Evaluation of suspected malignancies
Author:
Mikael Häggström [note 1]
Further reading: |
For evaluation of suspected malignancies, the most important aspects of a tumor is whether it benign or malignant. If malignant, then staging is necessary.[1] There are generally specific criteria for various forms of tumors, which should be used whenever applicable, but following are some generalizations.
A general approach is to start looking at the slide which seems to contain most tumor (excluding any necrosis), facilitating a diagnosis, and shows what kind of cells to look for in the periphery.
Contents
Benign or malignant
Benign[2] | Malignant[2] | |
---|---|---|
Gross examination |
|
Possibly:
|
Microscopy | Almost no irregularities of cellular structures | Nuclear atypia:
|
Staging
Staging is generally done by TNM classification. Specific TNM systems should be used, as per the manual by the American Joint Committee on Cancer (AJCC), whenever applicable. Otherwise, a general system may be used:[1]
T: size or direct extent of the primary tumor
N: degree of spread to regional lymph nodes
M: presence of distant metastasis
|
Radicality
Determine if malignant cells are located close to, or even in, any surgical resection margins.
Typing and grading
Beyond determining overall malignancy, probable origin and staging, classification of tumors into a specific histopathologic type or grade is generally of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management.
Additional slices
Additional slices are indicated in the following situations
- Re-excision does not identify tumor cells in a clearly non-radical primary excision or biopsy.[notes 1]
- The most aggressive pattern is seen in the last available section, in which case more sections are indicated (from the same paraffin block if additional tissue is not available).
Notes
- ↑ In such cases, step slices are taken rather than serial ones.
- ↑ 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
- ↑ 1.0 1.1 . Cancer staging. National Cancer Institute. Retrieved on 4 January 2013.
- ↑ 2.0 2.1 . General oncology. Amboss. Retrieved on 2020-01-29.
Image sources