Background: The incidence of non-palpable breast cancer is increasing due to widespread screening and neo-adjuvant therapies. Among the available tumor localization techniques, radio-guided occult lesion localization (ROLL) has largely replaced wire-guided localization (WGL). The aim of this study was to compare the ROLL and WGL techniques in terms of the effectiveness of isotopic marking of axillary sentinel lymph nodes and to assess patient perspectives along with surgeon and radiologist preferences. Methods: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Results: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Conclusions: While ROLL provided advantages in terms of patient comfort and logistical simplicity, WGL was superior for axillary sentinel lymph node marking, particularly in inner quadrant tumors, suggesting that WGL may be preferred in these cases.

Accurate specimen marking is crucial during breast cancer surgery to avoid misorientation, which can lead to inadequate re-excision and tumor recurrence. We studied the marking methods at various breast cancer centers to create a tool that would prevent specimen misorientation. An online questionnaire was used to survey marking procedures at major breast cancer centers in Hungary, and a tool was developed using a troubleshooting method. Twelve out of twenty units responded (60%). Nine use an institutionally standardized marking system. Less than half of the surgical teams found specimen mammograms to be unambiguous. In more than 70% of departments, pathologists were uncertain about breast specimen orientation. Ambiguous marking methods caused orientation errors in half of the cases, while unclear marking directions caused the rest. Most pathologists (85%) and surgeons (75%) believed that coronal plane specimen mammography would help solve the problem. A plastic specimen plate has been developed to anchor breast tissue to a coronal breast scheme as seen in mammography images, providing clear localization information throughout the surgical process. There is a lack of standardization in breast specimen orientation and marking in Hungary. An optimized orientation toolkit is being developed to ensure consistent interpretation of specimen mammograms by surgeons and pathologists.

The incidence of non-palpable breast cancer is increasing due to widespread screening and neoadjuvant therapies. Among the available tumor localization techniques, radio-guided occult lesion localization (ROLL) has largely replaced wire-guided localization (WGL). This study aimed to compare ROLL and WGL techniques in terms of the effectiveness of isotopic marking of axillary sentinel lymph nodes and to assess patient perspectives along with surgeon and radiologist preferences. A single-center, prospective randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (Technetium-99m labelled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p<0.05 and strong significance at p<0.01. Both techniques were successful in localizing non-palpable lesions (100%). However, patients reported WGL as more painful. A notable difference was observed in axillary lymph node marking, with subareolar isotope injection (used in WGL) showing better results compared to ROLL. While ROLL provided advantages in terms of patient comfort, and logistical simplicity, WGL was superior for axillary sentinel lymph node marking, particularly in inner quadrant tumors, suggesting WGL may be preferred for these cases.

Background: Accurate orientation of resected breast specimens is essential for proper pathological evaluation and margin assessment. Misorientation may compromise analysis, lead to imprecise re-excisions, and increase the risk of local recurrence. This study aims to evaluate a novel specimen plate designed to maintain consistent tissue orientation and compares its effectiveness to traditional suture marking. Methods: In a single-center, prospective, randomized two-arm trial, 56 specimens were oriented with the new plate and 54 with conventional sutures. Outcomes included intraoperative imaging interpretation, specimen handling, and pathological assessment, with a focus on orientation accuracy and margin evaluation. Results: The specimen plate significantly reduced misorientation (p < 0.01) and improved interpretation during intraoperative imaging. Pathologists reported greater ease in identifying direction and tumor-free zones, leading to a more accurate margin assessment. Non-R0 resections requiring re-excision were fewer with the specimen plate (8.9%) compared to suture marking (22.2%). Conclusions: The newly developed specimen plate can offer a reliable solution for improving specimen orientation in breast cancer surgery; however, further validation in multicenter studies is needed to confirm its applicability across diverse surgical settings. By ensuring consistent orientation and enhancing diagnostic interpretation, it may help reduce re-excisions and improve patient safety.

Esetismertetés: Progresszív gyomorürülési zavar miatt végeztünk műtétet egy hatvanöt éves nőbetegnél. A colon transversumot infiltráló irreszekábilis gyomordaganatot és peritoneális karcinózist észleltünk. Palliatív gasztro-jejunosztómiát és ileo-descendosztómiát helyeztünk fel. A klinikum, az endoszkópia – linitis plastica –, a műtéti kép és az intraoperatív hisztológia gyomor shigillocellularis karcinómát véleményezett. Palliatív onkológiai kezelése alatt állapota stagnált. A három évvel a műtét után kialakult recidív multiplex bőráttétek és a jobb emlő külső-felső negyedében észlelt daganat szövettani hormonreceptor-pozitív, humán epidermális növekedési faktor receptor-2 negatív lobuláris emlőkarcinómát igazolt. A korábbi műtéti minta szövettani revíziója megerősítette az utóbbi diagnózist. Ezt követően palliatív hormonkezelés hatására a tumoros folyamat csaknem komplett radiológiai regressziót mutatott. A beteg panasz- és tünetmentes a kezdeti hasi panaszokat követő hat évvel.Megbeszélés: Az emlő rosszindulatú daganatainak mintegy tizede lobuláris karcinóma. Az emlőrák többi típusától eltérően gyakrabban multicentrikus, bilaterális, okkult és metasztatizál savós hártyákra, hasűri, kismedencei zsigerekbe. Esetünk illusztrálja, hogy az onkológiai kezelés fejlődésével a palliáció új értelmet nyer. Az emlőrákos betegek növekvő túlélése miatt várhatóan a jelenleg ritka emlőrák-eredetű hasűri áttétek száma is növekszik. Előrehaladott hasüregi tumoros folyamatok esetén is nélkülözhetetlen a hisztológiai megerősítés, különösen a szokatlan kórlefolyás esetén. Interdiszciplináris együttműködés, onkoteamdöntések kínálnak csak további javulást az emlőrák diagnosztikájában és terápiájában.