lymphoscintigraphies

“While I was doing this I realised that, after
injecting thematerial into the tumour, sometimes it
did not move from the cancer site and we were
missing 30% of the nodes,” he continues. Paganelli
and colleagues found that injecting near the tumour
instead found the sentinel node with much greater
precision. “After nowcarrying outmore than 12,000
sentinel node lymphoscintigraphies,wehavemissed
the sentinel node in only 99 cases, which is a

sensitivity of more than 99%, and the technique is
nowroutine for breast cancer.” It is notable, though,
thatEuropediffers inpractice fromtheUS. “Themoleculewe
use is not authorised by theFood andDrug
Administration, and is larger than the one used in
America – and they see more lymph nodes as their
molecule is not so easily trapped by the sentinel
node. So ourmethod ismore precise.”
This sparked off another innovation.Challenged
in the coffee bar by a surgeon to solve with his ‘hightechmethods’the
growingproblemof locatingnon-palpable
lesionsmoreprecisely,Paganelli’s immediate and
not entirely serious response was, “Simple – inject a
dropof radioactivematerial into the centre of the lesion
and use a gamma probe to locate and remove it.” But
the ideabecame a studyprotocolwithina fewdays and
proved very effective – and has become known as
ROLL (radioguided occult lesion localisation).
Now ‘on a roll’with the work, Paganelli and his

teamhave takenthe elegant stepof combining itwith
the pretargeting approach to add another option for
eliminating residual cancer after a tumour has been
removed in breast conserving surgery.Postoperative,
partial breast irradiation using external beam technology
is the standard treatment, butusually requires
travelling to and fromhospital for daily sessions over
aperiodof sixweeks.Atechniquenowinphase II trial
is to shorten this therapy with a radioisotope treatment,
using the tried and tested avidinbiotinsystem.
“The surgeon injects avidin into the tumour bed
during the operation – no special skill is needed –
thenthe day after, orwhenthe patienthas recovered,
she receives an injection of radioactive biotin in the
nuclearmedicine department. It’s very simple, very
cheapandcanbedone anywhere, andI thinkwemay
be able to replace external beam radiotherapy altogether.
There aremany placeswhere linear accelerators
for radiotherapy arenot available ornot covered