Breast biopsy or excision
Generally 10% neutral buffered formalin. Breast specimens should be immersed for 6-72 hours.
Selection and trimming
- Determine total specimen size. Optionally, determine weight
- Ink margins.Template:Ink note If sample orientations are marked, use different colors for different directions.
- Palpate specimen for masses. Compare with radiograph if available
- Make 3-4 mm thick slices.
- 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
Breast specimens where breast cancer are possible should generally not be decalcified even when containing small calcifications, to preserve the ability to perform immunohistochemistry.
See also: General notes on gross processing
- Size of original tissue sample, preferably in 3 dimensions.
- Tumor properties, at least:
Usually H&E staining.
Routine immunohistochemistry usually include estrogen and progesterone receptors (ER, PR) and HER2.
If tumor is found, determine:
- Tumor size
- Distance from excision margin
The most important is to classify a sample as either of the following:
- Carcinoma in situ
- Invasive cancer
Most common types
|Fibrocystic breast changes||40%|
|Fibroadenoma||7%||Proliferation of both stromal and epithelial components,[notes 1] 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. 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.|
|Atypical ductal hyperplasia||7%||Epithelial proliferations which are not qualitatively or quantitatively abnormal enough to be classified as ductal carcinoma in situ.|
|Other benign mammary dysplasias and neoplasms||5%|
|Breast cancer (in situ or invasive)||10%||See next section.|
Breast cancer types
|Invasive ductal carcinoma (IDC)||Carcinomatous cells are seen below the basement membrane of lactiferous ducts. Otherwise, there are no specific histologic characteristics, essentially making it a diagnosis of exclusion.|
|Ductal carcinoma in situ (DCIS)||Malignant epithelial cells confined to the ductal system of the breast, without invasion through the basement membrane.|
|Invasive lobular carcinoma (ILC)||The "classic" pattern is round or ovoid cells with little cytoplasm in a single-file infiltrating pattern, sometimes concentrically giving a targetoid pattern.|
|Lobular carcinoma in situ (LCIS)||
Cells have indistinct cell borders, pale cytoplasm, and uniform small nuclei with evenly distributed chromatin and inconspicuous nucleoli.
|Mucinous carcinoma||Extracellular mucin areas around tumor cells.|
|Medullary carcinoma||Seemingly fused tumor cells (syncytial pattern), and a prominent lymphoid infiltrate.|
- Further information: Evaluation of tumors
If tumor is not found
Look for other abnormalities that may explain any diagnostic findings, mainly dense stromal fibrosis.
A normal biopsy may be reported as follows (with text in parentheses in a more comprehensive report):
|(Fibrofatty tissue with benign ducts and lobules.) Negative for (atypia and) malignancy.|
- The proliferation of two histological components is called "biplasia", from Latin bis (“twice”) and -plasia (“formation”), or "biphasic proliferation"
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