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World J Surg. 2012 Aug;36(8):1915-21. doi: 10.1007/s00268-012-1577-1.

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.

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Department of Surgery, Azienda Ospedaliero-Universitaria of Udine, Udine, Italy.



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.


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.


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.


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.

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