Radioguided Occult Lesion Localisation (ROLL) for Excision of Non-Palpable Breast Lesions, a Personal Experience in a Patient with Multifocal Breast Cancer

Background: Breast conservation therapy (BCT) is the standard of care for early stage breast cancer. The procedure can be a challenge for the surgeon if the lesion is non-palpable. For excision of non-palpable breast lesions, they should be localized precisely before surgery. There are different techniques such as the WGL (Wire Guided Localization), ROLL (Radio-guided Occult Lesion Localization), etc. Some centers consider ROLL as the gold standard technique for excision of non-palpable breast lesions. Case presentation: A 44-year-old woman with multifocal breast cancer presented to the breast clinic. Her imaging including MRI scan confirmed the presence of three tumors in the left breast and malignant looking nodes in the left axilla. Under ultrasound guidance, Core Needle Biopsy (CNB) of the breast lesions and Fine Needle Aspiration (FNA) of two lymph nodes in the left axilla were performed. Pathology of all three masses confirmed Invasive Ductal Carcinoma (IDC) and FNA of the lymph nodes was suspicious for malignancy. She was treated with breast conserving surgery using the ROLL technique. All three tumors were excised with adequate margins and axillary lymph node dissection was performed. The cosmetic results were satisfactory. Conclusion: The ROLL technique is simple to perform and has several advantages compared to the WGL. We recommend this procedure, especially in multifocal non-palpable lesions.