Localización preoperatoria radiodirigida del cáncer de mama no palpable comparada con la localización mediante guía metálica

Abstract

INTRODUCTION In patients with breast cancer, precise preoperative radiologic localization of nonpalpable breast lesions (NPBL) is particularly important because of the need to obtain disease-free surgical margins while excising the smallest amount possible of healthy tissue. Stereotactic- or sonographic-guided wire localization (WL) continues to be the current standard method for preoperative localization of NPBL. In general, this technique provides good results, but it is not free of difficulties and complications for the radiologist and patient during the procedure, and for the surgeon during localization and removal of the lesion. In this scenario, a new preoperative localization technique based on the use of radioisotopes has emerged. This technique, which is known as ROLL (radioisotope occult lesion localization), attempts to reduce the problems associated with WL. Before the development of this thesis, we performed a preliminary, prospective randomized controlled study in which we determined that intratumoral tracer injection was as effective as peritumoral injection for sentinel node detection and biopsy in patients with breast cancer. This opened the door to simultaneous performance of the ROLL technique. WORKING HYPOTHESIS The ROLL technique, involving intratumor tracer injection, enables preoperative localization of NPBL, and therefore, is a viable alternative to the classic WL method. OBJECTIVES The main objective of this study was to determine whether there are differences in the effectiveness of localization and complete resection of non-palpable breast cancer by ROLL technique as compared to standard WL. The secondary objectives were to evaluate and compare in the two groups a series of parameters related to the quality of the procedure: time spent in radiologic and surgical localization, presence of affected margins that require a second surgical intervention, weight and volume of the surgical specimens, the simultaneous effectiveness of sentinel node biopsy (SNB), and assessment of patient-perceived discomfort during preoperative localization. MATERIAL AND METHODS A randomized prospective study was performed including 134 patients with malignant breast disease established by percutaneous biopsy, non-palpable breast lesions, no axillary lymph adenopathy, and an indication for conservative surgery and SNB. Patients were randomly distributed in two groups according to the technique used for preoperative localization: WL versus ROLL. In all cases, localization of the breast lesion was done under stereotactic or ultrasound guidance. The ROLL group underwent imaging-guided intratumor injection of radiotracer, with the same tracer being used to localize the breast lesion and the sentinal node. RESULTS Preoperative localization was performed with WL in 68 cases and with ROLL in 66 cases. The time used in radiologic localization was significantly lower with ROLL than with WL, and ROLL was better tolerated by the patients. The duration of biopsy was lower with ROLL. With both techniques, surgical excision of the lesion was achieved; the weight and volume of the surgical specimens were slightly larger with the ROLL technique. We obtained a higher percentage of disease-free margins and a higher sentinal node detection rate with ROLL. CONCLUSIONS Based on the results obtained in this study, we conclude that the ROLL technique is effective for preoperative localization of NPBL, and is faster, simpler, and more tolerable for patients than the WL technique. With the use of ROLL, complete excision of the lesion is achieved with a higher percentage of disease-free margins. Furthermore, this technique enables simultaneous localization of the breast lesion and sentinal node in a single puncture, without a loss of efficacy in SNB. These findings lead us to conclude that ROLL should be the technique of choice for preoperative localization of NPBL in breast cancer patients with an indication for conservative treatment and SNB

Date of Award	1 Feb 2013
Original language	Spanish
Supervisor	Jaume Fernandez-llamazares Rodriguez (Director), Manuel Fraile Lopez Amor (Director) & Juan Francisco Julian Ibañez (Director)