Guide to a Breast Cancer Pathology Report

You will find the follwoing sections on your pathology reports. They may have different headings.

The first section contains your personal information. The next section contains the diagnosis made by the pathologist based on the specimens submitted by your doctor. The specimens are listed in the order in which your doctor submitted them.

The description of the specimen includes the tissue removed from a specific location during the procedure listed. There will be a diagnosis from the pathologist based on his or her examination of that tissue.

The section on staging has the most important information in the pathology report because it is what your doctor will use to determine the stage of your breast cancer. The stage is a major factor in determining your treatment options.

The Comment section lets the doctor know that additional tests will be performed on the tissue samples. It also may give other pertinent information. Those results are usually given to the doctor in an addendum that is separate from the first pathology report. However, this section may vary among institutions, and some may include this information in the original pathology report.

The tests for estrogen receptor, progesterone receptor, and cERB2 may take several days to perform. The first pathology report may be submitted without these test results so your doctor can begin to plan treatment. The test results will follow later. However, in some institutions, these tests may be performed in time to be included in the first pathology report.

The Summary section provides specific details on the cancer diagnosis based on the tests performed in the pathology laboratory. Because pathology reports vary among institutions, some reports will not have a separate Summary section, instead listing all of this information in the Diagnosis section.

The results of these tests are listed in detail to help your doctor establish the stage of your cancer and plan your treatment options.

The classification of type of breast cancer is based on whether the cancer started in the ducts or in the lobules, if the cancer is confined to the ducts or lobules or if it has invaded through them, and how the cancer looks through microscopic evaluation.

Tumors are measured at the widest point. The size of the tumor or tumors is described using centimeters. There are about 2½ centimeters in 1 inch.

The grade indicates how fast growing or aggressive the tumor is likely to be and how it will behave. Grade is based on the three parameters of the Nottingham Score, which are evaluated microscopically and assigned a numerical value.

Grade is described as well differentiated, or grade 1; moderately differentiated, or grade 2; or poorly differentiated, grade 3. The description may use grades or the terms low, intermediate, or high grade.

A low-grade tumor, or grade 1, is well differentiated and is likely to grow slowly and be less aggressive. A high-grade tumor, or grade 3, is poorly differentiated and is more aggressive. Lobular cancers are considered intermediate grade, or grade 2.

The Nottingham Score considers three microscopic factors in indicating aggressiveness of the cancer. The factors are tubule formation, nuclear pleomorphism, and mitosis. Each factor is graded from 1 to 3 based on how the tumor cells appear. The grade of each factor is added together to get the Nottingham Score. The lowest total score of 3 indicates the least aggressive disease while a total score of 9 indicates very aggressive disease.

The edge of the specimen is called the margin. A clear or negative margin means that the cancer does not extend to the edge of the specimen and indicates that the diseased tissue has been entirely removed. A positive margin means that the cancer was close to or involving the edge of the tissue.

Perineural invasion is the spread of cancerous cells around and into the nerves around the tumor site. Perineural invasion has not been proven to have independent prognostic significance, although it often occurs in high-grade tumors.

For a sentinel node biopsy, there may only be one node removed or there may be two or more removed. The report indicates the number of nodes positive out of the total number of nodes examined.

If the sentinel node were positive, an axillary node dissection would be performed and would be submitted as a separate specimen for examination. The number of nodes submitted in this specimen would vary. This separate pathology report explains the more extensive examination of the sentinel nodes, which is usually completed 1-2 days after the surgery. The serial step sectioning and cytokeratin staining are performed to detect any metastasis missed during the initial sectioning.

Estrogen and progesterone are hormones that stimulate growth of both normal and abnormal breast cells, including cancer cells, by interacting with receptors on the cells' surface. A test will check whether the cancer is positive for estrogen or progesterone receptors.

cERB2, also known as ERB2 or HER2, is an oncoprotein overexpressed in cancer and is detected by immunohistochemical staining or by fluorescence in situ hybridization, known as FISH, which detects gene amplification. This test is performed at the same time as testing for hormone receptivity, or estrogen and progesterone receptors.

Intraoperative consultation is performed during surgery. The sentinel node or nodes are removed first and immediately sent to the pathology laboratory. The specimen is examined for cancer. If cancer is found the surgeon will perform an axillary node dissection after the lumpectomy or mastectomy. If no cancer is found, an axillary node dissection is not performed. More extensive examination of the nodes, with immunohistochemical stain for cytokeratin to find micrometastases, requires additional days of testing. If cancer is found later an axillary node dissection is performed as a separate surgery.

The Gross Description provides information on the specimen's attributes that can be seen without the aid of a microscope. It describes how the specimen is received, and its size, color and consistency. After dissecting or sectioning the specimen, all findings are described and measured. This section includes information on how many sections are submitted and how the specimens are labeled or designated in the cassettes in which they are stored.

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