RADIOGUIDED LOCALIZATION OF OCCULT BREAST-LESIONS

Clinically occult breast lesions are found with increasing frequency b y breast screening, and several methods have been used to locate suspi cious occult lesions prior to excision. We have developed a new locali zation technique called ROLL (radioguided occult lesion localization) in which a small quantity of Tc-99m-labelled colloidal serum albumin i s injected into the lesion during mammographic or ultrasonic examinati on. Correct positioning is checked by scintigraphy. A gamma detecting probe is then used to locate the lesion and guide its surgical removal . We report on the first 225 patients in whom we have employed this te chnique: all had non-palpable breast lesions identified by mammography or ultrasound as clusters of microcalcifications or small opacities. Pathology revealed 134 cancers, 133 of which were treated by breast-co nserving surgery. In all but 2 cases (99%), radiolabelling coincided w ith the lesion site. X-radiography verified that the specimen removed contained all of the lesion. Removal of clinically occult breast lesio ns is greatly facilitated by the gamma probe, which locates the skin p rojection accurately, allowing choice of the most appropriate incision , and which can be employed continuously during surgery.