Development of an intraoperative pathology consultation service at a free-standing ambulatory surgical center: Clinical and economic impact for patients undergoing breast cancer surgery

Department of Surgery, University of Michigan Comprehensive Cancer Center, 3304 Cancer Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
American journal of surgery (Impact Factor: 2.29). 12/2011; 204(1):66-77. DOI: 10.1016/j.amjsurg.2011.07.016
Source: PubMed


Second surgeries represent a significant detriment to breast cancer patients. We examined the impact an intraoperative pathology consultation service had on multiple facets of breast cancer surgery.
We compared the 8 months before the establishment of a pathology laboratory, when intraoperative pathology consultation was not available, with the 8 months subsequent, when it was performed routinely.
The average number of surgeries per patient decreased from 1.5 to 1.23, and the number of patients requiring one surgery increased from 59% to 80%. Re-excisions decreased from 26% to 9%. Frozen section allowed 93% of node-positive patients to avoid a second surgery for axillary lymph node dissection. A cost analysis showed savings between $400 and $600 per breast cancer patient, even when accounting for fewer axillary lymph node dissections based on the American College of Surgeons Oncology Group Z0011 data.
Incorporation of routine intraoperative margin/sentinel lymph node assessment at an outpatient breast surgery center is feasible, and results in significant clinical benefit to the patient. Use of frozen section decreased both the time and cost required to treat patients.

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    • "However, all three IMA pathological methods resulted in significant concordance levels: the combined use of gross tissue inspection and specimen radiology [31] (p < 0.001), imprint cytology [15] (p < 0.001) and frozen section [21] (p ¼ 0.002). With respect to second operation rate, frozen section had the largest difference between study and control rates [12] [21]. Gross tissue inspection with specimen radiography similarly reported a significant difference (p ¼ 0.029) [31]. "
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