ROLL / Hookwire Localisation and Excisions

Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

Breast Lesion Localisation

Breast lesion localisation is a critical pre-operative procedure used in the management of non-palpable breast lesions. Non-palpable lesions cannot be felt during a physical examination but are detected through imaging techniques such as mammography or ultrasound.

The primary purpose of breast lesion localisation is to accurately mark these hidden abnormalities so that they can be surgically removed with precision.

Overview of ROLL (Radioguided Occult Lesion Localisation)

Radioguided Occult Lesion Localisation (ROLL) is a technique used to guide the surgical removal of non-palpable breast lesions.

This method involves using a radioactive tracer that is typically injected directly into the lesion, guided by imaging techniques. The tracer emits gamma rays, which are detected during surgery, allowing the surgeon to accurately excise the lesion based on the highest concentration of radioactivity.

Overview of Hookwire Localisation

Hookwire localisation is another commonly used technique for identifying non-palpable breast lesions.

This method involves placing a fine wire, with a hooked end, into the breast under imaging guidance. The wire acts as a direct marker, leading the surgeon to the lesion during surgery.

Procedure Steps for ROLL

The ROLL procedure involves a series of steps to ensure the accurate placement of the radioactive tracer and successfully remove the breast lesion.

Pre-Procedure

Lesion Imaging: Before the procedure, detailed imaging studies, such as mammography or ultrasound, are performed to determine the exact location of the lesion.

Tracer Injection

Radiotracer Preparation: A radioactive tracer, typically Technetium-99m, is prepared in the nuclear medicine department.
Guided Injection: Under imaging guidance, usually using ultrasound or mammography, the radiologist injects the radiotracer directly into the lesion. The injection must be precise to ensure that the tracer sufficiently covers the target area.

Surgical Excision

Detection of Radioactivity: The surgeon uses a handheld gamma probe to detect the radioactivity emitted by the tracer.
Lesion Localisation and Excision: Guided by the probe’s readings, the surgeon identifies the area of highest radioactivity, which correlates with the location of the lesion. The lesion is then surgically removed.

Post-Procedure

Immediate Post-operative Care: The excised tissue is sent for pathological analysis to confirm the removal of all abnormal cells and to assess the margins.
Follow-up: Follow-up appointments are scheduled to monitor the surgical site and discuss the pathology results, ensuring the patient’s recovery and addressing further treatment needs.

Procedure Steps for Hookwire Localisation

The following steps outline the typical procedure for implementing Hookwire localisation:

Lesion Imaging: Accurate imaging studies, such as mammography or ultrasound, locate the lesion and plan the wire placement.

Local Anaesthesia: Local anaesthesia is administered at the insertion site to minimise discomfort.

Wire Placement: Under real-time imaging guidance, a radiologist inserts the hookwire through the skin and into or near the lesion. The wire has a hook at the end to anchor it securely within or around the lesion.

Confirmation of Placement: Imaging confirms that the hookwire is correctly positioned relative to the lesion.

Guidance to Lesion: During surgery, the protruding part of the wire guides the surgeon to the lesion.

Lesion Removal: Following the wire, the surgeon excises the lesion, including the hooked end of the wire within the excised tissue, to confirm complete removal.

Assessment of Margins: The excised tissue, along with the hookwire, is sent for pathological examination to assess if the lesion has been fully excised and to evaluate the margins.

Immediate Post-operative Care: Post-operative care includes monitoring for any complications at the wire insertion site and managing pain.

Follow-up: The patient will have follow-up visits to review the pathology report, assess healing, and discuss any further treatment necessary based on the surgical and pathological findings.

Comparison of ROLL and Hookwire Techniques

Accuracy and Precision

Both ROLL and Hookwire are highly accurate in localising breast lesions. However, ROLL may offer enhanced precision as the radiotracer provides a three-dimensional sense of the lesion’s location, which can be advantageous in complex anatomical situations.

Patient Comfort and Experience

ROLL is generally considered more comfortable for patients, as it involves a less invasive procedure, with the radiotracer injection typically causing less discomfort than the insertion of a hookwire.

Surgical Efficiency

The Hookwire technique is straightforward and provides a physical guide directly to the lesion, which is particularly beneficial in surgeries where achieving clear margins is important. Clear margins ensure that no malignant cells remain at the edges of the removed tissue, reducing the risk of recurrence and the need for further surgical interventions.

However, ROLL potentially reduces surgery time as it provides a clear indication of lesion boundaries, helping to minimise the amount of healthy tissue removed.

Risk of Complications

The risk of displacement or migration of the hookwire can be a concern, potentially leading to inaccurate lesion removal or the need for additional surgery. In contrast, the radiotracer used in ROLL is less likely to shift once injected, providing a stable target for surgical excision.

Dr Jesse Hu

Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

Dr Jesse specialises in managing both benign and malignant breast and thyroid conditions, which also includes breast pain, breast lumps, breastfeeding problems, neck lumps, amongst others.

Her dual expertise in cancer removal and plastic surgery techniques expands the design of individualized treatments, leading to holistic patient outcomes.

Dr Jesse was part of the teaching faculties of both NUS Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine, where she teaches and mentors the next generation of medical students and trainee doctors.

Surgical training at NUS School of Medicine
FRCS (Fellow of the Royal College of Surgeons) Edinburgh, UK in 2014
Completed 2 Health Manpower Development Program (HMDP) fellowships at Oxford University Hospital, UK in 2016

Dr Jesse is recognized as an authority in breast cancer and thyroid surgery and a sought-after conference speaker.

Read Full Bio

Our clinics are under the following

insurance panels

For Singaporeans, Singapore Permanent Residents and Foreigners.
Please speak to our friendly clinic staff about using your insurance plans.

Reach Out To Us

We are committed to providing a one-stop experience, where you’ll receive a meticulous consultation and high-quality service in a comfortable environment.

Get Started

Book An Appointment

ROLL / Hookwire Localisation and Excisions

Frequently Asked
Questions

Why is localisation necessary before surgical excision of a breast lesion?

Localisation marks the exact position of a breast lesion to guide surgeons during excision, ensuring precise removal and minimising damage to surrounding healthy tissue.

How does ROLL differ from traditional biopsy techniques?

ROLL involves injecting a radiotracer directly into the lesion and using gamma radiation to guide the surgical removal, unlike traditional biopsies that typically involve removing a sample of tissue for testing.

Can ROLL be used for lesions other than those in the breast?

While primarily used for breast lesions, ROLL can potentially be adapted for localising small, non-palpable lesions in other areas of the body, depending on the clinical setting.

What happens if the hookwire moves or dislodges before surgery?

If the wire dislodges or moves, it may require repositioning, which can be done under imaging guidance to ensure accuracy before surgery.

ROLL / Hookwire Localisation and Excisions

Breast Lesion Localisation