BACKGROUND:Microvascular free flap reconstruction is central to contemporary head and neck cancer surgery. Although plastic surgeons have traditionally performed these reconstructions, evolving training pathways have enabled other surgical subspecialties to acquire advanced microsurgical expertise. Comparative data between plastic surgeons and surgical oncologists trained in microsurgical reconstruction remain limited. METHODS:We performed a retrospective cohort study of 300 patients who underwent head and neck reconstruction at the Cancer Institute of Iran between 2013 and 2022. Patients were stratified by operating surgeon specialty (surgical oncologist vs. plastic surgeon). Primary outcomes included operative duration, postoperative hemorrhage, flap failure, intensive care unit (ICU) stay, and mortality. Cumulative sum (CUSUM) analysis was used to assess performance trends and learning curves over time. RESULTS:Of 300 reconstructions, 192 (64.0%) were performed by surgical oncologists and 108 (36.0%) by plastic surgeons. Baseline demographics and comorbidities were comparable between groups. There were no significant differences in flap failure (9.4% vs. 9.3%), postoperative hemorrhage (7.3% vs. 3.7%), ICU stay, or mortality (4.2% vs. 3.7%). Operative duration was longer in the surgical oncology group on unadjusted analysis; however, surgeon specialty was not an independent predictor after multivariable adjustment. CUSUM analysis demonstrated stable outcomes over time for both groups, with no evidence of an active learning curve. CONCLUSION:In a high-volume center with structured microsurgical training, surgical oncologists achieve outcomes comparable to plastic surgeons in head and neck reconstruction. These findings support expansion of microsurgical reconstruction beyond traditional specialty boundaries when appropriate training and institutional support are present.

This study aimed to compare the functional and esthetic results in patients following mandibular reconstruction with a free fibula flap (FFF) by virtual surgical planning (VSP) versus the conventional technique. Patients who had undergone mandibular reconstruction with a FFF by VSP or the conventional technique were retrospectively assessed. The two groups were compared regarding functional and esthetic variables with appropriate scales preoperatively, intraoperatively, and postoperatively. Twenty-four patients were evaluated in two groups: conventional ( n = 8) and VSP ( n = 16). The mean amount of mandibular asymmetry was 2.62 mm (SD = 1.59) in the conventional group and 1.19 mm (SD = 1.32) in the VSP group. Of the patients who underwent conventional surgery, 12.5% had mandibular asymmetry of <2 mm and 87.5% had asymmetry of 2 -5 mm. Of the VSP patients, 61.5% had mandibular asymmetry of <2 mm and 38.5% had mandibular asymmetry of 2 -5 mm ( p = 0.03). The mean difference in size of mandibular angle on the surgical and control sides was not significantly different between the two groups ( p = 0.62). The difference in mean length of the mandibular body on the surgical side relative to the control side was not significant between the two groups ( p = 0.75). Differences in functional variables between the two groups were not significant. Within the limitation of the study, it seems that the VSP technique resulted in better facial symmetry and superior esthetic outcomes compared with the conventional technique.

BACKGROUND:Thrombus formation following flap reconstruction reduces perfusion and can lead to flap compromise. Effective anticoagulation protocols are essential to prevent this complication. PURPOSE:The study's purpose was to measure and compare flap compromise associated with 3 different anticoagulation protocols. STUDY DESIGN, SETTING, SAMPLE:This retrospective cohort study included patients with head and neck cancer who underwent flap reconstruction. Exclusion criteria included patients who did not consent to participate, did not receive the anticoagulation regimen, or had a history of adverse reactions to heparin or aspirin (ASA). EXPOSURE:The primary exposure was the anticoagulation protocol, which was divided into 3 groups: intravenous unfractionated heparin (IV-UFH), subcutaneous UFH (SC-UFH), and SC-UFH plus ASA. MAIN OUTCOME VARIABLE:The outcome variable was postoperative flap outcome coded as compromised or not. COVARIATES:Covariates included patient demographics, cancer type, neoadjuvant therapy, flap type, surgical procedure, intensive care unit stay, medical history, and postoperative complications. ANALYSES:χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for baseline data analysis. Multivariate logistic regression was conducted to examine the adjusted association between anticoagulation protocol and flap outcome. P values < .05 were considered statistically significant. RESULTS:The study sample consisted of 300 patients who met inclusion criteria with a mean age of 48.3 (±17.69) years, 202 (67.3%) of whom were male. There were 28 (9.3%) cases of flap compromise. The unadjusted analysis showed that patients receiving IV-UFH had a significantly higher risk of flap compromise compared to those receiving SC-UFH (relative risk: 3.43 [1.62 to 7.28]). Adding ASA to SC-UFH did not result in a statistically significant reduction in the risk of flap compromise (relative risk: 0.95 [0.35 to 2.61]). After adjusting for confounding factors, the anticoagulant type was not associated with flap compromise (P = .05). However, in the subgroup analysis, compared to SC-UFH, subjects receiving IV-UFH still had higher odds of flap compromise (odds ratio = 2.69, 95% CI [1.003 to 7.205], P = .049) CONCLUSION AND RELEVANCE: Postoperative thrombosis in head and neck microsurgery remains a significant risk factor for poor outcomes. SC-UFH administration may be a practical approach to managing these risks compared to intravenous administration; however, the choice of anticoagulation protocol is not associated with the flap compromise.

