Radioguided Surgery for Nonpalpable Breast Tumors Following Neo Adjuvant Systemic Therapy

Background: The tumor burden in the breast can be markedly decreased following Neoadjuvant chemotherapy (NAC).Nevertheless, surgical excision of the residual tumor, or the tumor bed in cases of complete response is required. Accurate intraoperative tumor localization is essential. Wire-guided localization is currently being the most commonly used, yet, with several drawbacks. As a result, localization techniques using radio-isotopes were developed, including radio guided occult lesion localization (ROLL) and sentinel-node and occult-lesion localization (SNOLL). Over the past decade, ROLL has become popular due to its numerous benefits.Aim: To verify the efficiency of radio guided surgical management of breast cancer patients with nonpalpable residualbreast lesions post-NAC.Patients and Methods: This is a prospective cohort study undertaken at the National Cancer Institute (NCI), CairoUniversity between April 2021 and 2023 on female breast cancer patients with clinically nonpalpable breast lesions post-NAC.Results: Our study included 52 female patients with breast cancer post-NAC. The highest pathological complete responserate was observed in triple-negative patients. The median scar length was 4.5 cm. The largest volume of breast tissueexcised was 8˟6 cm and the smallest was 3˟2 cm with a median excision size of 6˟4 cm. Thirty three patients weresubmitted to sentinel lymph node biopsy and 19 patients underwent axillary lymph node dissection. The maximumnumber of positive lymph nodes (LN)s in patients who underwent sentinel lymph node biopsy was 2LNs. All pretreatmentclips were retrieved successfully with no major complications. ROLL positive margin rate was (3.8%).Conclusion: ROLL is superior to wire-guided localization for nonpalpable breast lesion localization, with manyadvantages as reaching a higher percentage of clear margins in spite of smaller specimen size and scar length with lesscomplications. SNOLL can be performed during the same procedure. Therefore, we recommend ROLL in nonpalpablebreast lesion localization.