Champlain Primary Care Digest

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Radioactive Seed Localization and Breast Cancer

With improved breast imaging and earlier detection of cancer, more than a third of breast cancers are not palpable. Before surgery, a breast specialty radiologist must use image guidance (ultrasound or mammography) to place a small wire in the breast. The wire must be inserted on the same day as the surgery and at the same hospital, which requires the patient to travel within the hospital with a wire hanging out of her breast.

A new technique to localize breast cancers for surgery called radioactive seed localization (RSL) has been developed. Instead of using a wire, the radiologist inserts a tiny seed the size of a grain of rice into the breast cancer. The seed is embedded with a minuscule dose of radioactivity, i125. Not harmful to the patient or environment, the seed allows the surgeon to identify the tumor at surgery at least as well as a wire. The benefit for the patient is that she may have the seed placed in her tumor several days before the day of surgery. It decreased her anxiety, and improves scheduling of surgery.

Dr. Jean Seely and Dr. Carolyn Nessim have led a committed team of radiologists, breast surgeons, pathologists, nuclear medicine physicians, radiation safety officers, and administrators in developing the protocols and training: Dr. Jon Aro, Dr. Denis Gravel, Dr. Hung Tan, Dr. Lionel Zuckier, Jennifer Smylie and Paula Doering. Approval by the Canadian Nuclear Safety Commission to start the program was obtained in March 2015. The Ottawa Hospital RSL program began in April 2015.

Article written by: Dr. Jean Seely and Dr. Carolyn Nessim

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