Purpose: The pectoralis major flap (PMF) is an important reconstructive tool for defects in the head and neck region but excessive bulk and a limited arc of rotation can be problematic. These problems can be addressed by passing the pedicle deep to the clavicle but some authors feel that this modification may compromise the vitality off the flap. In the current article, these problems have been addressed by using a modified method. Patients and methods: During the past 15 years (2000 to 2014) 182 head and neck cancer patients were treated for primary reconstruction following tumor ablation. PMF was modified by passing the pedicle deeply to the clavicle. Following flap harvest, the pedicle was passed in the subclavicular plane for reconstruction. Results: It was possible to increase the average length of PMF to 2.5-3.5 cm compared to the supraclavicular route by using this modification. Minor complications were observed in 9 of 182 cases (5%): Partial flap necrosis occurred in 6 cases and fistula formation was observed in 3 cases. Conclusions: The subclavicular route increases the length and arc of rotation without compromising vascular supply to a higher degree compared to the conventional supraclavicular route. Furthermore, this concept decreases the bulk of the flap pedicle which is functionally and cosmetically favourable.

Article info: Received: 12 July 2018 Accepted: 27 August 2018 Available Online: 15 September 2018 Checked for Plagiarism: Yes Peer reviewers approved by: Dr. Melika Andrew Language Editor: Prof. Dr. Muhammad Azam Kakar Editor who approved publication: Prof. Dr. Nanuli Doreulee

Purpose: To assess the availability, success rate and complications of microvascular iliac crest free flap for reconstruction of mandibular segmental defects. Methods: In this retrospective-descriptive study, we report patients who had undergone segmental mandibular resection for pathologic lesions and received reconstruction with iliac crest microvascular free flap between 2016 and 2019. Clinical and demographic data of all the cases were collected. Success was regarded as complete consolidation of the bone graft in panoramic radiograph. Postoperative complications were defined as major or minor based on the need for intervention. T-test, Kolomogorov_Smirnov, and multivariate analysis were used and the p-value<0.05 was considered to be statistically significant. Results: Of all 30 patients, 16 were women and 14 were men with an average age of 27.2 years (range 14-40). Patients were followed for 12-60 month (mean: 38.4). One flap was lost due to unsalvageable venous thrombosis. Six other cases had post-op complications while smoking and diabetes were associated with more complications (P = 0.036). Twenty-three patients received primary reconstruction which was more successful than secondary ones (P = 0.003). Osteogenic sarcoma was associated with greater risk of complications (P < 0.01). Conclusions: The results of this study suggest that iliac crest microvascular free flap serves as a promising option for the reconstruction of mandibular defects, providing excellent contour and acceptable success rate with low donor site morbidity. Future studies will focus on the role of systemic diseases in post-op complications and flap failures.

