Decreasing breast cancer patient morbidity is of foremost concern for a Breast Health Navigator and their multidisciplinary team. Having breast cancer surgery is emotionally traumatic for a patient. Finding that a second surgery is needed because of positive margins or positive nodes, increases a patient’s physical morbidity and prolongs their emotional stress. Not only is the patient impacted, the costs associated with a second surgery are higher as shown by a recent study at the University of Michigan Comprehensive Cancer Center. The study reported on the impact of intraoperative pathology consultation for breast cancer patients.
Methods: The center 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 routinely performed.
- 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 2011 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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