Author: Lindsey Harle, PhD
A new technique for localizing breast masses is being introduced in U.S. hospitals. The approach, termed radioactive seed localization, uses a small radioactive pellet to allow marking of the mass for future removal. The pellet is inserted within the breast mass by a radiologist. Surgeons then use a wand with a small Geiger counter to detect the location of the pellet, and determine the best approach for removal.
The implant can be used to mark the location of nonpalpable breast masses that require surgical removal. Many breast masses are asymptomatic and are diagnosed by mammography. Often the masses cannot be felt with palpation, making adequate surgical removal difficult.
The radioactive seed, which is about the size of a grain of rice, can be placed within the breast up to 5 days before surgery. The amount of radiation released from the pellet is less than that received during a routine chest x-ray.
Needle localization is the current method for marking breast masses before surgery. This method involves the insertion of a metal wire through the skin and into the mass. One end of the wire hooks into the mass, while the other protrudes through the patient’s skin. This procedure has to be performed the same day of surgery, to prevent the wire from moving. This technique is more cumbersome for the surgeon, as the wire may not be inserted at the most desirable incision point. Additionally, the wire may not take a direct path to the mass, making it more difficult to track the wire to its endpoint.
After insertion of the new radioactive seed, patients can go about their normal daily lives without fear of moving the pellet. The wand that detects radioactive emissions from the seed allows the surgeon to locate the mass in the operating room and plan his or her approach appropriately. This technique eliminates unwanted surgical incisions and unnecessary removal of normal tissue.
An important benefit of the radioactive seed implant technique is that it allows for a more precise removal of the tumor. When surgically removing cancer, surgeons must be sure to excise the tumor along with a rim of normal tissue. If pathological examination of the breast mass shows tumor cells present at the rim (positive margins), the patient must go back to surgery to have more tissue removed. Studies have shown that use of the radioactive pellet allows surgeons to more accurately locate the mass and remove sufficient tissue to prevent the need for repeat surgery.
Nonpalpable breast masses are the most common diagnosis necessitating presurgical localization of a mass. With the current needle localization technique, identification of the potentially malignant breast mass is imprecise, and removal of the mass sometimes fails. During surgery, breast tissue that is removed must be sent for radiographic examination to ensure the mass has been correctly located. Studies with the radioactive implant localization technique showed it to be easier to locate in the operating room. Surgeons can use the wand directly in the room to detect the presence of the radioactive seed in removed tissue.
Patients report that the seed implant is more comfortable and convenient than needle localization.
The radioactive seed is currently under investigation by the Food and Drug Administration, and is being used in a small number of U.S. hospitals.
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About the Author
Lindsey Harle is a medical doctor who is currently pursuing training in pathology at the University of Hawaii. She has written and published several scientific articles on the subjects of cancer cachexia and androgen deprivation therapy, and has performed original research on the diagnosis of myelodyspastic syndromes.
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