Background: Breast cancer may result in remodeling of adjacent normal appearing breast tissues. Magnetic resonance imaging (MRI) is increasingly used in the diagnosis and follow-up of breast cancer by means of diffusion weighted imaging, which is based on thermal motion of water molecules in the extracellular fluid. Objectives: We investigated the correlation of visual assessment of peri-tumoral edema with peri-tumoral and tumoral apparent diffusion coefficient (ADC) values. Patients and Methods: In this cross-sectional study, from 2016 to 2018, 78 patients with 89 malignant breast lesions (mean age, 47 years) were examined by 1.5-T breast MRI. The lesions were categorized based on the visual assessment of peri-tumoral edema on T2 weighted imaging (T2WI) into two groups: (A) with edema (36 lesions) and (B) without edema (53 lesions). Measuring ADC values in the contralateral normal breast tissue, peri-tumoral tissue and peri-tumoral-normal tissue ADC ratio were compared between the two groups for all lesions. Results: The number of in situ lesions was higher in group B (7.5% vs 2.7%) with the p value of 0.01. The mean of ADC values in the normal breast tissue was 1.76 × 10-3mm2/s. Tumor ADCs were significantly lower in group A compared to group B (0.95 × 10-3mm2/s vs. 1.11 × 10-3mm2/s) with the P value of 0.003. However, peri-tumoral ADCs were significantly higher in group A (1.82 × 10-3mm2/s vs. 1.53 × 10-3mm2/s) with the p value of 0.005. The peri-tumoral-normal tissue ADC ratio was 0.87 in group B and about 1 in group A. However, the difference between normal tissue ADCs and peri-tumoral ADCs was only significant (P value of 0.005) in group B. The cut-off point value for differentiating normal tissue ADCs and peri-tumoral ADCs was 1.61 × 10-3mm2/s with the sensitivity of 65% and specificity of 70%. Conclusion: Breast cancer with peri-tumoral edema has lower tumoral ADC values, higher peri-tumoral ADC values and lower prevalence of in situ lesions. Visual assessment of peri-tumoral edema on T2WI could predict the tumoral characteristic on diffusion-weighted imaging.

Background: Diffusion-weighted imaging (DWI) is one of methods in evaluation of breast lesions. We aimed to investigate the apparent diffusion coefficient (ADC) values in breast tumors and their accuracy in differentiating benign versus malignant lesions. Methods: In this cross-sectional study, 72 patients with 88 breast lesions were investigated by 1.5-T breast MRI from 2015 to 2017 in Athari Imaging Center in Tehran, Iran. Nearly all patients has undergone histopathology evaluation. One small region of interest (ROI) were placed on the most restricted region inside the solid part on the ADC map. Care was taken to avoid cystic or necrotic, fatty regions and hematoma inside the mass. A large round ROIs were placed in healthy fibroglandular tissue of contralateral breast ADC values were measured and compared in normal breast tissue and in most restricted parts of breast lesions (mass and non-mass). After determining cut-off for differentiation of benign and malignant lesions, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated. Results: Mean age of patients was 43.3 years. The average tumor size of benign and malignant lesions were calculated 26.0 mm, 35.3 mm respectively and 23 mm and 46 mm in mass and non-mass respectively. Invasive ductal carcinoma include the majority of pathology result (in 37.5% of the patients). Our results revealed that the measured ADC values in normal breast tissue were higher than breast lesions (P≤0.01). Mean ADC value in benign lesions was 1.40×10-3 mm²/s and for malignant lesion was 1.08×10-3 mm²/s. ADC value in the normal breast tissue was 1.79×10-3 mm2/s and was significantly higher than ADC value of breast lesions (benign and malignant). Cut-off value in non-mass was not valid, but in mass was 1.19×10-3 mm²/s with sensitivity, specificity, positive predictive value, negative predictive and accuracy of 89.7%, 83.8%, 87.5%, 86.6%, and 87.1% respectively. Conclusion: In DWI imaging, ADC value can differentiate benign and malignant masses with high sensitivity and specificity but not helpful in non-mass lesions.

This cross-sectional study aimed to assess and compare quality of life in patients with advanced oral cavity tumors after mandibular resection in 3 groups (no reconstruction, reconstruction with plate, and reconstruction with flap) at the Cancer Institute, affiliated to Tehran University of Medical Sciences. Quality of life was measured using the European Organization for Research and Treatment of Cancer core quality of life questionnaire and European Organization for Research and Treatment of Cancer head and neck cancer-specific quality of life questionnaire-35 items. The comparison was tested using Kurskal-Wallis analysis. All 120 patients were entered into the study. The mean age of patients was 48.5 (standard deviation=18.1) years. Patients presented with advanced stage of the disease and underwent mandibular resection with no reconstruction (n=40), reconstruction with plate (n=41), and reconstruction with flap (n=39). The findings showed that in general, there were no statistically significant differences in quality of life among 3 groups except for speech problem (P=.4), dry mouth (P=.03), and feeling ill (P=.04). Although there were no significant differences in quality of life among patients in 3 groups, overall patients who received reconstruction with flap reported better functioning and fewer symptoms. Those who did not receive any reconstruction reported the worse conditions.

