Pilot Study Looks at a New Procedure for Locating Breast Tumours

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Women undergoing breast cancer surgery may soon have the option of a more precise method of locating tumours. Radioactive seed localization allows the surgeon to better pinpoint the location when operating for breast cancer. Last year physicians at St. Joseph’s Healthcare Hamilton became the first in Canada to take a look at the procedure.

If a tumour is palpable, surgery can be guided by feel. But because of screening and awareness about thirty to forty per cent of breast tumours detected today are non-palpable, and need some kind of localization.

Dr. Peter Lovrics, head of general surgery and medical director of the ICU at SJHH, led the investigation into the procedure. “Currently, when a breast tumour is hard to locate, mammogram or ultrasound images are used to guide a needle to the suspicious area of the breast. The radiologist typically replaces the needle with a wire and sends the patient to the surgeon with only a wire in place. The surgeon then uses the path of the wire as a guide to locate the abnormal area to be removed.”Using the new method, radioactive pellets as small as a grain of rice are implanted into the affected area of the breast. This method is purely diagnostic; to find the tumour, not treat it. The amount of radiation given off by the radioactive seed is less than the amount emitted from a standard X-Ray. With the seeds in place, the surgeon is then able to accurately target the tumor using a hand-held radiation detector. The surgeon is guided to the precise location to remove the cancer and radioactive seed.

Results of a U.S. study showed that the radioactive seeds are a superior technique for patients undergoing lumpectomies. “We hope our larger, well-designed, randomized study will prove it,” said Lovrics. “And of course the whole aim of this is that we have greater precision in surgical margins. That would mean a higher likelihood that all cancer will be removed from the breast in the initial operation. And then women won’t need to go back for further surgery and hopefully they’ll be fewer mastectomies.”

Dr. Lovrics said there has been a lot of work to get the study going. “This involves a lot of collaboration. Nuclear medicine is involved, as is the operating room, the sterile processing department, the radiologists, and mammogram and ultrasound technologists. And St. Joseph’s Healthcare encourages us in our research. We’ve all been pleased with the results so far.”

With the completion of the pilot study, Dr. Lovrics and his colleagues at SJHH, along with physicians at Hamilton Health Sciences and Princess Margaret Hospital in Toronto, are preparing for a larger study that would involve 320 women. The Surgical Outcomes Research Centre, Department of Surgery, McMaster University, supported the study’s generation. Investigators have received close to $225,000 from the Canadian Breast Cancer Foundation-Ontario Chapter for the multi-institutional, two and a-half year study.

“The collaborative nature of the work and the involvement of research colleagues at all these hospitals make this a very exciting project,” said Dr. Lovrics. “I think this procedure is a better way of doing things, and that means better for our patients.”