ROLL failure rates

Published Date: 19th July 2016

Publication Authors: , Carini S, Harris O, Thind R, Desmond S, Jois RHS

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Background:  We have used Radioisotope Occult Lesion Localization (ROLL) of breast lesions at our unit since 2002. Literature reports failure rates of 4 - 10% for Wire Guided Localisation (WGL). Ours is the first reporting of the difficulties with ROLL (UK) and lessons learnt from it.

Method:  A consecutive series of patients underwent ROLL during 2002- 12. Successful localisations on imaging but failing to show abnormality in the specimen after excision were defined as failed localisation. Variables resulting in the failure were scrutinised and risk factors identified.

Results:  618 ROLLs were performed. 135 ROLLs were stereotactic & 483 US-guided. 13 / 618 (2.1%) localisation failed on first intervention; 9/13 stereotactic guided & 4/13 US-guided. Failure with stereotactic localization was 9/135 (6.6%). The mean size of missed lesions was 7.7mm. The lesion location was the main risk factor for failure. In 5 cases, no obvious cause for the miss was found and was assumed to be incorrect Z axis depth calculation. All cases with DCIS or invasive malignancy were successfully excised on second intervention. 0.8% (4 / 483) US-guided failed. The causes of US-guided failures were: large haematoma obscuring the lesion; partial removal of the lesion during core biopsy and presumed incorrect positioning of the injection needle tip and dispersion of the isotope.

Conclusion:  Failure rate of ROLL (2.1%) compares favourably with published data for WGL. In our experience ROLL is by far superior technique with better failure rates better than WGL.

Jois, R; Carini, S; Harris, O; Thind, R; Desmond, S; Audisio; R. (2013).  ROLL failure rates for occult breast lesions: What lessons learnt-internal audit . European Journal of Surgical Oncology,. 39 (5), 481.

 

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