Background: Magnetic resonance imaging (MRI) guided wire localization presents several challenges apart from\r\nthe technical difficulties. An alternative to this conventional localization method using a wire is the radio-guided\r\noccult lesion localization (ROLL), more related to safe surgical margins and reductions in excision volume. The\r\npurpose of this study was to establish a safe and reliable magnetic resonance imaging-radioguided occult lesion\r\nlocalization (MRI-ROLL) technique and to report our initial experience with the localization of nonpalpable breast\r\nlesions only observed on MRI.\r\nMethods: Sixteen women (mean age 53.2 years) with 17 occult breast lesions underwent radio-guided localization\r\nin a 1.5-T MR system using a grid-localizing system. All patients had a diagnostic MRI performed prior to the\r\nprocedure. An intralesional injection of Technetium-99m macro-aggregated albumin followed by distilled water was\r\nperformed. After the procedure, scintigraphy was obtained. Surgical resection was performed with the help of a\r\ngamma detector probe. The lesion histopathology and imaging concordance; the procedure�s positive predictive\r\nvalue (PPV), duration time, complications, and accuracy; and the rate of exactly excised lesions evaluated with MRI\r\nsix months after the surgery were assessed.\r\nResults: One lesion in one patient had to be excluded because the radioactive substance came back after the\r\ninjection, requiring a wire placement. Of the remaining cases, there were four malignant lesions, nine benign\r\nlesions, and three high-risk lesions. Surgical histopathology and imaging findings were considered concordant in all\r\nbenign and high-risk cases. The PPV of MRI-ROLL was greater if the indication for the initial MR examination was\r\nactive breast cancer. The median procedure duration time was 26 minutes, and all included procedures were\r\ndefined as accurate. The exact and complete lesion removal was confirmed in all (100%) patients who underwent\r\nsix-month postoperative MRI (50%).\r\nConclusions: MRI-ROLL offers a precise, technically feasible, safe, and rapid means for performing preoperative MRI\r\nlocalizations in the breast.
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