Radioactive Seed Localization: A new option for breast cancer patients
At Brigham and Women’s Faulkner Breast Center, breast cancer surgeons see many patients with non-palpable lesions that were discovered on screening mammograms. For these patients, a lumpectomy rather than a mastectomy is often the best surgical option. But the surgeon needs to be able find the lesion within the breast tissue. For this, surgeons rely on the help of their colleagues in the Sagoff Breast Imaging and Diagnostic Center. Radioactive seed localization, a procedure new to BWFH, is making that whole process a little easier.
In the past, radiologists used mammography or ultrasound to place guide wires into the breast tissue to mark the location of an abnormality or lesion on the morning of surgery. “With such busy imaging and surgical practices at BWFH, scheduling patients for the necessary same day image guided localization prior to their operation can sometimes be challenging,” says Dr. Bethany Richman, Medical Director of the Sagoff Breast Imaging and Diagnostic Center. “With radioactive seed localization, the imaging portion can happen on a separate day, up to a week before their surgery date.”
Separating the patient’s surgery date from their localization date allows the operating room to remain on schedule and gives the patient one less thing to worry about on the day of their surgery. “From the patients point of view, they are able to come in for the procedure several days before their surgery so they don’t have to be fasting from midnight the night before and they still have time to prepare for the actual day of surgery, which just makes the procedure less stressful,” says Dr. Tari King, Chief of Breast Surgery at Dana-Farber/Brigham and Women’s Cancer Center, who also operates at BWFH.
Implanting the seed is a simple procedure. “We use local anesthetic and place the seed into the breast using ultrasound or mammography guidance. The site is covered with a Band-Aid and the patient can go home,” explains Dr. Richman. Then, on the day of surgery, the seed is removed within the surgical specimen.
There are also benefits for the surgeon. “With wire localization, a portion of the wire is inside the breast and a portion remains outside; secured with a bandage. It only takes one wrong move and the wire can be miss-placed from the original target. If this happens then our ability to accurately identify the lesion may be compromised,” explains Dr. King. “With radioactive seed localization, we don’t have to be concerned that anything has happened to the position of the seed between the time the patient leaves radiology and the time they arrive in the operating room, as the seed is safely placed completely inside the breast. We then use a probe in the operating room that allows us to localize the seed within the lesion in real time, further adding confidence that we are performing the surgery as accurately as possible.”
Radioactive seed localization is now available at both Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital to all patients with non-palpable lesions identified on ultrasound and/or mammogram; patients who need a localization of a finding on MRI will still require wire localization.