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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cfetoday @cfetoday

Depends on hospital. Mayo does something called Frozen Section Pathology Lab while still in surgery. When I had my lumpectomy and few lymph nodes removed, they were able to check margins while still in surgery. I knew I had clear margins after surgery.

Article about:
https://www.mayoclinic.org/departments-centers/surgery/overview/frozen-section-pathology-lab
Laurie

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My breast cancer surgeon knew while we were in surgery that she had clear margins.

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Did she have the pathologist look at it while in surgery?

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I suspect that is the only way she could have known that the margins were clear. I know when I had surgery for papilomas in my breast I was conscious and I heard the doctor say to send the specimens to pathology before she closed me up.

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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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I had a mastectomy, and the pathologist was on the surgical floor and told my surgeon that she had not gotten a totally clear margin after removing the large tumor. She went back for more, and the pathologist gave her a thumbs up. The Mayo Clinic in MN is where I had the surgery, and it is standard procedure there. You need to have a serious talk with your surgeon!!!!! Ego vs. common sense.

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I am treated at Dana Farber, Boston and this unfortunately not protocol. One of my 1.8cm ILC did not have great margins but the radiologist said that would be "boosted" during the final 3 radiation treatments. Sure hoping that worked - I bet a staffing issue - scheduling with pathology makes it tricky but would be a game changer, for sure. Thanks for sharing - I will discuss with my onco at upcoming visit it October at Dana Farber. xoox

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@roch

cfetoday @cfetoday

Depends on hospital. Mayo does something called Frozen Section Pathology Lab while still in surgery. When I had my lumpectomy and few lymph nodes removed, they were able to check margins while still in surgery. I knew I had clear margins after surgery.

Article about:
https://www.mayoclinic.org/departments-centers/surgery/overview/frozen-section-pathology-lab
Laurie

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Very valuable info! Knowledge is power.
Thank you!

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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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@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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I'm glad your margins came back clear the second time. This will be my third and I hope they get it all. I just don't understand why some hospitals can get a path report during surgery and some can not.

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