Tumour Size After Surgery
A pathologist will study the tissue removed during breast cancer surgery and take measurements. Some samples of the tissue may need to be studied under a microscope to check for small amounts of cancer. The largest length of the tumour is the tumour size.
On your pathology report, the post-neoadjuvant treatment tumour size will be indicated with ypT followed by numbers and sometimes, letters. The y notes the measurement was taken after neoadjuvant therapy. The p means a pathologist took the measurement from the tissue removed during surgery.
Sometimes, theres more than one area of cancer in the breast. The largest continuous area will be reported as the tumour size. Youll see the letter m to note there were multiple areas of cancer in the breast.
More About Excision Biopsies
The excision biopsy or excision specimen may include a localization wire the excision specimen with the wire in place will be sent to the Pathology Laboratory with a copy of the mammogram. The Pathologist will orientate the specimen to match the mammographic appearance and can also obtain a specimen X-ray.When the area of a mammographic abnormality is confirmed on specimen X-ray and the tissue is fixed, the Pathologist can sample the abnormal breast, identifying each tissue block taken. The excision margins of the specimen may also be sampled and measured macroscopically.
Whole specimen mammography is obligatory for clinically occult lesions excised under mammographic localization and is recommended for palpable lesions that are associated with micro-calcifications .
If possible, all specimens should be oriented by the Surgeon. Specimen radiography is essential to confirm the accurate removal of the mammographic abnormality and to guide the pathologist to the appropriate area for sectioning and microscopic study. Visualization of the clip or a tissue reaction to the clip helps the Pathologist and the Surgeon identify the prior biopsy site.
Specimen radiography can also show whether the lesion is in proximity to the edge of the specimen. In such cases, additional tissue may need to be removed to increase the likelihood of negative margins .
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Your Surgeons Operative And History & Physical Notes:
You should also ask for a copy of your surgeons Operative note and History and Physical note. These documents provide an excellent summary of your breast cancer care. Keep for your own health records and share this information with new physicians in the future. You will likely not remember all of the details of your care years later. As time passes, these records are difficult to obtain from retired physicians or cumbersome hospital medical record departments.
This outline What is a Pathology Report? explains why it is important to have copies of your pathology report. The Susan G. Komen organization is a leading advocacy group dedicated to assisting patients, funding research, and ensuring quality breast cancer care.
Review their page Interpreting Your Initial Pathology Report to better understand your breast biopsy report. This site was created for patients by the American Society of Breast Surgeons.
Their page on Your Pathology Report has information about the specifics of tumor type, receptors, and other important information. Living Beyond Breast Cancer is a non-profit organization dedicated to providing quality information about breast cancer to patients.
Teaching everyone to be an expert in their own breast cancer care.
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What Is A Biopsy Of Breast
A breast biopsy is a test that removes tissue or sometimes fluid from the suspicious area. The removed cells are examined under a microscope and further tested to check for the presence of breast cancer. A biopsy is the only diagnostic procedure that can definitely determine if the suspicious area is cancerous.
What If A Carcinoma Is Infiltrating Or Invasive
These words are used to mean that the cancer is not a pre-cancer , but is a true cancer.
The normal breast is made of tiny tubes that end in a group of sacs . Cancer starts in the cells lining the ducts or lobules, when a normal cell becomes a carcinoma cell. As long as the carcinoma cells are still confined to the breast ducts or lobules, without breaking out and growing into surrounding tissue, it is considered in-situ carcinoma .
Once the carcinoma cells have grown and broken out of the ducts or lobules, it is called invasive or infiltrating carcinoma. In an invasive carcinoma, the tumor cells can spread to other parts of your body.
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What Is A Pathologist
A pathologist is a doctor who specialises in diagnosing diseases by examining tissue that has been removed from the body. The breast pathologist may be presented with a range of breast specimens, which may be obtained by fine needle aspiration , core biopsy, or open surgical excision. The initial role of the pathologist is to determine the correct diagnosis. The investigation of a breast abnormality relies on a combination of clinical, imaging and biopsy techniques, which culminate in the examination of a cell or tissue sample by a pathologist.
If I see a patient who has undergone their preoperative diagnostic core biopsy elsewhere, or I see a patient for a second opinion, who has undergone surgery elsewhere, I have a low threshold to ask our pathologist to review the outside pathology slides, especially if the results reported perhaps dont quite fit in with the clinical scenario.
All patients are discussed both pre and postoperatively in our multidisciplinary team meetings, and all of the breast imaging, including MRI scans reviewed, so the pathologist is usually familiar with the patients case before they even receive the operative specimen, especially obviously if they have reported the preoperative diagnostic core biopsy.
