Radioactive Seed Localisation (RSL) for Breast Tumours

As the technology behind screening mammograms becomes more refined, we are able to detect a greater number of breast cancers before they are able to be felt by physical examination.  It also makes it more challenging to precisely locate and remove the cancer. 

Radioactive Seed Localisation (RSL)

RSL offers a new alternative. Radioactive seeds are tiny metal seeds, about the size of a sesame seed or the point of a pencil. The seed can be placed several days or weeks prior to surgery.  It will not move out of place.  

Having this placed in advance will decrease the time spent at the hospital on the day of surgery. The radioactive seed is placed by a Radiologist. This is done in the Breast Unit at the University Hospital of North Tees. 

With this procedure, a Radiologist places a very low-energy radioactive seed into the cancer to mark its location. This helps the surgeon to quickly identify it during surgery.

Advantages of RSL

• RSL offers increased accuracy of cancer localisation. 

• The need for further surgery can be reduced from approximately 17 women in every 100 to around 5 to 9 women in every 100.¹^,²^,³

• The Radiologist can implant the seed up to a few weeks before the surgery, reducing the waiting time for patients. 

• There is also evidence to suggest that patients prefer RSL and have reduced anxiety on the day of surgery and higher overall satisfaction.^4,5

What will happen during seed localisation?

The radioactive seed is inserted by a Radiologist. The seed placement procedure is very similar to the needle biopsy procedure you underwent to obtain your diagnosis.

You will begin by having an ultrasound or mammogram of your breast to locate the cancer. 

The Radiologist will inject a local anaesthetic (numbing medicine) into your breast which will sting for a few seconds but will numb your breast quickly.

The Radiologist will then place the seed, using a small needle, into the cancer in your breast. You may feel pressure during the procedure but if you feel pain, please let the staff know so more anaesthetic can be given.  You will not be able to feel the seed.

After the procedure, 2 or more mammograms will be taken to confirm the correct position of the seed placement. Your Surgeon will refer to these during the surgery. 

A small dressing will be placed over the puncture site. 

Your seed localisation procedure will take about 30 minutes.

What happens after the seed localisation?

You can remove the dressing the next day.  You may return to work and most activities the next day.  

You should avoid vigorous arm movements and heavy lifting (more than approximately 4.5 kilos or 10 pounds) for the next 24 hours.  

You may apply ice to the insertion site (do not place ice directly on the skin).  This may help to reduce swelling and pain.

You may shower the next day and allow water to run over the insertion site.  Pat this area dry.  Do not soak in a tub or pool for  48 hours. 

It is recommended you wear a comfortable supportive bra to minimise breast movement.  A ‘sports’ bra works best. 

You may have some mild discomfort and bruising. If you need something for discomfort try over the counter pain medicines (such as paracetamol and/or ibuprofen).

When to seek help

It is normal to have a small amount of blood (about size of a twenty pence piece) show through on the dressing.

Call your Breast Care Nurse if you have any of the following symptoms during working hours.

Out of hours within the first 7 days after your procedure Ward 31 can be contacted. After this please contact NHS Choices for advice.

(All contact numbers at the end of the leaflet).

• Having heavy bleeding from the insertion site (bleeding which soaks the dressing or is flowing from the site). Apply firm pressure to the site if this occurs. 

• If you find any signs of infection such as high temperature, significant swelling, firmness or warmth, increased redness or seepage around the site that is pus-like.

Will I or those around me be exposed to harmful radiation if I have radioactive seed localisation?

We are all exposed to background radiation during our lives. The seed gives off only enough radiation to act as a marker for the Surgeon and is not harmful to the rest of your body. 

It also does not cause harm to those who are in close contact with you. For example, you cannot harm anyone by shaking hands, hugging or kissing, and you can sleep with a spouse or partner in the same bed.   

Once you have the operation and the seed is removed, the radiation is gone. The seed is disposed of according to strict guidelines.

Contact numbers

In case you cannot attend your scheduled surgery date, please contact your Breast Care Nurse or your Consultant Surgeon’s Secretary to inform us. 

If you have any further question about the radioactive seed localisation, please speak to your Consultant Surgeon or a member of his Team.  You can also contact your Breast Care Nurse or the Nuclear Medicine Department.

University Hospital of North Tees

Breast Care Nurses

Telephone:  01642 624371

Monday to Friday, 9.00am to 5.00pm

Ward 31  

Telephone: 01642 382831  

24 hours a day, 7 days a week  

University Hospital of Hartlepool

Breast Care Nurses

Telephone: 01642 622387

Monday to Thursday, 9.00am to 3.00pm

Nuclear Medicine Department

Telephone: 01429 522681

Monday to Friday, 8.00am to 8.00pm

References

1. Pieri A, Milligan R, Critchley A, O’Donoghue J, Sibal N, Peace R, et al.  The introduction of radioactive seed localisation improves the oncological outcome of image guided breast conservation surgery.  European Journal of Surgical Oncology.  2017 May 1;43(5):S12. 

• Theunissen CIJM, Rust EAZ, Edens MA, Bandel C, Van’t Ooster-van den Berg JG, Jager PL, et al.  Radioactive seed localisation is the preferred technique in nonpalpable breast cancer compared with wire-guided localisation and radioguided occult lesion localisation.  Nucl Med Commun.  2017 May;38(5):396–401. 

• Janssen NNY, Nijkamp J, Alderliesten T, Loo CE, Rutgers EJT, Sonke J-J, et al.  Radioactive seed localisation in breast cancer treatment.  Br J Surg.  2016 Jan;103(1):70–80. 

• Burroughs J, Fencl JL, Wakefield MC.  Radioactive Seed Localisation Program for Patients With Nonpalpable Breast Lesions.  AORN J.  2017 Jun;105(6):593–604. 

• Pearson R, Milligan R, Cain H.  Radioactive iodine-125 seed localisation of breast carcinoma in advance of the day of surgery reduces pre-operative anxiety levels.  European Journal of Surgical Oncology.  2017 May 1;43(5):S7. 

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