Purpose: We aimed to investigate the influence of different methods of region-of-interest (ROI) placement onapparent diffusion coefficient (ADC) values in breast tumours and their accuracy in differentiating benign versusmalignant tumors in mass and nonmass lesions. Methods and Materials: In this prospective study, 79 patients with98 breast lesions, from 2015 until 2017, were investigated by 1.5-T breast MRI. Histopathology evaluation were donefor all malignant lesions and most of the benign ones. ADC values were measured in normal breast tissue and by twoways of ROI placement in the breast lesions (mass and non-mass): 1- ROI covering the whole lesion, 2- ROI in thehighest part (most restricted area) of the lesion in DWI images. The accuracy of these two approaches were compared.Results: The age range was 17-68 years with mean age 43.3 ± 9.9 years. 49% of the lesions were benign and 51% oftumors were malignant. Our results revealed that the measured ADC values in normal breast tissue were higher thanbreast lesions (P≤0.01). Appropriate cut off determination in non-mass was not valid by both methods, but in mass inthe first way was 1.45×10 -³mm²/s and in the most restricted part was 1.16×10-³ mm²/s. ADC values differed significantlybetween the two ways of ROI placement in mass lesions (P<.001). Most restricted part ADC showed the best diagnosticperformance in mass lesions with area under curve 0.88 versus 0.82. Conclusion: ROI placement has significant impacton the meseaured ADC values of breast lesions and ROIs in most restricted parts were more accurate than whole-lesionROIs. Cut-off values differed significantly based on the methods of measurement.

Introduction Breast magnetic resonance imaging (BMRI) has been identified as a valuable modality in the diagnosis of breast cancer and monitoring the response to chemotherapy. The aim of this study was to evaluate the relative importance of different descriptors of breast masses in contrast-enhanced breast MRI. Material and methods In a database of pathologically proven breast lesions, in total 433 masses in 312 patients detected by contrast-enhanced breast MRI were selected. All images were assessed according to the MRI BI-RADS lexicon and those with significant positive MRI findings (BI-RADS categories 3, 4, 5) were enrolled in the study. Results Mean age of patients was 45.09 ±10.5 years. The most frequent BI-RADS score was 4 (60.7%), followed by 3 (27%). Among the morphologic descriptors of the enhancing masses, the findings most strongly associated with malignancy included spiculated margin (60.6%) and irregular shape (38%). Considering the dynamic descriptors, a wash-out pattern in the time-intensity curve was the most powerful finding associated with malignancy (27.9%). Among all breast MRI descriptors, the best odds ratio (OR) in association with malignancy was noted for speculated margin (OR = 10.2) followed by wash-out or plateau curves (OR = 6.1), size greater than 1 cm (OR = 4.3) and irregular shape (OR = 3.1). Conclusions It seems that morphologic descriptors of MRI BI-RADS for enhancing masses are quite specific, while dynamic descriptors of the masses are highly sensitive. Appropriate consideration and combination of different BI-RADS findings could help in better characterization of enhancing masses on breast MRI, lowering the rate of false positive reports and avoiding unnecessary biopsies.

INTRODUCTION:Academic institutions are the most important organizations for implementation of internationalization policies and practices for integrating an international, intercultural and global dimension in higher education system. Also, a globally increasing demand for higher education has been seen in the past two decades so that the number of students enrolled in higher education institutions in the worldwide nation-states has increased dramatically. The National Plan of International Development of Medical Education was designed with the aim of identifying available potentials in all the universities of medical sciences, encouraging the development of international standards of medical education, and planning for the utilization of the existing capacity in Islamic republic of Iran.METHODS:Authors have tried to review the several aspects of international activities in higher education in the world and describe national experiences and main policies in globalization of medical education in Iran within implementation of the National Plan for Development and Innovation in Medical Education.RESULTS:The findings of some global experiences provide the policy makers with clear directions in order to develop internationalization of higher education.CONCLUSION:The Program for International Development of Medical Education was designed by the Deputy of Education in the Ministry of Health and the effective implementation of this Program was so important for promotion of Iranian medical education. But there were some challenges in this regard; addressing them through inter-sectoral collaboration is one of the most important strategies for the development of internationalization of education in the field of medical sciences.

