ROLL Is Successful At Localizing Axillary Lymph Nodes: A Single Tertiary Centre Experience

Background In breast malignancy, axillary staging is crucial in deciding on tailored treatment and determining prognosis. Currently less aggressive approaches like sentinel lymph node biopsy and targeted axillary dissection are preferred over axillary clearance in the management of selected node positive breast cancer patients. Ultrasound-guided Radioguided Occult Lesion Localization (ROLL) is a relatively new technique in the management and localization of axillary lymph nodes. The authors aim to share the experience of ROLL in this single tertiary centre Material and methods From March 2020 to December 2024, 41 suspicious axillary nodes from 30 patients who underwent ultrasound guided ROLL were included in this study. Results Radioisotope was appreciated in post injection scintigram of 39 nodes which resulted in a 95.1% success rate of intra-operative indentification of these nodes. There were 21 patients (26 nodes) who underwent neoadjuvant chemotherapy (NACT) with mean size of lymph node pre and post NACT measuring 2.1 cm(1.0-4.3 cm) and 1.2 cm(0.7–3.2 cm) respectively. Distance from lymph node to skin was 1.5 cm(0.8–2.5 cm). The primary pathology was breast cancer in 26 patients(33 nodes). Tissue marker clip was inserted into 27(65.9%) lymph nodes prior to NACT. Conclusion Ultrasound-guided ROLL is an effective method for localization of axillary nodes. There is better flexibility in scheduling and patients are more comfortable. Its high success rate is promising, and aids the transformation of practice from axillary lymph node dissection to targeted axillary dissection. Clipped nodes which disappear after NACT leaving behind the clip are especially challenging to localize.