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Frozen Section Examination during surgery

Posted by polianad22 @polianad22, Oct 13, 2022

Hello everyone,

I just met Dr. Alexandra Heerdt, Memorial Sloan Kettering, for a second opinion. She allows you to ask questions, she is approachable. Overall we are happy with her.
My first Dr. Elisa Port from Mount Sinai was good too, but not so approachable. We couldn't really ask her questions.

One thing that it's a bit confusing for me is that Dr. Port wanted to take out a group of sentinel nodes, do the frozen section examination ( cryosection) during the surgery and remove all the axillary nodes if the sentinel nodes were to be found positive. Everything done during the surgery, lumpectomy or mastectomy.

Dr. Heerdt shared that they don't do frozen section examination during surgery at Memorial Sloan Kettering. She is going to remove ( 1-5) sentinel nodes during the surgery, and examine those nodes like a normal procedure which will take a few days. In the case they are found positive then I will have an axillary dissection after the surgery ( lumpectomy or mastectomy).

Can you please share your experience?

Interested in more discussions like this? Go to the Breast Cancer Support Group.

Mentor
Helen, Volunteer Mentor | @naturegirl5 | Oct 13, 2022

@polianad22. You've provided an excellent description of the differences between surgeons in how they examine lymph nodes. I had endometrial cancer and interestingly what had been done for many years with breast cancer and examination of sentinel nodes had become standard practice at Mayo Clinic in 2019 where I had my surgery. My surgeon did the first option - frozen section that examined by pathology while I was still in the OR. In my case the sentinel nodes were negative so no other nodes were removed. At the sentinel nodes been positive then pelvic nodes would have been removed. All of this happens during surgery.

I expect that what you've described are different procedures at different cancer centers as practiced by different surgeons.

My GYNOncology surgeon at Mayo Clinic was very approachable and spent a lot of time explaining my cancer, the procedure, and answered my many, many questions.

So, are you going with the surgeon at Sloan Kettering? I expect that both surgeons would be very good but it is ultimately your decision in where and with who you feel most comfortable.

Is your surgery planned for soon? Would you feel comfortable sharing why you sought out a second opinion?

REPLY
1 reply
polianad22 | @polianad22 | Oct 13, 2022
In reply to @naturegirl5 "@polianad22. You've provided an excellent description of the differences between surgeons in how they examine lymph..." + (show)
@naturegirl5

@polianad22. You've provided an excellent description of the differences between surgeons in how they examine lymph nodes. I had endometrial cancer and interestingly what had been done for many years with breast cancer and examination of sentinel nodes had become standard practice at Mayo Clinic in 2019 where I had my surgery. My surgeon did the first option - frozen section that examined by pathology while I was still in the OR. In my case the sentinel nodes were negative so no other nodes were removed. At the sentinel nodes been positive then pelvic nodes would have been removed. All of this happens during surgery.

I expect that what you've described are different procedures at different cancer centers as practiced by different surgeons.

My GYNOncology surgeon at Mayo Clinic was very approachable and spent a lot of time explaining my cancer, the procedure, and answered my many, many questions.

So, are you going with the surgeon at Sloan Kettering? I expect that both surgeons would be very good but it is ultimately your decision in where and with who you feel most comfortable.

Is your surgery planned for soon? Would you feel comfortable sharing why you sought out a second opinion?

Jump to this post

I wanted a second opinion, because Dr. Port wasn't answering to our questions. It felt that she was dismissive. She reminded me of my Romanian doctors during communism. However, I think she is a good surgeon as she was recommended by a few people. Dr. Alexandra Heerdt was opened to answer to our questions, she drew on paper for us, explained a lot of things. We met her at 10:45 am. I had an ultrasound at 1:30 and met Dr. Heerdt again around 3:00 pm. Although she answered to more questions after the ultrasound, her energy was a bit dismissive. My husband and I are thinking that she was tired after a day of work.

My surgery is scheduled with Mount Sinai for November 3rd, but I think that I might go with Dr. Heerdt.

I still wonder why Sloan Kettering doesn't do the Frozen Section during the surgery. Maybe because I am stage 1 at this moment.