Introduction: Non-melanoma skin cancer (NMSC) has recently been one of the three most common cancers in Iran. Inappropriate management of the disease has led to an increase in the prevalence and overhead costs. Data mining techniques are helpful in the analysis of patient records and accurate management of diseases. This study aimed to find hidden patterns and relationships in the data of NMSC patients using data mining algorithms. Methods: In this applied study, study population consisted of medical records of 828 NMSC patients referred to the Cancer Institute of Imam Khomeini Hospital in Tehran during 2006-2015. Demographic variables and NMSC risk factors were clustered using K-Means algorithm. Apriori algorithm was applied as well for extraction of association rules and determination of patient’s common information with a confidence of ≥ 0.9. Results: According to the studied variables, NMSC patients were classified in four clusters and three important factors influencing the disease were identified as abnormal BMI, high risk occupations and previous history of cancer. Seven rules were approved by association rules and the highest associations were found between the past history of the disease, the involved site, the relapse, and the type of NMSC. Conclusion: For the first time, this study could highlight the most important factors affecting NMSC using data mining methods. These factors should be considered either in self examination or screening skin tests in high-risk groups. In future studies, the contribution of physiological, ecological and genetic factors in the development of skin cancer should be jointly investigated as well.

Background: In pattern skin flap, distal flap necrosis happens as a result of insufficient blood reserve. Micro needling with a roller device is a new treatment. In this study, the we search micro needling to increase flap viability.Methods: 30 adult male Sprague-Dawley rats were divided into two groups of 15. The study group was exposed to McFarlane flap elevation and repositioning. The microneedling procedure was performed four times: 3 days before, on the day of, and on the third and sixth days after surgery. The control group was only exposed to surgery. The skin flap necrosis area was measured on the seventh postoperative day topographically by digital imaging and scintigraphy. After determination of necrosis area, the amount of neovascularization and number of vascular structures within the papillary dermal layer were countedResults: The mean percentages of necrosis in the flap area as determined by the Digimizer analysis program were 37.51 +/- 5.08 in the control group and 29.42 +/- 7.37 in the study group. The comparison of flap necrosis percentages showed that the study group is equal to study group. Vessel counts in the study group also do not showed significantly with control group (p> 0.05).Conclusions: The authors study showed that the microneedling method applied directly on the flap could modality flap viability but we suggested microneedling method apply 1 week before operation.

Preservation of Forehead Flap Pedicle in Nasal Reconstruction: A Technical Note Ata Garajei, Ali A. Kheradmand, Azadeh Emami, and Ali Homayouni Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Department of Head and Neck Surgical Oncology and Reconstructive Surgery, The Cancer Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Corresponding author: Ata Garajei, The Cancer Institute, Imam Hospital Complex, Keshavarz Blvd., Tehran, Iran. Tel: +98-2166581544, Fax: +98-2166428655, E-mail: atagarajei@tums.ac.ir

Introduction: Breast cancer is one of the most common cancers among women. One complication after mastectomy following breast cancer is ipsilateral upper extremity lymphedema. This study aims to compare the effect of complex decongestive physical (CDP) therapy with a combination of intermittent pneumatic compression pump and CDP therapy on secondary upper extremity lymphedema volume and quality of life in patients after mastectomy following breast cancer. Material and Methods: A total of 20 women with secondary upper extremity lymphedema after mastectomy following breast cancer were selected according to criteria. After the initial assessment, the patients were randomly divided into two groups. One group was treated with CDP therapy techniques, and another group was treated with intermittent compression pump in addition to CDP therapy techniques. These techniques were included manual lymphatic drainage, bandaging, therapeutic exercise, skin care, and intermittent compression pump. Patients were treated for 2 weeks and 5 days/week. Lymphedema volume and quality of life were evaluated before and after treatment. The quality of life was assessed by cancer-specific questionnaire (QLQ-C30) and breast cancer-specific quality of life questionnaire (QLQ-Br23), and lymphedema volume was measured by volumeter. Results: The mean of lymphedema volume was significantly decreased after treatment as compared with before treatment in both groups (P 0.050). Conclusion: The results of this study showed that the combination of CDP therapy and intermittent compression pump are useful for improving the affected limb lymphedema volume and quality of life. Keywords: Upper extremity lymphedema; Complex decongestive physical therapy; Intermittent compression pump; Quality of life

