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Judy C. Boughey, M.D., Breast/Melanoma Surgery, Mayo Clinic: When surgical resection of breast tissue occurs, pathological evaluation -- the review of the tissue under a microscope -- is a critical component to optimal patient care. While pathologic information can take days or weeks to obtain, at Mayo Clinic this tissue is evaluated by our pathologists while you are asleep in the operating room using an immediate frozen section method.
Frozen section analysis provides benefits on multiple levels. For patients undergoing excisional biopsy of benign breast lesions, it allows intraoperative confirmation that the tissue removed was benign. Importantly, for those cases where an unexpected malignancy is identified, this information can be given to the surgeon during the operation so that additional margins can be resected if necessary. This also means that the patients and her family can be informed by the surgeon about the pathologic findings on the day of surgery, and additional consultations or procedures planned, as needed.
For patients undergoing preventative or prophylactic mastectomy to decrease the long-term risk of breast cancer development, an unexpected cancer is identified in just a few percent of cases. In our practice, we routinely prepare for that possibility with the injection of a radioactive tracer in the breast that is undergoing preventative mastectomy. Once the breast is removed the pathologist evaluates the tissue. In cases where no cancer is identified, no lymph nodes are removed. If a hidden (or occult) cancer is identified, the surgeon proceeds with sentinel lymph node surgery. This preparation helps avoid the potential need for a second operation in the setting of a surprise finding of cancer.
This immediate and close collaboration between the breast surgeons and the pathologists for each individual minimizes the need for further operations and also decreases the waiting time for patients to find out the pathology from the surgical procedure.
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