REPLY
1 reply
polianad22 | @polianad22 | Oct 14, 2022
In reply to @polianad22 "I wanted a second opinion, because Dr. Port wasn't answering to our questions. It felt that..." + (show)
@polianad22

I wanted a second opinion, because Dr. Port wasn't answering to our questions. It felt that she was dismissive. She reminded me of my Romanian doctors during communism. However, I think she is a good surgeon as she was recommended by a few people. Dr. Alexandra Heerdt was opened to answer to our questions, she drew on paper for us, explained a lot of things. We met her at 10:45 am. I had an ultrasound at 1:30 and met Dr. Heerdt again around 3:00 pm. Although she answered to more questions after the ultrasound, her energy was a bit dismissive. My husband and I are thinking that she was tired after a day of work.

My surgery is scheduled with Mount Sinai for November 3rd, but I think that I might go with Dr. Heerdt.

I still wonder why Sloan Kettering doesn't do the Frozen Section during the surgery. Maybe because I am stage 1 at this moment.

Jump to this post

I couldn't really sleep last night as I have so many questions in my head:

- what are the benefits of not doing the frozen section during the surgery?
- what are the benefits of doing the frozen section during the surgery?
- is more difficult to have axillary nodes removed during surgery?
- is more difficult to have axillary nodes removed after the surgery?
- is it full anesthesia for axillary nodes surgery?
- in the case of a mastectomy, how the axillary lymph nodes removal surgery will be?
- in the case of a lumpectomy how the axillary lymph nodes removal surgery will be?
- in the case of lumpectomy, if the margins are not clear, then the axillary lymph nodes removal surgery will be done at same time with a second lumpectomy?

REPLY
Mentor
Helen, Volunteer Mentor | @naturegirl5 | Oct 14, 2022

@polianad22. I noticed in your post that you mentioned Romania. Is that where you are from? I have a good friend from Romania and this is how she describes her experiences there also. How wonderful it is that you are in NY where there are centers of excellence for the cancer care that you need. And that you have a choice.

There are many reasons why one surgeon explains things differently than another. Your experience with Dr. Heerdt is much like mine at Mayo Clinic where the surgeon drew pictures for me on a piece of paper and wrote notes that I could take with me.

Is there a patient portal at Sloan Kettering that you can use? If so, can you write a note and ask why a frozen section isn't done there for sentinel nodes? There could be medical reasons for you that weren't explained at the time.

Thank you for sharing this information and your concerns here. This is what Mayo Clinic Connect is all about. You get support and along the way you support others. Will you let me know what you find out and what you eventually decide to do?

REPLY
1 reply
polianad22 | @polianad22 | Oct 14, 2022
In reply to @naturegirl5 "@polianad22. I noticed in your post that you mentioned Romania. Is that where you are from?..." + (show)
@naturegirl5

@polianad22. I noticed in your post that you mentioned Romania. Is that where you are from? I have a good friend from Romania and this is how she describes her experiences there also. How wonderful it is that you are in NY where there are centers of excellence for the cancer care that you need. And that you have a choice.

There are many reasons why one surgeon explains things differently than another. Your experience with Dr. Heerdt is much like mine at Mayo Clinic where the surgeon drew pictures for me on a piece of paper and wrote notes that I could take with me.

Is there a patient portal at Sloan Kettering that you can use? If so, can you write a note and ask why a frozen section isn't done there for sentinel nodes? There could be medical reasons for you that weren't explained at the time.

Thank you for sharing this information and your concerns here. This is what Mayo Clinic Connect is all about. You get support and along the way you support others. Will you let me know what you find out and what you eventually decide to do?

Jump to this post

I am originally from Romania. Moved here, in NY, in 2005.

It's really tempting to go with Lumpectomy, trust the surgeon, and have a positive attitude about it, if I need to go into the second lumpectomy.

Why do I feel that the mastectomy is safer? Less recurrence etc.

REPLY
Mentor
Laurie, Volunteer Mentor | @roch | Oct 15, 2022

I had frozen section examined during my surgery for breast cancer at Mayo. The biggest benefit of having results during surgery is completing everything in one surgery and not have to go back at later date to do more surgery.

Here is short description on what / why do.
https://www.mayoclinic.org/departments-centers/surgery/overview/frozen-section-pathology-lab#:~:text=Mayo%20Clinic%20is%20one%20of,still%20in%20the%20operating%20room.

I went into surgery knowing I had a positive lymph node. During surgery they found another. They only removed two lymph nodes in addition to tumor in breast (lumpectomy). The fewer lymph nodes they remove the better to avoid lymphedema, but have to trust surgeon they get all the ones with cancers.

It is normal to be nervous.

Wishing you the best.
Laurie

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