Sentinel node and occult lesion localization (SNOLL): a systematic review.

BACKGROUND: Sentinel node and occult lesion localization (SNOLL) is an alternative to wire-guided localization (WGL) for guiding surgical excision of non-palpable breast cancer and the performance of concurrent sentinel lymph node biopsy (SLNB). This review provides an overview of the available evidence on the accuracy of SNOLL in patients undergoing breast-conserving surgery.

METHODS: PubMed, Embase and the Cochrane Library were searched systematically in April 2013 for studies that address localization of non-palpable breast cancer using SNOLL. Studies were deemed eligible if they reported on the proportion of patients with tumour-positive margins, re-operation rates, performance of concurrent SLNB and considered non-palpable malignant disease only (invasive and in situ) in SNOLL.

RESULTS: Seven studies reported data on SNOLL in 983 patients with non-palpable breast cancers. Overall complete resection rates ranged from 82 to 90.5 per cent. Second operation rates ranged between 2 and 12 per cent and SLNB success rates between 88.2 and 100 per cent. The risk of failed surgical localization was between 0 and 4.5 per cent in the studies.

CONCLUSION: Available scientific evidence suggests that SNOLL is a safe and accurate technique for the localization of non-palpable breast cancers.