Impalpable Breast Cancer

Published Date: 19th July 2016

Publication Authors: Herbert J, , Chagla LS, Desmond S, Galea M, Harris O, Ray A, Thind R, Jois RHS

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Background:  The detection of impalpable breast cancer lesions is on the rise due to mass population screening. Radio-guided occult lesion localisation (ROLL) has recently been used in the management of early lesions while sentinel lymph node biopsy (SLNB) has been used to detect occult lymph node metastases. In order to optimise localisation many international centres have proposed a technique involving the combined use of ROLL and SLNB, also known as SNOLL.

Materials and Methods:  All patients with impalpable invasive cancer and clinically negative axillae were analysed. The impalpable breast lesions were localised with an intra-lesion injection of 0.1 mls of 99Tc nanocolloid (1 MBq) 1 to 4 hours before surgery. SLNB was identified using 0.2 mls of 99Tc nanocolloid (20 MBq) injected subdermally in the periareolar region within the index quadrant, the day before surgery. All lymph nodes and target tissue that were focally radioactive were denoted using signals from a gamma probe.

Results:  SNOLL was utilised on 79 patients (median age, 63; range 57-68) between 2007 and 2009. 76 procedures were for invasive breast cancers. The median primary tumour size was 12mm (range, 10 -17 mm). Over two thirds of the lesions were in the upper half of the breast. of these 54.4% were located in the inner quadrant while 15.5% in the outer quadrant. The mean number of SLNBs retrieved was 1.86. In addition to SLNBs, 12 patients (15.2%) had non sentinel lymph node biopsies performed. of note, none were positive. The number of SLN positive patients was 7 (8.9%) with a mean retrieval of 2.

Conclusion:  SNOLL successfully localised all lesions. The combined use of radio-isotopes for lesion and sentinel lymph node removal in early breast cancer is feasible and reliable. Such a technique could rapidly become a standard practice within the NHS.

Galea, M; Ramesh, HSJ; Chagla, LS; Ray, A; Herbert, O; Desmond, S; Thind, R; Audisio, RA. (2012).  An early experience with SNOLL in the management of impalpable breast cancer . European Journal of Cancer. 48 (Supp 1), S74-75 

 

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