[Histonet] Handling Breast Lumpectomy Specimens with radioactive seed localization

[Normington Lacy]

James,

Luckly our breast surgeons are good at notifying our Pathologists' Assistants when a case with radioactive seeds is sent to our laboratory.  Everything under the sun is labeled with radiation stickers, and additional stickers are provided with the tissue requisition.  We also have a chain of custody sheet that is delivered with the specimen.  

1.       Since the lumpectomy is obviously "hot" what precautions are taken to remove the seed and give it back to radiology?  

The individual removing the seed wears a radiation detection ring.  The ring is evaluated monthly by our radiation safety department.  The specimen is scanned with a survey meter to located all seeds.   Once the seed is removed, the seeds are placed in a lead lined PIG and stored in a locked safe within our gross room.  A representative from our breast center is required to pick up the seeds within 24 hours and document this on the chain of custody form.  

2.       Does the pathologist  or pathology assistant remove the seed?

The Pathologists' Assistants performs the removal as they are required to perform CBT on radioactive safety training..  

3.       After seed removal is the specimen handled similarly to a wire-located specimen.....In other words is the specimen then fixed for a period of time before grossing?

Yes, normal fixation procedure is followed.  Histology staff are notified of the case, however, no special radiation safety precautions are needed.

4.       How is the location of the seed marked in the lumpectomy specimen when the seed is removed?  Do the pathologists use an ink to mark the location, do they then fix the tissue as before?

We follow an inking protocol for lumpectomies, whether wire or seeds.

If you are interested in our procedure, please let me know and I can email it to you.

Lacy Normington, HTL(ASCP)CM
Manager, Surgical Pathology Lab Services
UW Health - UW Hospital
600 Highland Avenue
Madison, WI 53792-2472
Phone: 608-890-9373


-----Original Message-----
From: Vickroy, James via Histonet [mailto:histonet at lists.utsouthwestern.edu] 
Sent: Tuesday, October 04, 2016 12:31 PM
To: histonet at lists.utsouthwestern.edu
Subject: [Histonet] Handling Breast Lumpectomy Specimens with radioactive seed localization

Our organization is looking into the workflow necessary to handle breast lumpectomies with radioactive seed localization. Right now we have more questions than answers.  I have looked at several articles and am aware of the drastic changes that will need to be in place to handle the radioactive seed.   My experience in the past has been handling a wire-located lumpectomy proceeded usually by a sentinel node biopsy by frozen section.   From what I read the sentinel node biopsy procedure will probably not be changed, however I have several questions regarding handling the lumpectomy specimen and would appreciate any thoughts from someone already handling these specimens.  I know there are precautions on how to handle and remove the seed as well as procedures in case the seed is cut during the removal.  I am trying to figure out how the workflow will proceed.

Wire-located lumpectomy procedure:

Currently the sentinel nodes are sent to the lab from surgery and frozen sections are performed.  The pathologist then calls the surgeon and depending on whether the sentinel nodes were positive further nodal dissections may or may not be necessary.   The  wire-located lumpectomy specimen is usually sent over to pathology after the sentinel node biopsies.  The lumpectomy specimen has usually been x-rayed to show the location of the wire prior to being received by pathology.   Pathology then usually gets a copy of the x-ray along with the fresh lumpectomy specimen.   Next the pathologist or pathology assistant would place the specimen in formalin and let it fix for sometimes overnight.  The next day the fixed lumpectomy specimen was grossed and sectioned for histologic examination.  Special care is taken to take specific sections where the wire was implanted.

Radioactive seed lumpectomy procedure questions:


1.       Since the lumpectomy is obviously "hot" what precautions are taken to remove the seed and give it back to radiology?

2.       Does the pathologist  or pathology assistant remove the seed?

3.       After seed removal is the specimen handled similarly to a wire-located specimen.....In other words is the specimen then fixed for a period of time before grossing?

4.       How is the location of the seed marked in the lumpectomy specimen when the seed is removed?  Do the pathologists use an ink to mark the location, do they then fix the tissue as before?

Finally another "WRENCH"  to this new procedure is that we usually send our larger tissue specimens to be grossed and processed at a hospital lab.  We are being asked to perform the frozen section onsite and then send the fixed tissue left over from the frozen sections with the lumpectomy specimen to the hospital lab. Obviously the radioactive seed has to be removed before transportation to the  hospital lab.

As you can see there are more questions than answers and I would appreciate hearing from someone  that is already handling the new radioactive seep lumpectomy specimens.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvickroy at SpringfieldClinic.com<mailto:jvickroy at SpringfieldClinic.com>



This electronic message contains information from Springfield Clinic, LLP that may be confidential, privileged, and/or sensitive. This information is intended for the use of the individual(s) or entity(ies) named above. If you are not the intended recipient, be aware that disclosure, copying, distribution, or action taken on the contents of this information is strictly prohibited. If you have received this electronic message in error, please notify the sender immediately, by electronic mail, so that arrangements may be made for the retrieval of this electronic message. Thank you.
_______________________________________________
Histonet mailing list
Histonet at lists.utsouthwestern.edu
http://lists.utsouthwestern.edu/mailman/listinfo/histonet