Memorial Sloan-Kettering is the first and only hospital in New York, New Jersey, and Connecticut to offer a new, more patient-friendly approach for doctors to precisely pinpoint and remove very small breast cancers that can be seen on a mammogram but not felt in the breast.
The procedure, called radioactive seed localization, begins with a breast radiologist injecting tiny sealed radioactive sources called “seeds” into the patient’s breast to mark the exact location of the cancer. The radiologist can perform this image-guided procedure up to two weeks before a biopsy or lumpectomy.
Once in the operating room, surgeons use a handheld radiation detection device, developed specifically for this procedure, to zero in on the seed and precisely navigate to the location of the cancer, which is removed along with the seed during the operation. After the procedure, there is no radioactivity remaining in the body. A pathologist ultimately takes the seed out of the breast tissue in the laboratory, and radiation safety officers ensure the seed’s safe disposal.
In the past, patients with such small breast cancers were required to undergo a procedure a few hours before their biopsy or lumpectomy called breast needle localization, in which a radiologist inserted a needle with a fine wire into the breast to map the location of the cancer. The wire remained in the breast, poking out of the skin for several hours, to guide the surgeon during the operation later the same day.
Studies suggest that radioactive seed localization results in more-precise removal of small breast cancers as compared to traditional breast needle localization. It also reduces the need to have a second surgery due to incomplete removal of the abnormal tissue.
“Seed localization has improved our patients’ experience by allowing them to go directly to the operating room – bypassing the need for breast needle localization – on the day of their lumpectomy,” says Monica Morrow, Chief of the Breast Surgical Service at Memorial Sloan-Kettering. “It is more convenient because it avoids the need for a wire in the breast for several hours, which many patients find uncomfortable.”
The use of this technique at Memorial Sloan-Kettering was initiated by Elizabeth Morris, Chief of the Breast Imaging Service, and Jean St. Germain, an attending physicist and radiation safety officer at Memorial Sloan-Kettering. Dr. Morris and her staff have offered radioactive seed localization to more than 250 patients since December 2011, and it is now standard practice for the majority of Memorial Sloan-Kettering’s patients with small breast cancers.
“Getting this technique up and running took months of training and coordination among experts in radiology, surgery, medical physics, and pathology to make certain that the procedure would be safe and effective for our patients,” St. Germain explains. “This collaboration has ultimately improved our efficiency as well as provided a better surgical experience for our patients.”