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

• Published in: The American journal of surgery Vol. 204; no. 1; pp. 66 - 77
• Main Authors: Sabel, Michael S., M.D, Jorns, Julie M., M.D, Wu, Angela, M.D, Myers, Jeffrey, M.D, Newman, Lisa A., M.D., M.P.H, Breslin, Tara M., M.D., M.S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2012; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Axilla; Biological and medical sciences; Biopsy; Breast cancer; Breast Neoplasms - economics; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer surgery; Cancer therapies; Chemotherapy; Colleges & universities; Cost analysis; Cost control; Costs and Cost Analysis; Dissection; Feasibility Studies; Female; Frozen section; Frozen Sections; General aspects; Gynecology. Andrology. Obstetrics; Humans; Interdisciplinary Communication; Lymph Node Excision; Mammary gland diseases; Mastectomy, Segmental - methods; Mastectomy, Segmental - standards; Mastectomy, Segmental - trends; Medical sciences; Middle Aged; Pathology; Pathology, Surgical - economics; Pathology, Surgical - organization & administration; Referral and Consultation - economics; Referral and Consultation - organization & administration; Reoperation - statistics & numerical data; Sentinel Lymph Node Biopsy; Surgery; Surgicenters - economics; Surgicenters - organization & administration; Tumors; Breast cancer; Cost analysis; Frozen section; Sentinel lymph node biopsy; Breast disease; Sentinel lymph node; Free form; Freezing; Surgery; Consultation; Development; Ambulatory; Mammary gland; Human; Center; Histological preparation; Patient; Intraoperative; Malignant tumor; Mammary gland diseases; Anatomic pathology; Treatment; Biopsy; Economic aspect; Economic impact; Cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2011.07.016

Abstract Background 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. Methods 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. Results 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. Conclusions 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.