In the O.R.

On Cancer: Patient Experience Improves with New Collaborative Approach to Pinpoint and Remove Small Breast Cancers

By Esther Napolitano, BS and Allyson Collins, MS
Friday, March 16, 2012
Pictured: Elizabeth Morris Elizabeth Morris, Chief of the Breast Imaging Service

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.”

Comments

I had a mammo-site done in May of this year. It was fantaskic. I had a small lump removed. Then radiation for 5 days twice a day. I was back to driving truck again with my husband within the week. I had no complication with radiation burns since it was done internally. My sister went the traditional route and was burned and had the hassle of going to treatment daily for 8 weeks. I know not every lump can be treated this way but if it can it's the way to go. Thank you so much for this procedure.

I too had the seed implanted and lesion removed yesterday 9/17 at sloan...my reason was stero-tactic biopsy was not accurate....I am optimistic that if positive I can have same proceedure.

Unfortunately I found out about this 3 weeks too late. Now wondering if I should go for the radiation or not such a long drawn out ordeal. I had DCIS very early, removed by sterotacticbiopsy, lumpectomy showed it was all gone. But then you never know .

MY BREAT EXAM/MAMOGRAM SHOWED A WELL DEFINED OVAL 5X3 mm ASYMMETRY PERSISTS WITHIN THE SUPERFICIAL LATERAL RIGHT BREAST..a SAME DAY ULTRASOUND DEMONSTRATED A 6X3X4 mm OVID HYPOECHOIC NODULE WITH ASSOCIATED POSTERIOR ACOUSTIC SHADOWING. ALTHOUGH THE SHAPE OF THIS FINDING IS BENIGN TO INDETERMINATE, POSTERIOR ACOUSTIC SHADOWING IS MORE CONCERNING. iT IS NOT KNOWN IF THIS IS A NEW MASS BASED ON MAMMOGRAM.. ALYPIA AND EARLY CARCINOMA CANNOT BE EXCLUDED. ULTRASOUND GUIDED CORE BIOPSY IS ADVISED...
I AM INTERESTED IN OTHER PROCEEDURES/ RATHER THAN STEROTACTICBIOSY...AND WOULD APPRECIATE MORE INFORMATION REGARDING YOUR NEWEST PROCEEDURE...THUS AVOIDING THE WIRE STAYING IN MY BREAST AFTER THE BIOPSY AND OR BIOPSY FOLLOW UP /
SUCH AS A LUMPECTOMY.

Hi, Marian, you can read about our breast biopsy techniques here: http://www.mskcc.org/cancer-care/adult/breast/detection-diagnosis If you would like to make an appointment with a Memorial Sloan-Kettering doctor, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thank you for your comment.

I'm interested in participating in a DCIS study - I had an abnormal mammogram showing a curving line of calcifications in my right breast. I subsequently had a stereotactic biopsy and the pathology report listed DCIS, high grade, comedo, with luminal calcifications. I don't have the results of estrogen/progesterone receptors test, or my BRCA results back yet (should be w/in the week)

Gretchen, if you would like to learn more about what clinical trials MSKCC currently has open for DCIS, you can call our Physician Referral Service at 800-525-2225 during business hours or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

what does it mean ill-defined lobulated hypoechoic which appears to contain solid and cystic areas

Hi Cynthia, for this question we suggest you call the National Cancer Institute’s Cancer Information Service at 800-4CANCER (800-422-6237). Thank you for your comment.

I am 26yrs old and one day i do my breast exam and found a lump and the dr took out the lump it still swollen and pain ful and the other breast is paining now pls can u help me I has 2 beautiful
Children that really needs there mom thank u for your wonderful help.

Brendise, unfortunately we are unable to answer specific medical questions on our blog. If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

Thank u.

I am one of those women who had a lumpectomy yesterday, cancer is not in the lumf nodes and is non-invasive, however my surgeon wants to go back in again because the margins are not sufficient, is this necessary? and what are my options? I am 73 years old and still working full time and I am tired of unnecessary surgery, please your advise is needed.

Rosemary, unfortunately we are not able to provide personal medical advice on our blog. If you'd like to make an appointment to speak with a Memorial Sloan Kettering doctor, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

Does MSKCC offer Intra-operative radiation therapy?

Donna, we offer intra-operative radiation therapy for many kinds of cancer, including breast cancer. If you'd like to make an appointment to learn more, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your question.

I am a 35 year old woman who undergone breast reduction and was told I had a 0.25cm DCIS on my right breast. Fortunately it was removed, however I was referred to a breast specialist at Lenox Hill and was told, the best thing to do is have my right breast full removed followed by breast reconstruction. I am not sure what to think of this advice, considering i have not taken a genetic counseling test. I am scared and nervous. please help.

Dear Shanay, we are sorry to hear about your diagnosis. If you would like to make an appointment with one of our specialists, please call our Physician Referral Service at 800-525-2225.

You may learn more about DCIS, treatment, and reconstruction, visit http://www.mskcc.org/cancer-care/adult/breast.

Also, here is more information on genetic counseling and testing, which may be of interest: http://www.mskcc.org/cancer-care/hereditary-genetics/genetic-testing-counseling-msk

Thank you for reaching out to us.

I had the needle localization procedure 20 years ago and am not anxious to have it again. This week I found out that I will probably need to have two places removed from my left breast. The radiologist told me that a few places here in Jacksonville, Florida, offer radioactive seeds as an option. Do you have information on the outcomes of the two types of localization: seeds versus needles? What questions should I ask the doctors who use seeds? Thank you very much.

Nancy, thank you for reaching out. As this story describes, radioactive seed localization can be an effective substitute for traditional breast needle localization. However, as was emphasized, implementing the technique took a great deal of training and coordination among experts in radiology, surgery, medical physics, and pathology, at a center that performs a large number of procedures. We suggest that you should ask physicians who use radioactive seed localization how many procedures they have done using the technique and what kind of outcomes they have had. You also might inquire about radioactive seed localization at one of the NCI-designated comprehensive cancer centers, such as the Moffitt Cancer Center in Tampa. They may know of high-volume centers in your area who use the technique as well.

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