Procedure Description:

Invasive breast cancer is the most frequently diagnosed cancer in women in the United States and is second to lung cancer as a cause of cancer-related deaths. Suspicion of breast cancer can arise from an abnormal screening mammogram, the presence of a breast mass, skin changes (redness, scaliness or dimpling), or nipple changes (pain, retraction or discharge).

Pathologic evaluation of biopsy or surgical material can distinguish between benign processes, breast tissue with atypical features, or breast tissue with in-situ (pre-invasive) and / or invasive cancer. Making a diagnosis would likely rely on some, if not all, of the following tests offered on site:

• Microscopic evaluation of breast fluid (nipple discharge)
• Microscopic evaluation of fine needle aspiration biopsy material
• Histologic assessment of needle core biopsies, excisional biopsies and surgical resections
• Interpretation of special / immunohistochemical stains (IHC) that provide prognostic data
• Interpretation of fluorescence in situ hybridization studies (FISH) to determine the role for Herceptin use
• Consultative and review services

Careful documentation of histopathologic features (for both in situ and invasive tumors) is critical in guiding patient care; both in determining prognosis and in individualizing treatment protocols. Some of these features include accurate staging by way of the TMN staging system which reflects the size of the tumor, number of lymph nodes involved and the presence or absence of metastatic disease. Other factors include accurate grading and margin assessment (particularly in patients who opt to undergo breast conservation via a lumpectomy). Lastly, accurate interpretation of the tumor’s hormone receptor status and human epidermal growth factor receptor 2 (HER-2/neu) expression (further discussed below) is essential in determining the best options available should adjuvant therapy be needed. Our group’s commitment to the highest level of service is reflected in the fact that virtually all of our breast cases are reviewed by at least two pathologists. In most cases, we are able to provide a rapid turn around of results with 1-2 days. Initial diagnoses, (primarily via core biopsies), are usually reported within 24 hours of receipt of the specimen.

Spectrum pathologists understand the complexity of diagnosing and treating breast cancer. With ever changing technologies and treatment options, we work closely with our surgical, radiological, and oncological colleagues to offer rapid and reliable diagnoses. A number of our pathologists are called upon to share our expertise and skills; and have been intimately involved in regional multidisciplinary breast tumor conferences for many years.

We work closely with oncologists to facilitate Oncotype DX testing when needed. The Oncotype DX test (endorsed by both ASCO and NCCN) is a test performed to learn more about the biological activity of a patient’s breast cancer. The test is a multi-gene expression assay (currently 21 genes); the results of which are reported as a quantitative Recurrence Score. This score (between  1 -100) correlates with the likelihood of a patient’s cancer returning and therefore the likelihood that she would benefit from the addition of chemotherapy to the treatment plan.

Our group carefully monitors many quality measures including diagnostic and frozen section accuracy, turn around time and synoptic reporting. All 3 of the breast prognostic markers assessed by immunohistochemical stains (estrogen receptor, progesterone receptor and HER-2/neu receptor expression) have robust QC/QA programs. The results of which routinely adhere to (and exceed) the strict criteria put forth by both the College of American Pathology and the American Society of Clinical Oncologists.

Our group of knowledgeable and highly skilled pathologists are always available for consultative review of difficult or usual cases.

For more information regarding your diagnosis or breast cancer care, please click on a link below:
 

http://www.nationalbreastcancer.org

http://www.cancer.net/patient/Cancer+Types/Breast+Cancer

http://www.breastcancer.org/

http://www.cancer.org/docroot/lrn/lrn_0.asp

http://www.webmd.com/breast-cancer/default.htm