|By Jeff Hansel, Post-Bulletin, Rochester, Minn.|
|McClatchy-Tribune Information Services|
In fact, the rate of second surgeries needed after lumpectomies at other clinics is four times that at Mayo. The reason is Mayo's "frozen-section technique" -- perfected at the request of the Mayo brothers themselves -- which has been used for more than 100 years.
"We have something here that's going to minimize your risk of a second operation," said Dr.
The frozen section procedure involves sending removed tumor samples (including surrounding tissues) from the operating room directly to the nearby pathology lab. There, pathologists quick-freeze and shave off parchment-thin wafers of tissue samples, dye them and place them on slides for immediate analysis.
Most medical centers nationwide use some form of frozen sections. But it's rare to do the analysis and get the results while the patient is still in surgery. At other medical centers, slide review can take as long as 24 hours.
"This is something that we offer that other places don't offer -- and this is what I would want for my relative," Boughey said.
Pathologists analyze the samples to be certain each has a "clean margin," meaning, essentially, that the surgeon successfully removed enough cancer-free tissue so that both the tumor and nearby cancerous cells have been taken out.
"Every patient specimen gets processed this way," Boughey said.
It's a labor-intensive endeavor. The medical center in
At other medical centers nationally, 13.2 percent of patients need a second lumpectomy when pathology tests indicate the surgical margins are not clean. At Mayo in
According to Mayo, the technique not only decreases the need for further surgery. It also decreases missed diagnoses, patient worry, travel time, and costs for the patient, insurance companies and hospital.
Even so, the standard throughout the country is not to do tissue analysis during surgery," Boughey said.
In large part, that can be attributed to staffing. It's a major undertaking, and big upfront cost, to institute Mayo's protocol for frozen-section analysis during patient surgeries, she said.
Pathologists and staff at Mayo in
In Mayo operations, surgeons close up when "they feel we're cancer free" with lumpectomies, Boughey said. Other tumors in addition to breast cancer are reviewed in the same manner.
Altogether, patients remain under anesthesia for 10 to 20 minutes longer than they would otherwise. Boughey said during that time, "there's always something I'm working on towards their care."
While you were asleep
While the patient is under anesthesia after a tumor removal, a lot is happening in the pathology lab, said Dr.
After the tissue sample is frozen, a precise cutting tool called a microtome "comes across and cuts around a 6-micron section," Keeney said. The thin piece of tissue is placed by a pathology technologist in a rinse, then stained and picked up with a glass rod to be placed on a labeled glass slide.
Pathologists scrutinize the results. A slide containing a sample with an unusual presentation can be projected on to a large overhead screen to allow a rapid team consultation. If needed, highly specialized experts from across the Mayo campus can connect remotely to weigh in on a difficult diagnosis.