Incidence and Risk Factors of the Intraoperative Localization Failure of Nonpalpable Breast Lesions by Radio-guided Occult Lesion Localization: A Retrospective Analysis of 579 Cases

• Published in: World journal of surgery Vol. 36; no. 8; pp. 1915 - 1921
• Main Authors: Bernardi, Sergio, Bertozzi, Serena, Londero, Ambrogio P., Gentile, Giuliana, Giacomuzzi, Francesco, Carbone, Arnalda
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.08.2012; Springer‐Verlag; Springer Nature B.V
• Subjects: Abdominal Surgery; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cardiac Surgery; Chi-Square Distribution; Complete Axillary Lymph Node Dissection; Diagnostic Errors; Female; General Surgery; Humans; Incidence; Intratumoral Injection; Lesion Localization; Mammography; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Staging; Nonpalpable Breast Lesion; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Risk Factors; Sentinel Lymph Node Biopsy; Serum Albumin; Statistics, Nonparametric; Stereotaxic Techniques; Surgery; Thoracic Surgery; Ultrasonography, Mammary; Vascular Surgery; Lesion Localization; Complete Axillary Lymph Node Dissection; Sentinel Lymph Node Biopsy; Intratumoral Injection; Nonpalpable Breast Lesion
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-012-1577-1

Background The radio-guided occult lesion localization (ROLL) technique allows the identification of nonpalpable breast lesions by means of the preoperative, intratumoral injection of a radiotracer. Our study aimed to determine the incidence and risk factors of ROLL failure. Methods We collected data about all women who underwent ROLL in our department from 2002 to 2009, focusing on patient characteristics such as breast size and density, lesion size, localization, histology, radiologist, and surgeon experience. Data were analyzed using R v2.10.1, considering p  < 0.05 significant. Results A total of 579 ROLLs were performed on 555 women with a mean age of 58.7 (±10.96) years. Incidence of ROLL failure at the first intervention was 4 % (23/579). Through monovariate analysis, ROLL failure was significantly influenced by stereotactic mammography-guided procedure, invasive tumors, pathological and radiological lesion size ≤5 mm, and the lesion’s location in the central or upper breast quadrants. Through multivariate analysis, the most predictive factors for ROLL failure were as follows: lesion localization in the central quadrant, lesion radiological size ≤5 mm, and radiologist inexperience. Conclusions The main risk factors for ROLL failure were the radiologist’s inexperience, lesion size ≤5 mm, and its localization in the central subareolar quadrant, probably due to an unfavorable radiological and surgical reaching of the breast area.