Spinal cord injury (SCI) as a destructive crash result in neurons degeneration. The SCI lead to the onset of biochemical and molecular cascades such as inflammation that in turn has a key role in neurodegeneration development. The previous studies demonstrated the role of TNF-α and iNOS genes in intensifying the process after SCI. As a consequence, these genes overexpression intensify the inflammation and neuron degeneration process. In the present study, 32 male Wistar rats were chased and divided into four groups of eight. The SCI were induced in three groups and another group used as a sham. The progesterone hormone used as a therapeutic agent in rats with SCI. The results showed that injection of 10 μg/kg/12h progesterone hormone reduced the TNF-α and iNOS gene expression significantly and confirmed the role of progesterone in the reduction of inflammation. Also, the numbers of intact neurons in progesterone group were higher than other groups that demonstrated the protective effects of progesterone on neuron death. The BBB test was performed and demonstrated that progesterone is an effective factor to the improvement of locomotor response. These results of the study confirmed the anti-inflammatory activity of progesterone hormone and suggested that it can be used as a therapeutic factor for SCI.

In this study, the authors' aims were to measure the length and location of branching of the pedicle from iliac artery, to describe the anatomical variability of iliac crest free flap with deep circumflex iliac (DCI) artery pedicle. Fourteen patients with ameloblastoma, osteosarcoma, and squamous cell carcinoma underwent mandibular resection and iliac crest-free flap reconstruction in one-step surgery. During surgery and before harvesting the deep circumflex iliac artery vascular pedicle, the location, origin, and the branching pattern of the pedicles were studied. Then, the pedicle length was measured and the data was analyzed using chi(2) and independent samples t test. In all patients, the DCI vascular pedicles were separated with a common trunk from the external iliac artery and vein and the DCI arteries were posterior and lateral to the veins. Also after branching from the external iliac artery, all vascular DCI pedicles traveled upward and medially along the Iliacus muscle and the iliac fascia. The mean pedicle length was 21.78 mm for men and 19 mm for women. No statistically significant relationship was observed between the patient's age and the vascular pedicle length or number of branches. There are great variations in the anatomy of this vascular pedicle. According to the finding of this study, the length of the vascular pedicle is 2.78 mm higher in men which might help to increase the feasibility and success rate of this operation. No significant correlation was found between other variables.

BACKGROUNDThis study was designed to compare radioguided versus routine wire localization of non palpable nonmalignant breast lesions in terms of efficacy for complete excision, ease of use, time saving, and cosmetic outcome.MATERIALS AND METHODSPatients with nonpalpable breast masses and nonmalignant core biopsy results who were candidates for complete surgical lumpectomy were enrolled and randomly assigned to radioguided or wire localization groups. Radiologic, surgical, and pathologic data were collected and analyzed to determine the difficulty and duration of each procedure, ease of use, accuracy, and cosmetic outcomes.RESULTSThis prospective randomized study included 60 patients, randomly divided into wire guided localization (WGL) or radioguided occult lesion localization (ROLL) groups. The mean duration of localization under ultrasound guidance was shorter in the ROLL group (14.4 min) than in the WGL group (16.5 min) (p<0.001). The ROLL method was significantly easier for radiologists (p=0.0001). The mean duration of the surgical procedure was 22.6 min (±10.3 min) for ROLL and 23.6 min (± 9.6 min) for WGL (p=0.6), a nonsignificant difference. Radiography of the surgical specimens showed 100% lesion excision with clear margins, as proved by pathologic examination, with both techniques. The surgical specimens were slightly heavier in the ROLL group, but the difference was not significant (p=0.06).CONCLUSIONSThe ROLL technique provides effective, fast, and simple localization and excision of nonpalpable nonmalignant breast lesions.