Just about one in three women having breast cancer surgery must return to the operating room for added surgery after the tumour is evaluated by a pathologist.
A new service at the University of Michigan Comprehensive Cancer Center cuts that number drastically by having pathologists on-site in the operating suite to assess tumors and lymph nodes immediately after they are removed. Meanwhile, the surgeon and patient remain in the operating room until the results are back, and any additional operating can be done immediately.
This cut the number of second surgeries needed by 64 percent, to one of every 10 women.
U-M began offering the service about two years ago at its East Ann Arbor Ambulatory Surgery Center, where the majority of outpatient breast cancer surgeries now occur. A study evaluating 271 patients treated eight months before and 278 treated eight months after this program began appears in the American Journal of Surgery
"The frequent need for second surgeries among patients undergoing breast cancer surgery represents a tremendous burden for patients. 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," says lead study author Michael S. Sabel, M.D., associate professor of surgery at the U-M Medical School.
Patients must return to the operating room for two primary reasons: to remove additional tissue when the cancer cells are too close to the margin of tissue removed; and in some cases, to remove additional lymph nodes if the initial sentinel lymph node biopsy tests positive for cancer.
Before the on-site pathology, 25 percent of patients needed a second operation to remove more tissue, compared to 11 percent after the service began. Among patients with cancerous lymph nodes, 93 percent of them avoided a second surgery with on-site pathology.
In addition to reducing second surgeries, the study found that assessing the margins in the OR allowed more women to conserve their breasts. The study authors suggest that women who have positive margins requiring additional surgery are more likely to choose mastectomy because they fear their cancer will return or that they'll need a third operation.