Radio-Guided Breast Surgery

What is “Radio-guided” breast surgery?

In breast conservative surgery, a new approach called “radio-guided occult lesion localization” is being used for the localization and removal of non-palpable breast lesions. This technique was developed in recent years

Widespread mammography screening programs and recent technological advances in breast ultrasound have resulted in increased detection of breast non-palpable lesions. Breast cancer is the most frequent malignancy in women, and to date, detection of asymptomatic tumors is the best way to reduce mortality for this malignancy. Non-palpable lesions represent up to 25% of breast lesions detected by mammogram or ultrasonography. Radiological signs of non-palpable lesions are most commonly represented by clusters of microcalcifications and/or parenchymal distortions.

To perform breast-conserving surgery in these patients, the tumor needs to be localized correctly before surgical excision.

Radio-guided occult lesion localization (ROLL) is a new approach to diagnosing and resecting non-palpable breast lesions. Introduced in 1996, the ROLL technique utilises a radiopharmaceutical tracer injected into the tumour. This tracer is commonly used for lymphatic mapping and sentinel node biopsies. In the same surgical procedure, the tracer can be used to localise the primary tumour guided by a gamma probe.

How “radio-guided” breast surgery rose?

Over the past few years, doctors have changed how they diagnose breast cancer. Before, between 50 and 70% of breast cancers were found during a physical exam. With screening mammography, more subclinical lesions are being found. So, it became important to find ways to find and confirm small changes with histological tests that were not too invasive.

Wire localization (WL) is a well-known method used in breast surgery to find a lesion. It involves a flexible needle with a spear at the end. Since 1996, a method called radioguided occult lesion localization (ROLL) has been used.

A method called radioguided occult lesion localization (ROLL) has been used since 1996 . It was made at the European Institute of Oncology in Milan, Italy, and is now the standard of care in many breast surgery services. In this method, a radioactive substance is used to mark the site of the crime (under ultrasound or mammography guidance). The gamma-detecting probe helps the surgeon find a suspicious spot or group of microcalcifications during surgery. The cut on the skin can be planned so that it looks better. This method doesn’t use a spear.

Instead, a small amount of liquid is used to make the process less painful for the patient. The effectiveness and patient acceptability of local anaesthetics for ROLL, how patients feel about pain, and how they look after surgery have not been studied before.

Why is “radio-guided” breast surgery done?

Radioguided occult lesion localisation (ROLL) is a simple but effective way to guide the removal of clinically invisible breast lesions while leaving as little normal tissue as possible around them. Either a mammogram or an ultrasound is used to guide the injection of a small amount of radiolabeled colloid into the centre of the lesion. In the operating room, this spot of radioactivity is found by a handheld pencil-shaped gamma probe that turns the intensity of the gamma emission into a scale of sound and light.

The surgeon can use this to cut the skin right over the lesion and as close as possible to it. As the dissection goes on, the operator can use the probe as often as they want to guide them to the lesion and put it in the centre of the removed specimen. Lastly, the probe can find low amounts of radioactivity in the cavity to prove that the tumour has been completely removed. The amount of gamma radiation that both the patient and the operators are exposed to is very low and well within the safe limits set by the government. This method has been used in many places with wire localization as a control.

Reaching out to Dr. Mansi for obtaining surgical treatment for breast cancer

Dr. Mansi Chowhan is a renowned surgical oncologist who has been active in her area for over a dozen years. She is a very skilled surgeon with expertise in breast oncoplastic surgery, head and neck surgery, and reconstructive surgery. Her credentials are impeccable.

She has been practicing medicine for over 12 years and has worked at some of the most prestigious hospitals in the Delhi-National Capital Region (NCR). These hospitals include Fortis Healthcare (both in Delhi and Gurgaon), Artemis Hospital (Gurgaon), Paras Hospital (Gurgaon), and the Asian Institute of Medical Sciences (also in Gurgaon) (Faridabad).