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Home What is Breast Cancer Diagnosis Understanding your Pathology Report

Understanding your Pathology Report

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The pathology report is a document that contains information about any tissue that is removed from the body during a biopsy or surgery.  The final pathology report from your surgery will contain additional information about your breast cancer and aid in deciding the next step of your treatment. 

Within the pathology report you may find clinical information about yourself; a preliminary diagnosis; a description of your surgical procedure; a gross description of the specimen (such as what the tissue looks like to the naked eye and the location of where the tissue was taken from); a description of what the tissue looks like under the microscope; an official pathology diagnosis and results of any laboratory testing such as hormone receptor status.

GROSS DESCRIPTION

The gross description will describe the tissue specimen that is taken from your surgery and given to the pathologist.  The dimensions (length, width and height) of the tissue are recorded.  In the OR, the edges of your tissue were marked with ink to designate which portion of the tissue is top vs. bottom and right vs. left.  This information will be useful when the tissue is examined under microscope.  In the case that tissue margins are not clear, your surgeon will know from what area in the breast to remove additional tissue.  The presence of any surgical clips or wires used to locate the breast cancer will also be documented in this section.  If a sentinel node biopsy is performed and lymph nodes are removed, the number and size of the lymph nodes will be documented.  Finally, the pathologist will describe how the tissue is divided for additional analysis.

MICROSCOPIC DECSCRIPTION

The type of breast cancer you have will be described in the section.  It is here that you will find out the type of breast cancer you have.  Breast cancers are divided into non-invasive and invasive types.

Non-Invasive Breast Cancers

Ductal Carcinoma In-Situ (DCIS)/Intraductal carcinoma

These cancers remain within the breast duct and have not expanded through the basement membrane that surrounds the duct.  These cancers are further divided into subtypes based on how they appear under the microscope and more than one subtype may be present in the same breast.  Subtypes include comedo, papillary, micropapillary, solid and cribiform.

 

Lobular Carcinoma In-Situ (LCIS)

This is not considered a true cancer, but does represent an accumulation of abnormal cells.  These cells are localized to the breast lobule.  LCIS is occasionally found by chance in tissue specimens.

 

Invasive Breast Cancers

Invasive breast cancers have broken through the wall of the duct or lobule and have begun to grow into the surrounding tissue.  Invasive ductal carcinoma is the most common invasive cancer.  Some of the other types are also listed below:

  • Invasive Ductal carcinoma (85%)
  • Invasive Lobular Carcinoma (5-10%)
  • Medullary Carcinoma
  • Inflammatory Breast Cancer
  • Paget’s disease of the breast

 

In addition to the type of breast cancer present, the size of the breast cancer is recorded in centimeters.  In addition, whether the breast cancer extends to the edges or margins of the tissue specimen is determined and recorded.  If the margins are not clear this may be an indication for additional surgery.

 

 If cancer is present in the lymph nodes the size and type of the cancer is recorded.  Information about the size and shape of the tumor cells nucleus and the number of cells that are actively dividing are recorded in the nuclear grade.  Tumors with a low nuclear grade grow and spread more slowly.  An overall grade is given to the tumor (tumor grade) and describes how closely the cells resemble normal breast cells. The less the cells look like normal, or the more poorly differentiated the cells are the more aggressive they tend to be.

 

The hormone status of your breast cancer will also be reported in your pathology report.  If higher numbers of receptors for estrogen or progesterone are present in your tumor, the tissue is described as ER+ or PR+.  Tumors with over expression of a cell surface receptor called HER2/Neu are classified as HER2+.  Other genetic mutations can be tested for, such as BRCA1/BRCA2 status and the presence of p53 or PTEN mutations.  This information will help your oncologist in designing your treatment.

 

Finally, all of the above information is compiled to give a final stage of your breast cancer.  The tumor size, number of involved lymph nodes and presence of breast cancer at any location outside the breast (metastasis) will give the tumor stage.  Tumor staging helps to give your oncologist information about the prognosis of your breast cancer. 

 

Understanding the information within your pathology report will allow you to take a more active role in the discussion of your treatment plan.  If at any time you have any questions regarding the information within your pathology report you should contact your oncologist’s office for assistance.

 

Jamie Brewer