March 21, 2010
For Susan Wuerz of Winter Springs, Florida, the only thing worse than worrying about whether she had breast cancer were the tests.
The standard way of locating most breast tumors involves threading a wire through a needle to the site of a tumor identified by a mammogram or ultrasound. A surgeon later follows the wire to the tumor and removes it.
In the meantime, the patient is left with a wire protruding from her breast.
"It took the radiologist an hour and a half to get the wire in. I felt it sticking against my chest wall. It was very painful," Wuerz recalled.
Though having the wire in her breast for two hours while she awaited surgery wasn't painful, "it was very uncomfortable," she said.
When later tests showed another suspicious lump in her breast, Wuerz almost decided against having another biopsy. Then her doctor at Florida Hospital Orlando told her about a new procedure called radioactive-seed localization.
Florida Hospital is one of the few facilities across the country that uses a radioactive seed about the size of a grain of rice implanted in a woman's breast. A Geiger counter is used to read the radioactive signal and guide the surgeon to the tumor, which is removed along with the seed.
A 2008 study by the Mayo Clinic, which developed the procedure, showed seed localization more accurately pinpoints the location of a tumor. This means less healthy tissue is removed during the lumpectomy, resulting in less disfigurement to the breast.
Patients can have the seed implanted as an outpatient procedure up to five days before surgery. The wire method has to be done the same day as the surgery.
"That allows more flexibility for both the surgeon and the patient," said Dr. Louis Barr, surgical oncologist at Florida Hospital Orlando who performed the seed procedure on Wuerz.
Another advantage of the seed procedure is that it reduces "dirty margins," tumor tissues that remain after surgery.
"You want to remove as little tissue as needed, but you also want to make sure you've removed the tumor," Barr said.
Complete removal is dependent upon having a rim of healthy tissue — clear margins — surrounding the cancer. If the margin is positive and the cancer recurs, more surgery or a mastectomy is often required.
In the study by the Mayo Clinic — Barr was trained in the seed procedure at the clinic's Jacksonville location — 25 percent of patients who underwent the wire procedure had to have more surgery to remove leftover tumor tissue. In the seed method, 8 percent of patients returned to surgery.
"Our study showed the seed was significantly better at reducing trips to the operating room," said Dr. Sarah McLaughlin, a surgeon at Mayo in Jacksonville who has performed the seed procedure on patients there.
"From a doctor's perspective, it is an approach that should be more widely used," said McLaughlin. "From a patient's point of view, it's more convenient, more comfortable and cosmetically better."
Dr. Richard Gray, a surgical oncologist at Moffitt Cancer Center in Tampa who devised the technique, said it takes about the same amount of time as the wire method but is easier for the surgeon to use.
The seed, a tiny titanium capsule, emits a level of radiation less than that of a standard X-ray. But it nonetheless involves the use of radioactive material, which requires adherence to strict state and federal handling guidelines.
Although the seed technique is relatively new, it is covered by most insurance plans. Wuerz said Medicare covered the cost of her procedure.
Barr sees seed localization as the future standard for all breast lumpectomies. Wuerz, whose two sisters have been diagnosed with breast cancer, is on a mission to make it so.
"Because of what my sisters and I have gone through, I will probably become an activist," Wuerz said. "The old procedure was so uncomfortable it almost kept me from going back for more. It's probably kept other women from getting more treatment. I want other women to know they have a good option."
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