Efficacy of Radioguided Occult Lesion Localisation: How Well are We Doing?
AKY Au, AYH Wan, BST Leung, SSW Lo, WWC Wong, JLS Khoo
Hong Kong J Radiol 2016;19:269-78
DOI: 10.12809/hkjr1615317
Objective: To assess the radiological, scintigraphic, surgical, and histological success rates of radioguided occult lesion localisation (ROLL).
Methods: We retrospectively reviewed 94 consecutive patients who underwent stereotactic-guided ROLL for radiologically indeterminate to highly suspicious microcalcifications from September 2002 to May 2014. Mammograms, scintigraphic records, surgical records, pathology results, and consultation notes of patients were reviewed. Fisher’s exact test was used to assess the association between ductal carcinoma in-situ (DCIS), invasive carcinoma, and surgical success.
Results: Radiological success was achieved in 88 (93.6%) of 94 patients. There were four cases of inadvertent intraductal injection of iodinated contrast and two cases of contrast staining away from the suspicious microcalcifications. Scintigraphic success was achieved in 93 (98.9%) of 94 patients. There was one failure related to insufficient radio-isotope. Among the 87 cases of successful stereotactic-guided ROLL, 50 (57.5%) tumours were benign and 37 (42.5%) were malignant, including 24 (64.9%) cases of DCIS. There were five (20.8%) low-grade, 15 (62.5%) intermediate-grade, and four (16.7%) high-grade DCIS. Surgical success was achieved in 71 (81.6%) of 87 patients. Margin involvement by DCIS accounted for 14 (16.1%) failures, in which 10 (71.4%) patients had re-excision of margin. Subsequent modified radical mastectomy was performed in six (37.5%) patients and included two patients in whom there was failed re-excision of margin. Histological success was achieved in 82 (94.3%) of 87 patients, in whom ‘microcalcifications present’ was mentioned in the pathology report. All patients survived with no recurrence on follow-up breast imaging for 12 years except one patient who died from carcinoma of the ovary. There was a significant association between DCIS and lower surgical success (p = 0.017).
Conclusion: ROLL is effective in localising non-palpable breast lesions with high radiological, scintigraphic, surgical, and histological success. There was a significant association between DCIS and lower surgical success. A wider resection margin may improve surgical success.
Authors’ affiliation:
Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
中文摘要
放射導向隱匿性病灶定位的有效性和目前應用現狀
區嘉殷、尹宇瀚、梁肇庭、盧成瑋、黃慧中、邱麗珊
目的：評估放射導向隱匿性病灶定位（ROLL）的放射學、同位素顯像、手術和組織學成功率。
方法：回顧研究2002年9月至2014年5月期間所有接受立體定向引導ROLL的94例患者，經放射學檢查發現不確定至高度可疑的微鈣化灶的病例。回顧患者的乳房X線照片、顯像掃描紀錄、手術紀錄、病理結果和病歷紀錄。使用Fisher精確檢驗來評估導管原位癌（DCIS）、浸潤性癌和手術成功率之間的關係。
結果：放射學成功率為93.6%（94例中有88例）。其中4例發生不慎管內注射碘化造影劑，2例為可疑微鈣化灶的造影劑偏離。顯像成功率為98.9%（94例中有93例）。1個失敗病例與放射性同位素不足有關。87例成功進行立體定向引導ROLL中有50例（57.5%）腫瘤為良性，37例（42.5%）為惡性（包括24例DCIS，64.9%)。5例（20.8%）屬低度、15例（62.5%）屬中度，以及4例（16.7%）屬高度分化DCIS。手術成功率為81.6%（87例中有71例）。14（16.1%）例的DCIS切除邊緣呈陽性，其中10例（71.4%）重新進行了邊緣切除。隨後6例（37.5%）進行了根治性乳房切除術，包括2例邊緣切除失敗的患者。組織學成功率為94.3%（87例中有82例），其病理學報告中提及「微鈣化」。除1例死於卵巢癌外，所有患者術後12年的乳腺成像中均未發現復發。DCIS與手術成功率低之間存在顯著相關性（p=0.017）。
結論：ROLL對不可觸及的乳房病變的定位具有很高的放射學、同位素顯像、手術和組織學成功率。DCIS與手術成功率低顯著相關。增加切緣寬度可以提高手術成功率。