The Understanding Your Pathology Report Booklet
Printing the downloadable PDF available on this page is the best option for getting a printed copy of the Understanding Your Pathology Report guide. If you’d like to order professionally printed copies, you can place an order at breastcancer.anro.net. For a quantity of 1-99 copies, you will be asked to pay shipping. For quantities of 100+ you will be asked to pay both the cost of printing and shipping.
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Key Companies & Market Share Insights
The key players are focusing on partnerships, strategic collaborations, and geographical expansion, in emerging and economically favorable regions. For Instance, in September 2022, a USC-led team of scientists found evidence of liquid biopsy to be able to use for the determination of breast cancer at its early stages, the team was a collaboration between USC, Epic Sciences, Billings Clinic, USC Norris Comprehensive Cancer Center, and Duke University. Some prominent players in the global breast cancer liquid biopsy market include:
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The Menarini Group
Residual Breast Cancer After Neoadjuvant Therapy
Any breast cancer that remains in the breast or axillary lymph nodes after neoadjuvant therapy is called residual breast cancer. Many people have some residual breast cancer after neoadjuvant therapy. Your pathology report will include whether or not residual breast cancer was found in the breast and/or lymph nodes.
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Ductal Carcinoma In Situ
Ductal carcinoma in situ is concomitantly present in as many as 80% of IBC cases and is associated with increased risk of local recurrence after breast-conserving surgery .
Extensive intraductal component -positive carcinoma is present when DCIS is a major component of the area of invasive carcinoma and also is present outside the area of invasive carcinoma or there is extensive DCIS associated with a small invasive carcinoma .
Extensive intraductal component-positive invasive carcinoma. Ductal carcinoma in situ constitutes 25% of the area of invasive carcinoma and also is present outside the area of invasive carcinoma. A small invasive carcinoma is present in background of extensive DCIS.
The histological features of DCIS associated with increased risk of recurrence are large lesion size, high nuclear grade, certain architectural patterns, central necrosis, and positive surgical margin . It is essential to report the features of DCIS, including nuclear grade, presence of necrosis, and extent of DCIS, in cases of EIC-positive carcinoma .
Nuclear grade is determined according to pleomorphism, nuclear size, chromatin, nucleoli, mitoses, and orientation and is predictive of clinical outcome . Central necrosis is easily detected at low magnification within the central portion of ducts affected by DCIS. Focal necrosis means necrosis in small foci or single-cell necrosis and is indistinct at low magnification.
What If My Report Mentions Sentinel Lymph Node
In a sentinel lymph node biopsy, the surgeon finds and removes the first lymph node to which a tumor drains. This lymph node, known as the sentinel node, is the one most likely to contain cancer cells if they have started to spread. This procedure may be done during surgery to remove a breast cancer. It is a way to check for the spread of cancer to underarm lymph nodes without removing as many of them.
The sentinel lymph node is then checked to see if it contains cancer cells. If there is no cancer in the sentinel node, it’s very unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery is needed.
If a sentinel lymph node does contain cancer, your report will say that cancer was present in the lymph node. It may also say how large the deposit of cancer cells is. In some cases, if cancer is found in a sentinel lymph node, you may then also need additional treatment such as surgery to remove more underarm lymph nodes or radiation therapy to the underarm region. You should discuss this with your doctor.
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Looking At The Tissue Sample
The tissue sample removed during a biopsy is called a specimen. The medical staff who perform your biopsy place the specimen in a container with a fluid to preserve it. They label the container with your name and other details. A pathologist then describes how it looks to the naked eye. This includes the color, size, and other features. This is called a gross or macroscopic examination. The gross description includes the following information:
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The label written by the doctor who took the specimen
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Visual features
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What was done to the specimen
The sample may be needed for other tests based on what your doctor thinks the disease may be before the biopsy, called a suspected diagnosis. Molecular tests find genes that might be active, changed, or missing. Other gene or protein tests may be needed to identify which treatments will work. The pathologist or a technician will prepare a part of the specimen for these tests.
Can Individuals Get A Second Opinion On Their Surgical Pathology Results
Although the diagnosis of most cancers is straightforward, patients or their doctors may want to get a second opinion from another pathologist. Patients interested in getting a second opinion should talk with their doctor. They will need to obtain the slides and/or paraffin block from the pathologist who examined the sample or from the hospital where the biopsy or surgery was done.
Many institutions provide second opinions on pathology specimens. NCI-designated cancer centers or academic institutions sometimes provide second opinions. Patients should contact the facility in advance to determine if this service is available, the cost, and shipping instructions.
For each patient, the results of all pathology examinations and any other tests ordered by the pathologists are reviewed together by the tumor review board, a group of doctors who are experts in different specialties who plan the treatment approach for a patient.
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Are There Cancer Cells In Your Lymph Nodes
There are several lymph nodes located around the perimeter of your breast. The lymph nodes are small structures that filter harmful waste out of lymph fluid before it enters the blood stream. The lymph nodes contain immune cells that can help fight infection and destroy germs.
