Michael S. Sabel, M.D., was lead author of the study.

One and Done

On-site pathology evaluations reduce repeat surgeries

issue 16 | summer 2012

Nearly one in three women who have breast cancer surgery will need to return to the operating room for additional surgery after the tumor 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 surgery can be done immediately.

This cut the number of second surgeries needed by 64 percent, to one in 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 its outpatient breast cancer surgeries now occur. A study evaluating 271 patients treated eight months before this program began and 278 treated during the next eight months 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," says lead study author Michael S. Sabel, M.D., associate professor of surgery at the U-M Medical School. "Our experience shows that offering on-site pathology consultation has a substantial impact on quality of care."

Before the on-site pathology, 25 percent of patients needed a second operation to remove more tissue, compared with 11 percent after the service began. Among patients with positive lymph nodes, 93 percent of them avoided a second surgery with on-site pathology.

Conducting on-site pathology requires frozen section analysis for preserving and evaluating the cells. After this is completed, U-M pathologists then process the tumors for standard fixed tissue testing. The study showed consistent results across both types of analysis.

The study authors also considered new guidelines that suggest fewer women need to have their lymph nodes removed if the sentinel lymph node biopsy is positive. The authors factored in that reduction and still found that intraoperative analysis was highly cost-effective.

"Establishing an intraoperative pathology consultation service is feasible, highly efficient and extremely beneficial to patients and surgeons," says Sabel. "And it reduces the cost of cancer care."

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Michael S. Sabel, M.D. bio