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Objective:
The axilla is a favourable site for lymphadenopathy, metastasis, breast lesions arising from accessory breast tissue, soft tissue tumors and post-surgical complications. Lymphadenopathy accounts for 80% of axillary lesions. In breast cancer, the most common cancer among women, axillary staging is crucial in deciding on tailored treatment and determining prognosis. Currently, less aggressive approaches like breast conserving surgery, sentinel lymph node biopsy and tailored axillary treatment are preferred in the management of node positive breast cancer patients, however the accuracy, efficiency and safety of these techniques have to be consistently evaluated to avoid local recurrence, reoperation and further complications. A relatively new technique in the management of axillary lymphadenopathy is localization using Radioguided Occult Lesion Localization (ROLL) method that can be performed under ultrasound guidance. The localization technique has gained importance and popularity with the rising utilization of Neoadjuvant Chemotherapy (NACT) and targeted axillary dissection (TAD) and is preferred over other localization techniques like hookwire localization in breast cancer patients who present with regional lymph node metastasis at the time of diagnosis. In this study the authors aim to evaluate feasibility of the method in localizing axillary nodes.

Materials and Methods:
From March 2020 to July 2023, 24 axillary nodes from 17 patients underwent ultrasound guided ROLL localization in the Department of Diagnostic and Interventional Imaging (DDII) of KK Women’s and Children’s Hospital, all were included in the study. ROLL procedures were performed by experienced breast radiologists. A hand-held gamma probe was used to localize the area of maximum radioactivity, allowing the appropriate location of the incision and subsequent removal of nodes by the surgeon. The excised specimens were sent back to DDII for radiography/ultrasound to confirm the presence of clip. Finally samples from the retrieved specimens were fixed in formalin and sent to pathology department of KK Hospital for histopathologic evaluation.

Results:
Of 24 nodes, 11 (45.8) were clipped, mostly using UltraCor Twirl and rest were not clipped. Only in one patient with two clipped nodes, one of them was not visible with ultrasound and radioisotope was not injected. In 23 cases (95.8 %) ultrasound guided ROLL was successful in localizing axillary nodes and radioisotope was appreciated in post injection scintigram.

Conclusion:
Ultrasound guided ROLL is an easy, effective and accurate method for localization of axillary nodes, possessing many advantages like being patient comfort without collateral injury to vital structures in the axilla, cost effectiveness, low radiation exposure, schedule flexibility and combined use with sentinel lymph node biopsy in one surgical setting (SNOLL). The technique shows comparable clinical outcomes to the current standard of practice using wire guided localization.