Radio-guided occult lesion localization for nonpalpable suspicious breast lesions: A novel technique

Background : Breast screening programs and increased self-awareness has led to increased identification of early breast cancers. Up to 25% of mammographicaly identified lesions are nonpalpable, which require a precise technique to localize and excise completely. Radio-guided occult lesion localization (ROLL) is a technique, which uses hand held gamma probe to accurately localize and completely excise occult beast lesions. ROLL can also be combined with sentinel lymph node biopsy (SLNB) for early breast cancers. This is a minimally invasive approach with least morbidity and better patient compliance. Materials and Methods : 25 cases underwent ROLL for nonpalpable breast lesions. 99m Tc-sulphur colloid was injected into the center of the lesion under ultrasound guidance preoperatively. No guidewire localization was performed. Under general anesthesia, surgical excision of the lesion was carried out using the hand-held gamma probe. Fifteen patients were diagnosed with early breast cancer with clear margin status. These patients also underwent SLNB at the same procedure. Results : Fifteen out of 25 cases were found to harbor invasive breast cancer. The pathological margins were clear of tumor in all of these patients. The sentinel node was identified in all cases. In four out of the 15 cases, sentinel node harbored occult metastases. Conclusion : ROLL is a useful method for precise, three-dimensional localization of impalpable breast tumors with results comparable to those achieved by surgery of palpable lesions. Furthermore, ROLL is feasible in connection with sentinel node biopsy in the same setting. It is performed as a day-care procedure with good cosmesis

Radio-guided occult lesion localization for nonpalpable suspicious breast lesions: A novel technique

Background : Breast screening programs and increased self-awareness has led to increased identification of early breast cancers. Up to 25% of mammographicaly identified lesions are nonpalpable, which require a precise technique to localize and excise completely. Radio-guided occult lesion localization (ROLL) is a technique, which uses hand held gamma probe to accurately localize and completely excise occult beast lesions. ROLL can also be combined with sentinel lymph node biopsy (SLNB) for early breast cancers. This is a minimally invasive approach with least morbidity and better patient compliance. Materials and Methods : 25 cases underwent ROLL for nonpalpable breast lesions. 99m Tc-sulphur colloid was injected into the center of the lesion under ultrasound guidance preoperatively. No guidewire localization was performed. Under general anesthesia, surgical excision of the lesion was carried out using the hand-held gamma probe. Fifteen patients were diagnosed with early breast cancer with clear margin status. These patients also underwent SLNB at the same procedure. Results : Fifteen out of 25 cases were found to harbor invasive breast cancer. The pathological margins were clear of tumor in all of these patients. The sentinel node was identified in all cases. In four out of the 15 cases, sentinel node harbored occult metastases. Conclusion : ROLL is a useful method for precise, three-dimensional localization of impalpable breast tumors with results comparable to those achieved by surgery of palpable lesions. Furthermore, ROLL is feasible in connection with sentinel node biopsy in the same setting. It is performed as a day-care procedure with good cosmesis

Real-World Experience with Nivolumab in Metastatic Renal Cell Carcinoma Patients Who Have Progressed on Prior Therapies: A Single-Center Study from India

Abstract Amit Rauthan Introduction Nivolumab monotherapy is approved for the treatment of metastatic renal cell carcinoma (mRCC) patients who have progressed on prior therapies based on the pivotal Checkmate-025 trial. There is limited literature on the efficacy and safety profile of usage of nivolumab in the treatment of mRCC in India in a real-world setting. Methods A retrospective analysis was performed of patients who received nivolumab monotherapy for mRCC after having progressed on prior therapies. Tumor response was graded according to RECIST v1.1 and Kaplan–Meier survival analysis was used to estimate progression-free survival (PFS) and overall survival (OS). Immune-related adverse events (irAEs) were documented and graded according to CTCAE v5.0. Results Between 2016 and 2019, 35 patients received nivolumab for mRCC at our center after progression on prior therapies. A majority of the patients (n = 30, 85.7%) received it in a second-line setting, and the remaining in the third line and beyond setting. Clear cell was the most common histology (n = 26, 74.3%). There were 18 patients (51.42%) who belonged to IMDC intermediate risk, while 17 (48.58%) patients were at poor risk. The overall response rate was 60%, with complete response (CR) in 11.4%. Median duration of response was not reached among responders. Median PFS was 5 months (95% confidence interval [CI]: 3.06–6.93) and median OS was 26 months (95% CI: 1.90–50.09). Ongoing survival of 47, 42, 34, and 22 months was noted in four patients with CR, respectively. In our study, 23 patients (65.71%) experienced any grade of irAE. Grade 3 irAEs was seen in four patients (11.42%). Most common irAE was thyroid dysfunction seen in 12 patients (34.2%). Treatment discontinuation due to irAEs occurred in three patients (8.57%). Conclusion Nivolumab showed good efficacy with high response rates and an OS comparable to the pivotal Checkmate-025 trial. It was well tolerated with safety profile in terms of irAE consistent with those reported in literature