BreastFor Information Only
If calcifications can be seen in the specimen radiograph but not in the initial histologic sections, deeper levels should be examined. If needed, radiographs of the paraffin block(s) may be obtained to see if calcifications remain in the block(s). If microcalcifications cannot be confirmed by routine microscopic evaluation, polarized light may be helpful, since calcium oxalate crystals are birefringent but unstained in hematoxylin-eosin (H&E) sections. On rare occasions, calcifications do not survive tissue processing.
G.Vascular or Lymphatic Invasion
Peritumoral vascular invasion should be noted because it has been associated with local failure and reduced overall survival.13,14 Distinguishing lymphatic channels from blood vessels is unnecessary. While sometimes difficult to identify in skin biopsies, documenting the presence of dermal lymphatic invasion is particularly important because of its strong association with inflammatory breast carcinoma.15
It should be noted whether the tumor was sectioned prior to receipt, since this may preclude proper marking of the surgical margins of excision as well as ascertaining the dimensions of the specimen or tumor. Evaluation of margins does not apply to a diagnostic incisional biopsy.
I.Orientation and Identification of Surgical Margins
Whenever feasible, the specimen should be oriented so the pathologist can identify specific margins. This is particularly important for excisions less than total mastectomy, where it may be necessary for the surgeon to excise residual tumor at a specific margin (eg, superior, inferior, medial, lateral, deep). Identification of surgical margins also allows measurement of the distance between the tumor and specific margins. Data indicate that the most significant predictors of local control after breast conservation treatment with lumpectomy and radiation are the status of the surgical margins and the presence or absence of an extensive intraductal component (EIC).16 Correlating mammograms with the pathologic findings and assessing surgical margins are particularly important in patients with EIC.17
Orientation may be done by sutures or clips placed on the specimen surface or by other means of communication between surgeon and pathologist, and should be documented in the pathology report. Margins can be identified in several ways, including the use of multiple colored inks, by submitting the margins in specific cassettes, or by the surgeon submitting each margin as a separately excised specimen. Inks should be applied carefully to avoid penetration deep into the specimen.
Macroscopic or microscopic involvement of surgical margins by invasive carcinoma or DCIS should be noted in the report. If the specimen is oriented, the specific site(s) of involvement (eg, superior) should also be reported. When possible, the pathologist should report the distance from the tumor to the closest margin. Blocking of tissue should be directed to evaluating the distance from the edge of the tumor to the resection margin, in addition to other sampling.
Specimen radiography with compression of the specimen should be reserved for nonpalpable lesions (eg, microcalcifications). Accurate assessment of the distance of tumor from the surgical margin may be compromised following mechanical compression.