ROLL superior to WGL for nonpalpable breast lesions

Radio-guided occult lesion localization (ROLL) is better than wire-guided localization (WGL) for the treatment of nonpalpable breast lesions, a recent meta-analysis has found.

Accessing the databases of LILACS, Medline, Embase, and the Cochrane Central Register of Controlled Trials, the researchers retrieved nine eligible randomized controlled trials. A total of 1,096 participants were included, of whom 48.5 percent (n=534) were assigned to the WGL arm and 51.3 percent (n=562) to ROLL. Variability in the definition of a clear resection margin was detected.

Pooled analysis of seven trials found that ROLL led to the involvement of significantly fewer margins than WGL (odds ratio [OR], 1.52, 95 percent confidence interval [CI], 1.03–2.52; p=0.03). Similarly, localization time was significantly shorter in the ROLL vs WGL arm, according to a meta-analysis of five trials (mean difference, 5.83, 95 percent CI, 2.68–8.99; p=0.0003).

ROLL likewise resulted in a significantly shorter operation time than WGL (OR, 1.95, 95 percent CI, 0.27–3.63; p=0.02).

In contrast, both ROLL and WGL proved comparable in terms of re-excision time (p=0.2), weight (p=0.96) and volume (p=0.70) of specimen extracted, rate of successful localization (p=0.63), and the proportion of cancer diagnoses (p=0.10).

No meta-analysis was performed for ease of use, though isolated data points were suggestive that ROLL was superior to WGL in this area as well.

“The trials involved in this meta-analysis were heterogenous in their inclusion criteria, and there has since been a change with regards surgical excision criteria and targets,” the researchers pointed out.

“We would suggest, based on these findings, that future studies are conducted on biopsy proven cancers and B3 lesions not suitable for excision through vacuum assisted means, in order to reliably ascertain whether ROLL is indeed a feasible option in moving forward,” they added.