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Pathologist In Breast OR Means Fewer Returns

February 29, 2012
Written by: , Filed in: Breast Imaging
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Problem: More than a third of women who undergo breast cancer surgery will have to return for additional surgery after the tumor is evaluated by a pathologist.

Solution: Have the pathologist on-site in the operating suite, ready to evaluate the tumor and lymph nodes immediately after the surgery. The surgeon and patient remain in the operating room during the assessment. If further surgery is needed, it’s performed immediately.

Such a simple idea can make a big difference. The University of Michigan Comprehensive Cancer Center found that it reduced the percentage of women who had to return for additional surgery from 41 percent to 20 percent.

Michael S. Sabel, MD, is lead author of a study, published online in The American Journal of Surgery, that examined this new approach. “The frequent need for second surgeries among patients undergoing breast cancer surgery represents a tremendous burden for patients,” he said, as quoted in a University of Michigan Health System news release. He explained:

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.

Dr. Sabel is associate professor of surgery at the University of Michigan Medical School in Ann Arbor.

The university has been offering the service for two years at its East Ann Arbor Ambulatory Surgery and Medical Procedures Center. The study compared outcomes for the eight months before (271 patients) and after (278 patients) the establishment of the pathology laboratory.

If breast cancer patients must return to the operating room, it’s usually for removal of additional breast tissue because the cancer is too close to the surgical margin, or removal of additional lymph nodes if the initial sentinel lymph node biopsy finds cancer.

The establishment of on-site pathology reduced the number of patients who needed to return for removal of more tissue from 26 percent to 9 percent. It also reduced the number of women who eventually opted for full mastectomy. Of the patients whose lymph nodes tested positive for cancer, 93 percent avoided a return for more surgery.

And here’s something that will catch some eyes: The study found an average saving of between $400 and $600 per patient.

Dr. Sabel summed up the findings thus:

Establishing an intraoperative pathology consultation service is feasible, highly efficient, and extremely beneficial to patients, surgeons, and reducing the costs of cancer care.

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Related seminar: Breast & Women’s Imaging Seminar

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