In July 2016, Mr Chilton Chong, Breast Surgeon, and Ms Jane Fox, Director of Breast Surgery, at Monash Health Moorabbin Hospital participated in a Randomised Control trial led by Dr Donna Taylor at the Royal Perth Hospital in Western Australia called ROLLIS (Radio guided Occult Lesion Localisation using Iodine Seed).
The trial involved the use of tiny radioiodine seeds instead of hookwires for localising impalpable breast lesions.
Since the late 1970s, the standard way for breast surgeons to find and remove small tumours in breast cancer patients was tracing a steel wire known as Hookwires which are inserted into the breast lesion and pointing out of the breast. Hookwires are uncomfortable, can dislodge and require a radiologist to insert the wire on the day the patient has surgery.
The ROLLIS technology is a novel repurposing of a device hitherto used to treat prostate cancer, whereby individual radioiodine seeds containing a low dose of radioactivity are inserted next to the breast lesion by the radiologist up to two weeks before the planned surgery date. The Breast surgeon uses a hand held probe in theatre to accurately localise the breast lesion and plan the most appropriate incision to remove the lesion. The seed is then removed and returned to the nuclear medicine department for disposal.
The ROLLIS technique can be applied to all impalpable benign and malignant breast lesions.
Together with seven other major breast cancer units across Australia and New Zealand, the team at Monash Health have now published their findings in the British Journal of Surgery in January this year finding that ROLLIS technique reduced the need to return patients for re-excision of their cancers by 26% compared to conventional hook-wires.
Patients reported the procedure to be comfortable, convenient, and safe and in fact preferred them to standard hookwires.
Radiologists and Breast Surgeons also found the technique much easier.
There was improved efficiency and flow in radiology and in the operating theatre as scheduling surgery was now flexible and more efficient.
As a result, ROLLIS technology has now replaced hookwires as the standard of care for localising impalpable breast lesions at Monash Health.
Monash Health is the only hospital in Victoria using ROLLIS as the “wireless” advance in this field.
The Breast Surgery Unit are now using ROLLIS in a new diagnostic approach to avoid extensive surgery to the axilla.
The ROLLIS study has been a prime example not only of how determination and collaboration between multiple departments at a Victorian public teaching hospital can result in internationally recognised work but also of how clinical research can translate into real-world improvements in patient outcomes.
Mr Chilton Chong and Ms Jane Fox would like to take this opportunity to acknowledge all collaborators who actively contributed to the ROLLIS trial and its successful implementation, with special recognition to the trial participants, the Diagnostic Imaging unit, Nuclear Medicine Unit, the Pathology team, Theatre Department, Breast Surgeons research support team, Breast care Nurses, and teams at the Monash Breast clinics.
Jane Fox, Director of Breast Surgery
Chilton Chong, Breast Surgeon
Approved by Anjali Dhulia