Background: Due to the spread of mammographic screening programs, a constant increase
of clinically-occult breast cancer diagnosis has been registered. A correct approach to nonpalpable
breast lesions requires an accurate intra-operative localization in order to achieve a complete
surgical resection. The aim of this paper is to describe the state of the art of the US-guided
procedures such as Radio-guided Occult Lesion Localization (ROLL) and Radio-guided Seed Localization
(RSL) in comparison to the most widely adopted Wire-Guided Localization (WGL).
Methods: Links to full text papers and abstracts published in the last 25 years regarding localization
of non-palpable breast lesions were researched using PubMed service of US National Library
of Medicine. Using the term “non-palpable breast lesions localization”, different localization techniques
were considered and analyzed. Human studies, published in English, French, German, Italian,
and Spanish in journals with an impact factor index, were taken into account, independently of
the type of article (clinical trial, review, editorial, etc.) or radiopharmaceutical used. Since the aim
was to assess the clinical value of the procedures, a higher relevance was assigned to studies with
significantly high number of patients and to those comparing at least two localization techniques.
The reliability of each technique was evaluated taking into account several parameters such as correlation
index between two localization procedures, risk of complications, lesion margin involvement
and rate re-operation.
Conclusions: Since their introduction in clinical practice, several randomized clinical trials and
meta-analyses showed the accuracy and reliability of radio-guided procedures performed under ultrasonographic
ROLL and RSL offer a practical approach to the management of clinically-occult breast lesions.