpable invasive breast cancers excised with ROLL (151 pts; Dec 2002-June 2006) has been followed up for local and/or systemic recurrence with six monthly clinical examinations and 18 monthly mammograms. Bone scan, liver and brain imaging were requested when clinically appropriate. Clinical and/or radiological suspicious lesions for local recurrence were confirmed pathologically. RESULTS: The median follow-up was 33 months with all patients having a minimum 22 months follow-up. Three (out of 151 impalpable invasive cancers) local recurrences occurred (1.98%). CONCLUSIONS: Local recurrence of sub-clinical invasive breast cancer excised with radioisotope guidance compares well with the existing localisation techniques. Its implementation is highly recommended.

Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study.

BACKGROUND: A number of elderly cancer patients do not receive standard surgery for solid tumors because they are considered unfit for treatment as a consequence of inaccurate estimation of the operative risk. To tailor treatment to onco-geriatric series, oncologists are now beginning to use a comprehensive geriatric assessment (CGA). This study investigates the value of an extended CGA in assessing the suitability of elderly patients for surgical intervention. PATIENTS AND METHODS: Preoperative assessment of cancer in the elderly (PACE) incorporates validated instruments including the CGA, an assessment of fatigue and performance status and an anaesthesiologist's evaluation of operative risk. An international prospective study was conducted using 460 consecutively recruited elderly cancer patients who received PACE prior to elective surgery. Mortality, post-operative complications (morbidity) and length of hospital stay were recorded up to 30 days after surgery. RESULTS: Poor health in relation to disability (assessed using the instrumental activities of daily living (IADL)), fatigue and performance status (PS) were associated with a 50% increase in the relative risk of post-operative complications. Multivariate analysis identified moderate/severe fatigue, a dependent IADL and an abnormal PS as the most important independent predictors of post-surgical complications. Disability assessed by activities of daily living (ADL), IADL and PS were associated with an extended hospital stay. CONCLUSION: PACE represents a valuable tool in enhancing the decision process concerning the candidacy of elderly cancer patients for surgical intervention and can reduce inappropriate age-related inequity in access to surgical intervention. It is recommended that PACE be used routinely in surgical practice.