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Abstract
Introduction/Background We present 3 cases of gynecological cancer recurrences in which the ROLL technique has been used for its detection and extirpation.
Methodology The technique consists of the intralesional injection of the CT-guided radiotracer on the day prior to surgery by administering 5 mCi of Tc99m-Macroaggregated albumin. Scintigraphic imaging is performed immediately with SPECT-CT to confirm the correct intralesional injection. In the surgical act, a gamma wireless laparoscopic probe is used to localize the lesions.
Results The first case was a 25-year-old woman, diagnosed with a breast angiosarcoma treated in 2013 with simple mastectomy and adjuvant chemoradiotherapy.
In 2017 a suspicious lesions were observed in MRI at the level of the right subcostal wall and in the left hemipelvis. The decision was to remove both lesions with ROLL.
The second case was of a 58-year-old woman who underwent primary cytoreduction and adjuvant chemotherapy in 2013 due to borderline ovarian carcinoma.
In 2018 malignancy suspicious implants were visualized by MRI at the paraortic level and at the Douglas sac. They were excised with the ROLL technique.
The third case was a 46-year-old woman diagnosed with high-grade serous ovarian cancer in stage IIIC in 2015, treated with optimal primary cytoreduction and adjuvant chemotherapy. In September 2018, during the control MRI an implant was identified in the right iliac fossa in close contact with the external iliac vessels. It’s size was 15 mm and it was compatible with recurrence and inguinal node of 9 mm suspect. We decided to perform PET-CT for ROLL technique surgery.
In all cases, the implants were successfully removed by laparoscopy with surgical time, morbidity and length of hospital stay reductions.
Conclusion This technique, already used successfully in other specialties, is increasingly used in oncological gynecology. It allows accurately removing implants that, due to size and location would be difficult to remove otherwise.
Disclosure Nothing to disclose.
Intralesional injection of the radiotracer guided by CT
3D reconstruction of left hemipelvic lesion (case 1)