On-site lab reduces repeat surgeries

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A new service at the University of Michigan (U-M) Comprehensive Cancer Center in Ann Arbor, Michigan, has helped reduce the number of women who need additional surgery after an initial resection for breast cancer.

U-M's intraoperative pathology consultation service puts pathologists in the surgical suite to assess tumors and lymph nodes immediately after removal. The surgeon and patient remain in the operating room until the results come back, and any additional surgery can be performed immediately.

A team led by Michael S. Sabel, MD, reported in The American Journal of Surgery that among 271 patients evaluated in the 8 months before the facility established the intraoperative pathology consultation service, the average number of surgeries per breast cancer patient was 1.5. Eight months after the service was initiated, that average fell to 1.23 among 278 patients. 

The number of patients requiring one surgery increased from 59% in the 8 months prior to implementation of the service to 80% 8 months after, and reexcisions were reduced from 26% to 9%. Frozen section allowed 93% of node-positive patients to avoid a second surgery for axillary lymph node dissection.

Cost analysis indicated a savings of $400 to $600 per breast cancer patient, even when accounting for fewer axillary lymph node dissections. ONA

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