[Histonet] Handling Breast Lumpectomy Specimens with radioactive seed localization

[Bob Richmond]

Jim Vickroy, Histology Manager at Springfield [Illinois] Clinic asks: "Our
organization is looking into the workflow necessary to handle breast
lumpectomies with radioactive seed localization (RSL)".

Thanks for the heads-up - as usual, pathologists and histologists don't get
told. Nursing practice is to assume that what we do is ritual disposal of
corpse poison, and we're immune to all hazards. And "seed" is a magickal
word that shuts off thinking. Apparently RSL has been around for more than
ten years.

A titanium "seed" containing about 20 microcuries of radioactive iodine 125
is placed in the patient's breast lesion a day or so before surgery,
usually eliminating the need for wire localization or specimen radiography.
The "seed" is not removed from the specimen, which is delivered to the
pathology department.

Iodine 125 is a gamma emitter with a half-life of about 60 days (unlike the
technetium 99m used in the sentinel node biopsy, which has a half-life of
only six hours). It's a considerably more hazardous material, though I
think it's safe to briefly handle the "seed" with gloved hands. What you
don't want to do is lose the thing in your clothing or in the laboratory,
since it will take nearly two years to decay to a safe level of
radioactivity.

According to my online resource, the "seed" is recovered from the pathology
department with elaborate ceremony, in the presence of a "radiation safety
officer". I've yet to encounter a hospital that had a radiation safety
officer, and often there's nobody who knows the difference between
radiation and radioactive material.

If this procedure is thrown at you without warning, I suggest that your
pathologist stage a carefully planned hissy-fit.

I found an excellent online resource for this subject. Read the section
about laboratory procedures.

http://www.teambest.com/besttotalsolutions/PDFs/RadioactiveSeedLocalizationI125_LTDauer_et_al_Oct2013.pdf