Annals of Surgical Oncology

, Volume 20, Issue 8, pp 2569–2575 | Cite as

Guiding Breast-Conserving Surgery in Patients After Neoadjuvant Systemic Therapy for Breast Cancer: A Comparison of Radioactive Seed Localization with the ROLL Technique

  • Mila Donker
  • Caroline A. Drukker
  • Renato A. Valdés Olmos
  • Emiel J. Th. Rutgers
  • Claudette E. Loo
  • Gabe S. Sonke
  • Jelle Wesseling
  • Tanja Alderliesten
  • Marie-Jeanne T. F. D. Vrancken Peeters
Breast Oncology



Radioguided occult lesion localization (ROLL) with technetium-99 m colloid (ROLL-99mTc) is commonly used to perform breast-conserving surgery in patients with nonpalpable breast tumors. Radioactive seed localization is a relatively new technique that localizes the tumor with a radioactive iodine-125 (125I) seed. The feasibility and outcome of these techniques after neoadjuvant systemic treatment has not been widely investigated.


All patients treated with neoadjuvant systemic treatment between 2007 and 2010 in the Netherlands Cancer Institute who underwent breast-conserving surgery with the ROLL-99mTc technique (n = 83) or with 125I seed localization (n = 71) were analyzed. The weight of the resected specimen, the margins, and the percentage of patients requiring a second surgical intervention as a result of positive margins were assessed.


Patient and tumor characteristics and systemic treatment regimens were comparable between both groups. The median weight of the resected specimen (53 vs. 48 g), the median smallest margin (3.5 vs. 3.0 mm), and the risk for additional surgery for incomplete resections (7 vs. 8 %) did not differ significantly between patients treated with the ROLL-99mTc technique and 125I seed localization.


The ROLL-99mTc technique and 125I seed localization demonstrate comparable results when used to perform breast-conserving surgery after neoadjuvant systemic treatment. Because 125I seed localization does not require additional radiological localization shortly before surgery, it simplifies surgery scheduling. Therefore, we prefer 125I seed localization to perform breast-conserving surgery after neoadjuvant systemic treatment.


Positive Margin Complete Pathological Response 125I Seed Sentinel Node Procedure Nonpalpable Breast Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Nicola Russell for her critical review.


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Mila Donker
    • 1
  • Caroline A. Drukker
    • 1
  • Renato A. Valdés Olmos
    • 2
  • Emiel J. Th. Rutgers
    • 1
  • Claudette E. Loo
    • 3
  • Gabe S. Sonke
    • 4
  • Jelle Wesseling
    • 5
  • Tanja Alderliesten
    • 6
  • Marie-Jeanne T. F. D. Vrancken Peeters
    • 1
  1. 1.Department of Surgical OncologyNetherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of Nuclear MedicineNetherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Department of RadiologyNetherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  4. 4.Department of Medical OncologyNetherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  5. 5.Department of PathologyNetherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  6. 6.Department of Radiation OncologyNetherlands Cancer Institute, Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands

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