Getting Pathology Results ASAP After Lumpectomy

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QUESTION: I am scheduled for a lumpectomy. My question is whether there is a hospital in the United States that does the operation and tests the results at that time instead of having to wait 8-10 days to see if you need more surgery.

ANSWER: There are several ways that you can TRY to get a diagnosis prior to lumpectomy. If the lump is palpable (can be felt), your doctor can do a fine-needle aspirate or core biopsy. If the abnormality is not palpable, this can be done either with mammogram or ultrasound guidance. There are several limitations that you have to be aware of, however. First, these are sampling procedures only, which means that there is a low, but real, chance of not getting tumor tissue in the biopsy procedure and thereby coming out with an incorrect diagnosis of "normal." The results of the biopsy must make sense in the context of your physical exam and mammogram findings to be considered reliable and accurate. Finally, not everyone is a candidate for this type of diagnosis approach because of certain technical considerations.

In any case, the possibility should be discussed further with your doctor prior to the procedure. As far as immediate diagnosis while you are still in the operating room, I do not encourage the use of frozen section for several reasons. This is only a preliminary answer and generally does not give you the entire picture. If the lump is cancerous, you will get a better idea of true size and margins on permanent sections (which take several days to complete). If the lesion is borderline, allowing time for adequate tissue preparation will help to prevent "over reading" on final diagnosis. Again, if you discuss this with your surgeon, he or she will help you get the fastest answer possible without compromising the final diagnosis.

—Jennifer Sabol, M.D.

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