(Left) Traditional wire method: An uncomfortable harpoon, inserted into biopsied tumour. / (Right) Radioactive seed approach: The innovative way of removing small, non-palpable breast tumours, increasing surgical accuracy and comfort, for breast cancer patients.

Radioactive seeds are the latest innovation in breast cancer surgical oncology. The Ottawa Hospital has been using them since 2015 to help breast surgeons locate cancerous tissue in lumpectomy patients who have tumours too small to feel.

Unlike the traditional procedure of inserting metal wires into a woman’s breast on the day of surgery to localize the tumour, using radioactive seeds involves injecting a tiny piece of metal containing a radioactive isotope into the tumour location using guided imaging. “The radioactive dye in the seed gives off an auditory signal, so the surgeon knows exactly where to place the incision,” says Dr. Carolyn Nessim, the surgical oncologist who led the implementation of the radioactive seed program (now headed by Dr. Erin Cordeiro) at the hospital.

Early adoption, early success

As early adopters of this new approach, The Ottawa Hospital has improved the patient experience and improved both cost and operating efficiency. “Our studies show that we saved the hospital close to $180,000 and improved operating room efficiency, because the seed is inserted several days before surgery. Patients aren’t waiting for the wires to be inserted the day of, which usually causes delays,” says Dr. Nessim.

Prior to setting up the program at the hospital, Dr. Nessim and a team of breast surgeons, pathologists, radiologists, and specialists in nuclear medicine and radiation safety attended an intensive training course at the Mayo Clinic. “We’re very proud to be among the leaders,” she says. The Ottawa Hospital is the third in Canada to use seed technology.

To encourage other hospitals to adopt seed technology, the team has presented the results of the new approach at multiple conferences, including the Canadian Society of Surgical Oncology and the Canadian Surgical Forum, as well as The American Society of Breast Surgeons’ Annual Meeting, where their presentation won Best Scientific Impact Award. They also were awarded Top Oral Presentation at the Canadian Surgery Forum of the Canadian Association of General Surgeons, and their work has been published in Annals of Surgical Oncology.

Good news for patients

Rita Nattkemper had the radioactive seed implant prior to her lumpectomy surgery last fall. “The procedure was very comfortable,” she says. “The radiologist had the screen turned, so I could see where she put in the needle and left the seed. It was very easy, very quick, and very painless.”

More and more hospitals are looking to The Ottawa Hospital to implement their own seed programs, which serves as one more example of how it has established itself as a leader in Canadian health care.

“I think we’re making an impact,” says Dr. Nessim, “because many of my colleagues have reached out to us to help them set up a program at their hospital, and many other hospitals are starting to adopt this technique, which is good for patients with breast cancer.”