When cancer cells are found in the lymph nodes there is an increased risk that the cancer will spread. In this case your report will say positive. If there are no cells in the lymph nodes, then your results will be negative.
How many lymph nodes are involved?
Your treatment will vary depending upon how many lymph nodes contain cancer cells and how much cancer is in each node. The following terms are used when referring to the amount of cancer in each node:
- Only a few cancer cells are in the node
- A microscope is needed to see the cells
Regional Lymph Node Metastasis
Most patients with invasive carcinoma will have lymph nodes sampled for pathologic regional lymph node categorization . All lymph nodes must be examined histologically . The nodes commonly examined include sentinel nodes, nonsentinel nodes, nodes from axillary dissections, and intramammary nodes. When the total number of sentinel and nonsentinel nodes removed is less than 6, the AJCC sn modifier is used.
Classification of lymph node metastases. Multiple clusters of tumor cells. N category is based on the size of the largest contiguous cluster of tumor cells. Dispersed pattern of metastasis. Some lobular carcinomas may metastasize as single cells and may not form cohesive clusters. If more than 200 tumor cells are present in a node cross section, then the category of micrometastasis is recommended. Isolated tumor cells. A dispersed pattern of lobular carcinoma with fewer than 200 cells is detected by cytokeratin immunohistochemistry. Macrometastasis with extranodal extension. This metastasis is classified as a macrometastasis based on the size of cluster . Extranodal extension, an area of invasion outside the lymph node capsule , is noted.
The post-treatment pN classification system is the same as that for pre-treatment lymph nodes. Only the largest contiguous focus of residual tumor in the node evaluation is used for determining N category any treatment-associated fibrosis is not included .
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Breast Cancer Pathology Report And Lymph Node Specimens
Lymph node metastasis is an important part of cancer Staging and will affect future treatment.
Metastatic tumor clusters in lymph nodes that measure< 0.2 mm are designated as isolatedtumor cells.
Discontinuous clusters of metastatic tumor cells are measured as one focus in a definable part of a lymph node. Unevenly dispersed, clustered tumor cells are characterized by the largest cluster.
How Are Decisions About My Treatment Made
There are many factors that are taken into consideration in determining further treatment following surgery. The features in the pathology report will give your treating doctors an indication of the aggressiveness of the tumour. The presence of receptors on the cancer cells will also be an important factor, taken together with the size of the tumour and whether or not the lymph nodes in the arm pit contain cancer. Your general health at the time is also taken into consideration. These decisions are made in the multidisciplinary meeting and then will be discussed with you by your treating doctors.
You may feel overwhelmed as there is great deal of information to process. This is normal, and you should write down any questions that you have and even ask for a copy of your pathology report to take home. This will give you time to understand things and note down any questions that you may have to ask at your next visit.
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What Can Be Learned From The Biopsy Results
Once the biopsy is complete, a specially trained doctor called a pathologist examines the tissue or fluid samples under a microscope, looking for abnormal or cancerous cells. The pathology report, which can take one or two weeks to complete, is sent to the patients doctor. It indicates whether the suspicious area is cancerous and provides a full picture of your situation. For the patient, waiting for results can be a real challenge, but being able to make an informed decision regarding your treatment is well worth it. Your doctor will go over the report with you and, if necessary, discuss the treatment options.
If no cancer cells are found, the report will indicate that the cells in the lump are benign, meaning non-cancerous. However, some type of follow-up or treatment may still be needed, as recommended by the healthcare professional.
If cancer cells are found, the report will provide more information to help determine the next steps.
The report for a core-needle biopsy sample will include tumor type and the tumors growth rate or grade. If cancer is found, the pathologist will also perform lab tests to look at cells for estrogen or progesterone receptors.
In the case of a surgical biopsy, the results reveal data about the type, grade, and receptor status of the tumor, as well as the distance between the surrounding normal tissue and the excised tumor. The margin, as we mentioned earlier, shows whether the site is clear of cancer cells.
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What Are Pathology Results
If you have had a biopsy to diagnose breast cancer or you have had breast cancer surgery, the tissue removed will be looked at under a microscope by a doctor called a pathologist.
Tests may also be done on the tissue to get more information.
The results give details about the breast cancer that helps determine the treatment youre offered.
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Questions To Ask Before A Breast Biopsy
Its important to ask questions if theres anything youre not sure about. Here you can find a detailed list of questions to ask your doctor before getting a breast biopsy.
If the doctor doesn’t think you need a biopsy, but you still feel theres something wrong with your breast, follow your instincts. Dont be afraid to talk to the doctor about this or go to another doctor for a second opinion. If possible, try to see someone who specializes in breast health to discuss your concerns. A biopsy is the only sure way to diagnose breast cancer.