After 15-30 minutes of quick histopathological testing, also known as frozen biopsy, the doctor can determine whether the tumor is benign or malignant with 92% accuracy, thereby deciding on the most suitable surgical direction for the patient.
On May 9, Dr. Nguyen Van Thai, Deputy Pathologist, Tam Anh General Hospital, Ho Chi Minh City, said that frozen biopsy (frozen section biopsy or immediate biopsy) is performed in parallel with surgery, determining whether the tumor, body tissue, or lymph nodes are benign or malignant. From the 92% accurate result, the surgeon provides appropriate treatment direction, increasing the success rate for the surgery and subsequent treatment.
This method also helps doctors determine whether the margin section during melanoma surgery still has malignant cells or not, and plan appropriate follow-up treatment. Patients only need to undergo one surgery to solve two problems: diagnostic biopsy and surgical treatment.
“Without frozen biopsy, it is difficult for surgeons to make accurate decisions,” said master, doctor Huynh Ba Tan, Department of Breast Surgery, Tam Anh General Hospital, Ho Chi Minh City. Sometimes, the doctor must decide based on experience, the patient is at risk of having to have surgery again and again.
Doctor Thai examined each cut piece under a microscope. Image: Hospital provided
Frozen sentinel lymph node biopsy is performed in patients with early stage breast cancer. In this case, the doctor did not see swollen axillary lymph nodes and the ultrasound and mammogram results did not show any abnormalities. The sentinel node is the first blocking node on the lymphatic drainage path of malignant cells. If the sentinel lymph node has malignant cells, the risk of malignant cells spreading to other lymph nodes in the armpit is high, then the doctor must remove the patient’s axillary lymph nodes.
Previously, most breast cancer patients, whether in the early or late stages, had to have all axillary lymph nodes removed and checked for metastases. Curettage of all axillary lymph nodes can easily cause arm lymphedema complications such as arm swelling, pain, and limited arm mobility.
Patients are likely to have reduced or lost sensation in the armpit and inner arm due to damaged nerves during the lymph node dissection process. The surrounding skin areas may be numb, itchy, have reduced sensation, and mental health may be affected. Swelling also affects appearance. Arm lymphedema cannot be cured, only symptoms can be alleviated. People with early-stage breast cancer that has not metastasized to axillary lymph nodes still have their lymph nodes removed, leading to complications of arm swelling.
Like Ms. Hong, 40 years old, diagnosed with stage 1 breast cancer, she went to Tam Anh General Hospital in Ho Chi Minh City for examination. The doctor prescribed surgery to remove left breast cancer and reconstruct the chest with a rectus abdominis muscle skin flap. With breast cancer removal surgery, the doctor needs to biopsy the sentinel lymph node to see if the cancer has metastasized to the lymph nodes. If it has not metastasized, the doctor does not have to remove the lymph nodes to avoid complications of lymphedema.
For reconstructive surgery using the rectus abdominus muscle flap, the surgeon needs to biopsy the tissue behind the nipple. If the tissue has cancer cells, the team will need to remove the nipple. Dr. Ba Tan injected a green substance (methylene blue) so that the substance would drain along the lymphatic route to the armpit area and began to incise the skin, look for blue-stained lymph nodes in the armpit, and cut the tissue behind the nipple and send it to the surgery room. surgery. Then the breast is cut off for the patient.
The Breast Surgery Department team performed surgery on Ms. Hong. Image: Tam Anh General Hospital
Pathology Unit, Tam Anh General Hospital, Ho Chi Minh City received three specimens, filtered out fat around the lymph nodes, then cut the lymph nodes into 4 thin slices of about 0.2 cm, placing them on racks. In 60 seconds, the sample is completely frozen and ready for sectioning (the tumor sample is used for testing). After 10 minutes of receiving the sample, the specimen cut from the first axillary lymph node block was brought to the doctor’s table to read the results.
Doctor Thai examined each cut piece and informed the operating room of the results that the two sentinel lymph nodes received had no metastatic malignant cells and the tissue behind the nipple was benign. The entire process from receiving the sample to getting the results takes place in 15 minutes.
In the operating room, Dr. Tan received the information and decided to continue the surgery without removing the axillary lymph nodes, keeping the nipples, and reconstructing the patient’s breasts with a rectus abdominis skin flap.
Dr. Tan said that when there was no frozen biopsy, patients who chose breast reconstruction had to have their nipples removed. Once the wound heals and the condition is well controlled, the doctor will reconstruct the nipple using the skin of the chest and graft half of the other nipple.
Every day, the Pathology Unit receives frozen biopsy samples to evaluate the nature of tumor tissue, resection margins, lymph nodes… The doctor reading the results must have experience and decision-making ability to provide quick results. the most exactly.