MGH Breast Grossing Flashcards
Unoriented lumpectomy
Ink entirely blue
Section starting on any side, aim for ~3 mm.
As you are sectioning, remove localization tags and clips. Keep track of which slices the tag/clip was associated with.
Measure the distance of mass to the closest radial margin and to BOTH end margins.
How much to submit: 4 of the mass, demonstrating closest margins. If an end margin is close, submit it entirely.
Other sections: representative end margins, away fibroadipose tissue (at least 1 slice of buffer from tumor).
Oriented margin
Stitch designates the new margin
Ink the new margin blue, do not ink the other side
10 cassettes of margin, or entirely. Submit sequentially.
How much breast do you submit for mastopexy/mammoplasty?
Less than 50 years old with no immediate family hx of breast cancer: 2 cassettes, 2 pieces of tissue in each
Older than 50 or any immediate family history of breast cancer: 5 cassettes, 2 pieces of tissue in each
Mastopexy/mammoplasty
Take weight and dimensions
Section through without inking, then feel and look through the slices. Review imaging to see what you are looking for.
If you don’t find anything, submit the appropriate number of blocks of fibrous tissue.
Where do lesions occur in breast?
The fibrous tissue, NOT the adipose tissue.
Oriented Lumpectomy
Ink 4 colors:
Stitches are short anterior, long lateral, tie superior. Ink as follows: anterior blue, posterior black, superior green, inferior yellow. Continue to the medial/lateral - edges should look like a beach ball.
Find the long axis. Give 3 dimensions.
Section from one edge, laying out slices in order and taking note of any localization markers/clips and their associated slices.
Section the edge margins radially.
Mastectomy
Measure in 3 dimensions and weigh the specimen.
Ink the anterior blue, posterior black.
If there is a mass: 4-5 sections of mass including margins, then 1-2 from tissue ends submitted radially, 1 of distal uninvolved parenchyma.
If there is no mass: 10 cassettes, emphasize suspicious areas, 2 sections are the extremes of the specimen
Hx of microinvasive carcinoma, ductal carcinoma in-situ only, lobular neoplasia, or flat atypia:
-Excision/reexcision: 10 cassettes from biopsy site, including 2 sections of the extremes of the long axis, then all margins.
-Mastectomy: 10 cassettes from biopsy site, 2 cassettes away from biopsy site, including margins.
How thin does the breast service want their sections?
2mm
Why is it important to double check that sentinel lymph nodes are accessioned as such?
They have a special cutting protocol in histology that is associated with this accessioning
Breast inking exemption criteria
Either: The specimen is cosmetic
OR the following 3 are met:
3 or more pieces of tissue
All aproximately the same size
No stitches on any pieces of tissue
MGH breast specimen inking for an oriented lumpectomy
Basically, you always want the short ends to be the convergence of the colors.
With an unoriented lumpectomy or shave margin, you should ink. . .
the entire external surface black
Expectation for radiology reports in breast grossing at MGH
Radiology reports should be printed, read, and attached to the requisition form for all breast specimens
The expectation in MGH breast pathology is to use ____ verbatim as much as possible
breast grossing templates
Sizes of breast lesions and T staging
T1a 0.1-0.5 cm
T1b 0.6-1.0 cm
T1c 1.1-2.0 cm
T2 2.1-5.0 cm
T3 5.1 cm and greater
Example sections for an oriented lumpectomy
Example sections for mastectomy
