What used to begin with the sometimes painful placement of a wire in the patient's breast to mark the location of the tumor can now be done with a much more precise and less painful method.

Doctors call it radioactive seed localization, or RSL. The process uses a thin needle to place a tiny radioactive seed directly on the cancerous lump. It acts as a beacon on which the surgeon can hone in; removing the lump, the seed and ideally, cancerous tissue in the margins around the lump.

"This allows us to have a procedure that is less painful and allows patients to avoid the likelihood of a second operation to clear more cancer," explained Edibaldo Silva, MD, PhD, surgical oncologist at The Nebraska Medical Center.
The seed is the size of a pencil lead."

The previous and still most common approach to marking a breast cancer tumor with a wire requires the patient to have the wire placed in the breast in the morning, and then have lumpectomy surgery later in the day.

"RSL is an easier procedure," said Dr. Silva. "We can place the seed the day before surgery, and then the patient can return for surgery first thing the next morning does not have to wait around all day with the wire in place."

RSL also provides a level of accuracy not typically found with the wire method.

"The surgeon can map the location of the tumor and the margins in a way that is uniform in all directions," Dr. Silva said. "That's something that can't be done with a wire. Most importantly, the surgeon can find the least difficult and most direct approach to the area in question. That also allows the scar to be placed in the most cosmetically preferable place."

The radiation in the seed is not dangerous. It gives off only enough radiation to act as a marker for the surgeon.

"There is zero chance of it causing any radiation damage," said Dr. Silva. "In fact, the radiation dose given to a patient when they have the seed in place is many, many times less than what you would subject yourself to on an airplane trip from Omaha to New York."

Use of the radioactive seed is highly regulated. The medical center works closely with nuclear regulatory officials to account for the safety and location of all radioactive material.

The radioactive seed is strictly used for tumor marking. It does not replace radiation or chemotherapy as a method of treating the cancer.

The RSL approach is especially helpful for small tumors detected during mammograms. Tumors so small, they usually cannot be felt by touch.

Patients say they hope the RSL approach to surgery will reduce the fear that some women have of mammography and the possibility of a cancer diagnosis
Dr. Silva cautions women that a diagnosis of breast cancer will not always lead to mastectomy surgery. He believes the better accuracy provided with radioactive seed localization will result in fewer women having surgery to remove their breasts.

"Many women are having mastectomies because the initial lumpectomy with the wire localization did not afford them an adequate cancer margin which can be afforded with this surgery," he explained.

Dr. Silva believes mastectomies have become an all-too common approach to dealing with breast cancers that can be treated with much less radical methods.

Since Dr. Silva began using the RSL approach in early 2011, its popularity has increased. In an average week, four to five patients are having the seed implanted before surgery.

To make an appointment with Dr. Silva or to learn more about the internationally known cancer care at The Nebraska Medical Center, visit or call 1-800-922-0000