In the O.R.

On Cancer: Data on New Procedure to Remove Small Breast Cancers Shows Benefits to Patient Experience

By Media Staff  |  Tuesday, September 10, 2013
Pictured: Lawrence Dauer Medical Health Physicist and Radiation Safety Manager Lawrence Dauer

In late 2011, Memorial Sloan Kettering began offering women a new procedure to more precisely pinpoint and remove small breast cancers that can be detected on a mammogram but not felt in the breast. The method, called radioactive seed localization (RSL), begins with a breast radiologist injecting one or two tiny, sealed radioactive sources called seeds into the patient’s breast to mark the exact location of the cancer.

In the operating room, surgeons use a handheld radiation-detection device developed specifically for this procedure to zero in on the seed and precisely locate the cancer, which is removed along with the seed during the operation. No radioactivity is left in the body after the surgery.

Now, a multidisciplinary team of medical physicists, radiologists, pathologists, and surgeons, led by medical health physicist and radiation safety manager Lawrence T. Dauer, has detailed their initial year’s experience using RSL. Their report, published in the October issue of the journal Health Physics, shows that the procedure is safe and effective, and offers benefits to both patients and medical staff.

Memorial Sloan Kettering was the first hospital in the tri-state area to offer RSL, which is now standard practice for the majority of our patients with small breast cancers, and our experts have the most experience in the region with this technique.

Drawbacks of the Traditional Method

Traditionally, patients with small breast cancers have had the position of their tumor marked for surgery with breast needle localization (also called wire localization), in which a radiologist inserts a needle with a fine wire into the breast a few hours before a biopsy or lumpectomy. Because the wire remains partially outside the breast, it can be inadvertently moved before or during the surgery, which may limit the surgeon’s ability to locate the cancer and remove it completely.

In addition, the wire can be uncomfortable for patients, and because it must be placed in the breast the same day as surgery, wire localization is not only difficult to schedule in a busy hospital, it requires the patient to spend several extra hours at the hospital on the day of surgery.

Advantages of the New Procedure

Over the course of one year, radioactive seed localization was performed on more than 1,000 women who had small breast tumors surgically removed at Memorial Sloan Kettering. The research team found that the new procedure has significant benefits over breast needle localization, including fewer scheduling conflicts and a better overall patient experience. While surgeons have had years of experience using breast needle localization, in only one year the new technique produced similar operating times and the same likelihood that the cancer is removed completely.

“Our findings validate our initial enthusiasm for the procedure and show that it is safe, with significant advantages for both our hospital staff and our patients,” says Dr. Dauer. “The total length of time a patient needs to be in the hospital is drastically reduced, and our efficiency in the operating room is improved.”

Monica Morrow, Chief of the Breast Surgical Service and a coauthor of the report, adds, “For women with small breast cancers that can’t be seen or felt, a surgeon needs a reliable map to completely remove all cancerous tissue. Radioactive seed localization is the most patient-friendly mapping system we have available.”

The use of RSL at Memorial Sloan Kettering was initiated by Elizabeth A. Morris, Chief of the Breast Imaging Service, and Jean St. Germain, an attending physicist and radiation safety officer, who were also involved in the research.


Is this procedure for DCIS cancer?

Les, thank you for your comment. We consulted with Dr. Morris, who confirmed that the procedure is used to locate DCIS as well as invasive breast cancers.

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Surgeons are taught from textbooks which conveniently color-code the types of tissues, but that's not what it looks like in real life -- until now. At TEDMED Quyen Nguyen demonstrates how a molecular marker can make tumors light up in neon green, showing surgeons exactly where to cut. W/O RADIATION

Does this also work on breast micro calcifications if found to be cancerous ?
And when do I worry about micro classifications ? After biopsy?
Are there any questions I should ask at my next Mamo ( tomorrow ) that will help me feel better ?

Denise, thank you for your comment. We consulted with Dr. Carol Lee and she provided this response:

Seed localization can indeed be used before surgery to pinpoint microcalcifications that have been biopsied and found to be malignant. As for when to worry about microcalcifications, it is an unusual woman who doesn't have one or another calcification in her breast. On mammograms, radiologists analyze by how the calcifications look whether they need to be biopsied or not. Even when a biopsy is recommended for microcalcifications, the majority turn out to be benign.
When you have your mammogram, you can ask when and how you will get your results. It is important to remember that 90% of the time, a routine mammogram turns out fine.

Hi. After a lumpectomy using the radioactive seed localization, is radiation for DCIS still needed (generally) ? Thanks

Judy, thank you for your comment. We consulted with Dr. Carol Lee, and she responded:

The amount of radioactivity associated with the radioactive seed is extremely low and is used only to pinpoint the spot to be removed at surgery. In general, when a lumpectomy is done for DCIS, it is followed by radiation but each case is unique so a woman’s doctor can make the determination of whether radiation is needed after surgery in each individual case. Radiation therapy after surgery for DCIS does not depend on whether or not radioactive seed localization was done.

Thanks very much !

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