
On Sunday, for the very first time, I read a magazine article about the hospital where I received treatment for breast cancer. I had never before seen mention of my hospital, my doctors, my city in anything other than local and regional newspapers and on area television stations. I figured news about Shands Hospital at The University of Florida was out there -- in more areas than my own -- because it's a well-known facility. People travel from all over to receive treatment here. So I know it's a good place. But to see in the October 2006 issue of
Good Housekeeping an actual blurb about a new kind of lumpectomy -- pioneered right here in Gainesville, Florida -- is exciting.
I am the happy recipient of this new kind of lumpectomy -- which really is not new at all. It was developed 20 years ago by the surgeon who performed my own lumpectomy, and it allows women who undergo lumpectomy the chance to avoid return trips to the operating room.
The method is called
frozen section analysis, and it was first used by
Dr. Edward Copland III, first director of the
UF Shands Cancer Center, who was tired of waiting for pathology reports and tired of operating on patients two and three times to ensure clear tumor margins.
It all happens like this -- a surgeon removes the breast cancer tumor, takes tissue samples, freezes them in an embedding compound, and sends them to a pathologist for immediate analysis. In a typical case, this frozen section process adds just 15 minutes to the operating time. If pathology reveals more tissue must be removed, the surgeon returns to the patient, still under anesthesia, and continues surgery. The patient does not need to return for more surgery.
Surgeons at most institutions rely on a method called
permanent section analysis to determine whether or not cancerous cells remain along the margins of a tumor. The technique is labor-intensive, takes days to complete, and requires patients to return for additional surgery if margins are not clear. Surgeons using the frozen section method still consult permanent sections to confirm margins are clear -- but they are mostly certain of their findings during frozen section.
Studies show frozen section analysis to be safe and effective -- and it adds just $851 to the cost of surgery, a savings considering the cost of returning for surgery as a result of permanent analysis.
There are many advantages -- but the procedure is tricky and on occasion can fail to detect some cancerous margins, indicating frozen section should continue to be used in conjunction with permanent section. Opponents of the practice say false positives could result in unnecessary mastectomy. But Copeland says this has never happened at UF -- and he would never remove a woman's breasts until permanent section confirmed it was necessary.
Despite the promise of this method, only a handful of institutions make practice of this surgery-sparing technique. Shands at UF is the only hospital in North Florida where breast surgeons perform frozen section analysis on a regular basis.
The procedure -- which is not risky, is not harmful, and clearly saves patients from returning for surgery -- is the exact procedure I received almost two years ago. Dr. Copeland removed my tumor, froze tissue samples, sent them to pathology, and 15 minutes later knew my tumor had clear margins and had not spread to my lymph nodes. He visited my family in the hospital waiting room just after surgery and told them the good news -- clear margins, no spread, a 1.1 cm. tumor, stage I. And while other tumor criteria, such as ER/PR status and HER2 status, did not come my way immediately, I at least knew the basics when I woke from surgery. No waiting. No worrying. No complaints.