Breast biopsy or excision

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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
Atypical ductal hyperplasia 7%[7] Epithelial proliferations which are not qualitatively or quantitatively abnormal enough to be classified as ductal carcinoma in situ.[7] Micrograph of atypical ductal hyperplasia.jpg
Other benign mammary dysplasias and neoplasms 5%
Breast cancer (in situ or invasive) 10% See next section.

Breast cancer

Breast cancer types, with relative incidences and prognoses.
Cancer type Histopathology Image
Ductal carcinoma in situ DCIS - Intraductal carcinoma of the breast.jpg
Further information: Evaluation of tumors

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  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. 
  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.
  7. 7.0 7.1 David J. Myers; Andrew L. Walls.. Atypical Breast Hyperplasia. StatPearls, National Center for Biotechnology Information. Last Update: February 15, 2019.