Pathologist Presence Cuts Down Risk of Breast Cancer Repeat Surgery

Researchers at the University of Michigan Comprehensive Cancer Center (Ann Arbor, USA) examined the impact an intraoperative pathology consultation service had on multiple facets of breast cancer surgery by comparing 271 patients that underwent surgery during the eight month period before the establishment of a pathology laboratory, to 278 patients treated during the eight month period after it was performed routinely, when a pathologist examined the tissues and fed the results back to the waiting operating staff.

The results showed that the average number of surgeries per patient decreased from 1.5 to 1.23, and the number of patients requiring only one surgery increased from 59% to 80%. Reexcision rates decreased from 26% to 9%, with frozen section examinations allowing 93% of node-positive patients to avoid a second surgery for axillary lymph node dissection. In practice, one in every 10 women did not have to undergo a second surgery. A cost analysis showed savings between USD 400-600 per breast cancer patient, even when accounting for fewer axillary lymph node dissections. The study was published early online on December 16, 2011, in the American Journal of Surgery.

“The frequent need for second surgeries among patients undergoing breast cancer surgery represents a tremendous burden for patients,” said lead author associate professor of surgery Michael Sabel, MD. “Beyond the inconvenience and additional time away from work, additional surgeries can result in worse cosmetic outcomes and increased complication rates. Our experience shows that offering on-site pathology consultation has a substantial impact on quality of care.”

Including an on-site pathology lab in the OR requires a different approach for preserving and undertaking cell biopsies, called a frozen section analysis. Once completed, the pathologists perform standard biopsy tests using traditional methods; results for both types of analyses have proved consistent. To include on-site pathology requires overcoming more obstacles, such as transporting the tissue samples, building a pathology facility, and staffing it appropriately at an offsite surgical center.

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University of Michigan Comprehensive Cancer Center