Difference between revisions of "Breast biopsy or excision"

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(→‎Malignancy: Expanded)
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*Invasive cancer
 
*Invasive cancer
  
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===Most common types===
 
{|class="wikitable" align="center"
 
{|class="wikitable" align="center"
 
|+ Women seeking evaluation of a breast lump<ref name="Kumar">{{cite book |author1=Mitchell, Richard Sheppard |author2=Kumar, Vinay |author3=Abbas, Abul K. |author4=Fausto, Nelson |title=Robbins Basic Pathology |edition=8th |publisher=Saunders |location=Philadelphia |year= 2007|page=739 |isbn=978-1-4160-2973-1 |oclc= |doi=}}</ref>
 
|+ Women seeking evaluation of a breast lump<ref name="Kumar">{{cite book |author1=Mitchell, Richard Sheppard |author2=Kumar, Vinay |author3=Abbas, Abul K. |author4=Fausto, Nelson |title=Robbins Basic Pathology |edition=8th |publisher=Saunders |location=Philadelphia |year= 2007|page=739 |isbn=978-1-4160-2973-1 |oclc= |doi=}}</ref>
 
|-
 
|-
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! scope="col" | Finding
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! Finding
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! scope="col" | Percentage
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! Relative<br> incidence
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! Histopathology
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! Image
 
|-  
 
|-  
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| Fibrocystic breast changes || 40%
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| Fibrocystic breast changes || 40% ||  ||
 
|-  
 
|-  
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| No disease || 30%
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| No disease || 30% ||  ||
 
|-  
 
|-  
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| Fibroadenoma || 7%
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| Fibroadenoma || 7% || Biphasic proliferation of both stromal and epithelial components, arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts). Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.<ref name="WHO">{{cite book |editor=Tavassoli, F.A. |editor2=Devilee, P. |title=World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs |publisher=IARC Press |location=Lyon |year=2003 |isbn=978-92-832-2412-9 |url=}}{{page needed|date=February 2017}}</ref><ref name="POW">Pathology Outlines Website. [http://pathologyoutlines.com/breast.html#fibroadenoma] Accessed 12 February 2009.</ref><ref name="Rosen">{{cite book |author=Rosen, PP. |title=Rosen's Breast Pathology |isbn=978-0-7817-7137-5 |edition=3rd|year=2009 }}</ref> Furthermore, the epithelial proliferation appears in a single terminal ductal unit and has duct-like spaces surrounded by a fibroblastic stroma. The basement membrane is intact.<ref name="titleFibroadenoma of the breast">{{cite web |url=http://www.pathologyatlas.ro/fibroadenoma-breast-pathology.php |title=Fibroadenoma of the breast |access-date=2007-12-15 }}</ref>
 +
| [[File:Micrograph of a fibroadenoma.jpg|180px]]
 
|-  
 
|-  
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| Other benign mammary dysplasias and neoplasms || 13%
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| Other benign mammary dysplasias and neoplasms || 13% ||  ||
 
|-
 
|-
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| Breast cancer || 10%
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| Breast cancer (in situ or invasive) || 10% || See next section. ||
 
|-
 
|-
 
|}
 
|}
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 +
===Breast cancer===
 
[[File:Pie chart of incidence and prognosis of histopathologic breast cancer types.png|thumb|310px|Breast cancer types, with relative incidences and prognoses.]]
 
[[File:Pie chart of incidence and prognosis of histopathologic breast cancer types.png|thumb|310px|Breast cancer types, with relative incidences and prognoses.]]
  
−
<gallery>
 
−
File:Micrograph of a fibroadenoma.jpg|Fibroadenoma
 
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</gallery>
 
 
{{Evaluation of tumors}}
 
{{Evaluation of tumors}}
 
{{Bottom}}
 
{{Bottom}}

Revision as of 06:47, 2 October 2019

Author: Mikael Häggström [note 1]

Gross examination

Selection and trimming

  • Determine total specimen size. Optionally, determine weight[1]
  • Ink margins.Template:Ink note If sample orientations are marked, use different colors for different directions.[1]
  • Palpate specimen for masses. Compare with radiograph if available[1]
  • Make 3-4 mm thick slices.[1]
  • Submit:[1]
  • Entire specimen if it can fit in 3-5 slices.
  • If larger, 1 slice per cm of tumor (minimum of 3 slices of tumor), including both center and periphery of tumor.
  • Additional suspicious areas, including those indicated by mammography

  See also: General notes on gross processing


Report

  • Size of original tissue sample, preferably in 3 dimensions.
  • Tumor properties, at least:
  • Size in 3 dimensions.[1]
  • Distance from margins[1]
  • Consistency[1]

Microscopic evaluation

If tumor is found, determine:

  • Tumor size
  • Malignancy
  • Distance from excision margin

Malignancy

The most important is to classify a sample as either of the following:

  • Benign
  • Carcinoma in situ
  • Invasive cancer

Most common types

Women seeking evaluation of a breast lump[2]
Finding Relative
incidence 		Histopathology Image
Fibrocystic breast changes 40%
No disease 30%
Fibroadenoma 7% Biphasic proliferation of both stromal and epithelial components, arranged into either a pericanalicular pattern (stromal proliferation around epithelial structures), or an intracanalicular pattern (stromal proliferation compressing the epithelial structures into clefts). Fibroadenomas characteristically display hypovascular stroma compared to malignant tumors.[3][4][5] Furthermore, the epithelial proliferation appears in a single terminal ductal unit and has duct-like spaces surrounded by a fibroblastic stroma. The basement membrane is intact.[6] Micrograph of a fibroadenoma.jpg
Other benign mammary dysplasias and neoplasms 13%
Breast cancer (in situ or invasive) 10% See next section.

Breast cancer

Breast cancer types, with relative incidences and prognoses.
Further information: Evaluation of tumors

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Monika Roychowdhury. Grossing (histologic sampling) of breast lesions. Pathologyoutlines.com. Topic Completed: 1 August 2012. Revised: 19 September 2019
  2. ↑ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). Robbins Basic Pathology (8th ed.). Philadelphia: Saunders. p. 739. ISBN 978-1-4160-2973-1. 
  3. ↑ Tavassoli, F.A., ed (2003). World Health Organization Classification of Tumours: Pathology & Genetics: Tumours of the breast and female genital organs . Lyon: IARC Press. ISBN 978-92-832-2412-9. Template:Page needed
  4. ↑ Pathology Outlines Website. [1] Accessed 12 February 2009.
  5. ↑ Rosen, PP. (2009). Rosen's Breast Pathology (3rd ed.). ISBN 978-0-7817-7137-5. 
  6. ↑ . Fibroadenoma of the breast.

Image sources


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