Implementing a routine intraoperative margin/sentinel lymph node assessment at an outpatient breast surgery center resulted in significant clinical benefit to the patient, according to study results published in The American Journal of Surgery.
Approximately 40% to 60% of patients with breast cancer are required to undergo second or third procedures to attain clear surgical margins with breast conservation or complete axillary dissection for positive sentinel nodes. Intraoperative analysis of frozen sections of breast and sentinel lymph node specimens has been suggested as a possible method for reducing the number of secondary surgeries by resecting additional breast tissue and/or performing a completion axillary dissection during the initial surgery.
To determine the beneficial effect of an intraoperative pathology consultation service at the University of Michigan Comprehensive Cancer Center on multiple facets of breast cancer surgery, researchers compared outcomes of patients with breast cancer from 8 months before the establishment of a pathology laboratory (n=271) with the 8 subsequent months in which it was routinely performed (n=278).
“The frequent need for second surgeries among patients undergoing breast cancer surgery represents a tremendous burden for patients,” researcher Michael S. Sabel, MD, said in a press release. “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.”
According to study results, after the implementation of intraoperative margin/sentinel lymph node assessment, the average number of surgeries per patient decreased from 1.5 to 1.23. After initiation of frozen section analysis, the number of patients requiring only a single surgery increased from 59% to 80%, but 20% required a second surgery and only 1% required three or more surgeries (P<.001). Re-excisions decreased from 26% to 9%, whereas assessments of the frozen sections enabled 93% of node-positive patients to avoid secondary surgical procedures for axillary lymph node dissection.
“In large part, routine intraoperative analysis of lumpectomy margins is rare because of logistical issues, especially as breast surgery is more commonly performed at outpatient surgical centers,” Sabel said. “Despite these obstacles, we found that not only is this beneficial for our patients, but it reduced the costs of caring for patients with breast cancer.”
Disclosure: The researchers report no relevant financial disclosures.