Can a pathologist determine during surgery if 0 margin is met?

Posted by cfetoday @cfetoday, Sep 4, 2023

I have DCIS. Going for my third lumpectomy as I have not gotten a 0 margin. What I want to know is can a pathologist be on hand during surgery to determine if more tissue needs to be removed? I have had several people tell me that's what they had done which would have prevented me from having 3 surgeries. My doctor said no. Any input on this would be greatly appreciated.

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The pathologist on the surgical floor or downstairs in the lab can quickly determine if the margins are clear. It's simply a matter of whether the hospital is patient-oriented and establishes this quick relay system. I am very disappointed that M.D. Anderson (see a fellow cancer patient's note) doesn't have the same set up as the Mayo Clinic in MN. Cost effectiveness and poor administrative skills have replaced good medicine and caring patient treatment. Very sad.

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@dick61

The pathologist on the surgical floor or downstairs in the lab can quickly determine if the margins are clear. It's simply a matter of whether the hospital is patient-oriented and establishes this quick relay system. I am very disappointed that M.D. Anderson (see a fellow cancer patient's note) doesn't have the same set up as the Mayo Clinic in MN. Cost effectiveness and poor administrative skills have replaced good medicine and caring patient treatment. Very sad.

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I've been to two different hospitals. Conway Medical Center and now MUSC (Medical University of South Carolina) the latter being the best hospital in South Carolina. Both surgeons acted like they never heard of doing a path report during surgery. They both said you would have to freeze the sample. My second surgeon has great creditials with a degree from Harvard. There is no way I can go to the Mayo clinic as my insurance would not allow it. I am upset that they act like this is not done. I really would like to know if just the best hospitals do this? It is quite upsetting that I have to go through a third surgery and also pay $400 for each surgery when a path report could have been done on the 1st.

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Wow 3 surgeries .! And I’m sure they charge for each one . All the doctors I saw when getting second opinions -and third here In Dallas all do pathology during surgery .

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@dick61

The pathologist on the surgical floor or downstairs in the lab can quickly determine if the margins are clear. It's simply a matter of whether the hospital is patient-oriented and establishes this quick relay system. I am very disappointed that M.D. Anderson (see a fellow cancer patient's note) doesn't have the same set up as the Mayo Clinic in MN. Cost effectiveness and poor administrative skills have replaced good medicine and caring patient treatment. Very sad.

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It baffled me too . I had a consult with them and they said it was about a week and a half wait . The anxiety boy of waiting that long ! I think it’s because they are just backed up with cases since they handle so many !

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@cfetoday

I have other people tell me something similar. This is the second surgeon I am going to. The first one could not get a 0 margin with 2 surgeries. This will be my 3rd surgery. I have asked both doctors if they could get a pathologist to look at during surgery they both told me know because it has to be frozen. I'm going to MUSC in South Carolina. I'm very disappointed if all these surgeries could have been avoided if they did a pathology during surgery.

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Something to consider if you have not had your 3rd surgery yet. I did not have a clear margin by a small amount in 2016 surgery. Tumor Board suggested another surgery to get clear margins. I talked with my oncologist, surgeon, etc. Decided that the small margin would be addressed with radiation and would not require the disruption of another surgery. I just had my annual check up with examination of my breast and have had no recurrence of cancer in 7 years.

I had cancer in my internal mammary nodes and no surgery was done since they are along the sternum. They received the radiation as well and cancer was eliminated.

Encourage you to get a second opinion on the necessity of the 3rd surgery. Best to you as you make critical decisions.

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@cfetoday

I've been to two different hospitals. Conway Medical Center and now MUSC (Medical University of South Carolina) the latter being the best hospital in South Carolina. Both surgeons acted like they never heard of doing a path report during surgery. They both said you would have to freeze the sample. My second surgeon has great creditials with a degree from Harvard. There is no way I can go to the Mayo clinic as my insurance would not allow it. I am upset that they act like this is not done. I really would like to know if just the best hospitals do this? It is quite upsetting that I have to go through a third surgery and also pay $400 for each surgery when a path report could have been done on the 1st.

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I know you are frustrated and even frightened by having to wait for a path report. Our health care system in the US is absolutely failing to provide quality treatment. The medical insurance industry has financially strangled most hospitals and physicians. My fingers are crossed for!

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@dick61

I know you are frustrated and even frightened by having to wait for a path report. Our health care system in the US is absolutely failing to provide quality treatment. The medical insurance industry has financially strangled most hospitals and physicians. My fingers are crossed for!

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...you!

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@celestebradham

I have been and going to MDAnderson in Houston. Had a lumpectomy April 4. The pathology report did not come back for maybe a week? Margins were not clear missed it by like .5 mm or something( I’d have to look it up) I had second surgery April 21 and margins were clear. Never thought about pathology during surgery. That would have been wonderful, as the second surgery took me quite a while to feel good.

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When I had the chest wall/pectoral muscle tumor removed, I was left with a positive margin in the muscle. Like you, just a tiny bit more would have left me with a clear margin. Why cut it sooooo close? And, good question, why didn't they check for clear margins during surgery? I was not at a teaching hospital or cancer center, but the hospital I was at is not rinky dink and is in the top 50 nationally. Hmmm. Definitely, a good question everyone should ask before surgery.

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@californiazebra

When I had the chest wall/pectoral muscle tumor removed, I was left with a positive margin in the muscle. Like you, just a tiny bit more would have left me with a clear margin. Why cut it sooooo close? And, good question, why didn't they check for clear margins during surgery? I was not at a teaching hospital or cancer center, but the hospital I was at is not rinky dink and is in the top 50 nationally. Hmmm. Definitely, a good question everyone should ask before surgery.

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Yes we really do need answers on why some hospitals can do a path test during surgery and some can not.

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@cfetoday

I have other people tell me something similar. This is the second surgeon I am going to. The first one could not get a 0 margin with 2 surgeries. This will be my 3rd surgery. I have asked both doctors if they could get a pathologist to look at during surgery they both told me know because it has to be frozen. I'm going to MUSC in South Carolina. I'm very disappointed if all these surgeries could have been avoided if they did a pathology during surgery.

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Not all hospitals have the capacity to do this. Choose one that does if you can.

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