Ames Smith Jr MD - The Polyclinic
February 4, 2015 | by The Polyclinic

We are proud to announce that we are now using an innovative imaging technology to facilitate safe removal of small tumors in the breast that are detected by mammography but unable to be felt. The new imaging procedure, called radioactive seed localization, guides the surgeon precisely to a region of abnormal breast tissue for surgical removal. We are among only a few early adopters of this technique in Washington State.

In seed localization, a radiologist places a tiny, very low-dose radioactive seed (about the size of a grain of rice) in the center of the breast tumor, using mammography or ultrasound to guide placement. During surgery, the breast surgeon uses a hand-held device that detects radioactivity to locate and target the seed, along with the tumor, which can increase the ease and accuracy of excision.

Traditionally, a wire has been placed near the tumor to guide surgical removal. Because of the limitations in wire localization, the Moffit Cancer Center and later the Mayo Clinic developed the radioactive seed localization technique over 10 years ago. The seed localization procedure is now starting to be used by more medical groups around the country and offers improved accuracy in both mapping and removing the targeted region of tissue. An additional reported benefit has been a decreased need for re-excision (repeat surgery) in malignant cases.  

In addition to providing greater surgical accuracy, seed localization offers more convenience and comfort for the patient since they are able to schedule the seed localization up to five days before surgery, avoiding surgery scheduling issues and limiting the number of procedures on one day.

A challenge in traditional wire localization is the possibility that the wire will move since one end of the wire is inserted into the abnormal breast tissue and the other end remains outside the patient’s breast until it is removed during surgery. When the wire is placed during mammography, the patient is sitting up and during surgery the patient is lying down. The result of this change in body position is that the soft breast tissue and wire may move considerably, limiting the surgeon’s ability to accurately remove the lesion.

“Seed localization offers a big improvement over wire localization in locating and removing abnormal breast tissue,” said Ames Smith, MD, Polyclinic breast surgeon. “And since the majority of breast cancers are removed by lumpectomy, we’re thrilled to offer this proven procedure to our patients. It reflects a tremendous team effort between our Breast Imaging Center, Breast Surgery, and Facilities departments.”

Because the procedure involves the use of nuclear medicine, each medical group offering seed localization to patients must undergo rigorous training and facility inspections to ensure patient and staff safety. The Polyclinic received its approval from the Nuclear Regulatory Commission. In addition, The Polyclinic’s Breast Imaging Center was recently recognized as a Center of Excellence by the American College of Radiology. This accreditation means The Polyclinic meets the highest standards for imaging quality and safety and that personnel are well qualified to perform medical imaging and interpret the images.

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