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Breast Pathology Report

A pathologist is a physician who analyzes cells and tissues under a microscope to determine whether they are cancerous, pre-cancerous, or benign (non-cancerous). The pathologist’s report helps characterize specimens taken during breast biopsy or other surgical procedures and helps determine treatment. Usually, the pathology report is written in highly technical medical language that may be difficult for the patient to understand. This section deciphers the complex terminology that may appear on a pathology report of the breast.

The Pathologist's Analysis

Breast cell and tissue samples are usually analyzed by a pathologist after breast biopsy, lumpectomy,mastectomy, and lymph node removal to determine their characteristics and help dictate treatment. Specimens are usually prepared for examination in one of two ways:

  • Histologic sections: Immediately after the cells or tissues are taken from the breast, the specimen is placed in a fluid called a fixative for several hours. The fixative, often formalin (a 10% solution of formaldehyde gas in buffered water), causes the proteins in the cells to become hard and "fixed." The fixed specimen is then placed in a machine that automatically removes all the water and replaces it with paraffin wax. Several hours later, a technologist will remove the specimen and place it in melted paraffin, allowing the specimen to solidify by chilling. The specimen sections are floated out in water and picked up on a glass slide. The paraffin is dissolved from the tissue on the slide. With a series of solvents, water is restored to the sections, and the sections are stained in a mixture of dyes, making it easier to distinguish between the different parts of cells. Specimens may also be frozen immediately after they are taken from the breast. This technique allows the pathologist to examine histologic sections within a few minutes, but the quality of the sections is not as good as those of the permanent section.
  • Smear: If the specimen is a liquid or made up of mostly liquid as with a fine needle aspiration (FNA) biopsy, a smear analysis made be done. FNA is often used to drain and sample fluid from a cyst (accumulated packets of fluid). The specimen is smeared on a microscope slide and is either allowed to dry in air, is "fixed" by spraying or is immersed in a liquid. The fixed smears are then stained and examined under the microscope. Like the frozen section, smear specimens can be examined within a few minutes of the time the biopsy was obtained. This is especially useful in FNA procedures in which a radiologist is using ultrasound or CT scan to find the area to be biopsied. The pathologist may be present in the room with the radiologist while the procedure is being performed. The radiologist can make one pass with the needle and immediately give the specimen to the pathologist, who can determine within a few minutes whether a diagnostic specimen was, in fact, obtained. The procedure can be terminated at that point, sparing the patient repeated sticks with the needle.

The Sections of a Breast Pathology Report

The pathology report is usually divided into several sections:

  • Demographics: This information appears at the top of the report and identifies the patient and the physician. The patient’s name, address, birth date, and date of procedure are usually included.
  • Anatomic Pathology Diagnosis: This is most important section of the report. It gives the pathologist’s diagnosis and other clinical information that is necessary to determine treatment. The following are included in this section:
    1. Histology: The type of cancer found and the arrangement of the breast cells.
    2. Stage: The size of the cancer and the extent to which it has spread.
    3. Grade: The nature of the cells and their aggressiveness.
  • Clinical History/Pre-Operative Diagnosis: The patient’s initial diagnosis prior to the pathologist's diagnosis. For example, a breast lump was found, a suspicious nipple discharge was experienced, etc.
  • Specimen(s) Obtained: What was received by the pathologist following the procedure (cells, tissues) and when it was received.
  • Gross Description or "The Gross:" Characteristics of the specimen that the pathologist saw, measured and felt when examining the tissue with the naked eye (without a microscope).
  • Microscopic Description: What the tissues looked like to the pathologist upon examination under the microscope.
Understanding the Terminology of a Pathology Report
The following are terms commonly found on a breast pathology report:
  • Abscess: A closed pocket containing pus (a creamy, thick, pale yellow or yellow-green fluid that comes from dead tissue; most commonly caused by a bacterial infection).
  • Atypical: Literally, "not typical." Exhibits unusual characteristics. For example, atypical hyperplasia is a dangerous increase in the number of breast cells; a sign that breast cancer may develop.
  • Calcifications: Tiny calcium deposits that may indicate breast cancer.
  • Dysplasia: An atypical increase in the number of cells, much like hyperplasia.
  • Hyperplasia:A dangerous increase in the number of breast cells; a marker for breast cancer. Hyperplasia does not spread to other organs but can develop into localized cancer.
  • Inflammation: The clinical signs are breast swelling, pain, tenderness, redness, and/or heat. Pathologists may see inflammatory white blood cells during their examination.
  • In situ: Literally, "in place." The cancer has not invaded surrounding tissues or spread to distant organs.
  • Lesion: Term used to describe a tumor, area of inflammation, or other breast abnormality.
  • Metastatic: Term used to describe cancer that has spread from its original site to distant body organs. For example, metastatic breast cancer often spreads first to bone.
  • Necrosis: The death of tissue. Fat necrosis is a benign (non-cancerous) breast condition that may occur when fatty breast tissue swells or becomes tender spontaneously or as the result of an injury to the breast. However, necrosis within a cancerous tumor may indicate that the tumor is growing so rapidly that blood vessels are not able to multiply fast enough to nourish some of the cancer cells. Necrosis usually indicates that the tumor is very aggressive and can spread quickly.
  • Neoplasm or Neoplasia: An uncontrollable growth of the body’s own cells, either benign (non-cancerous) or malignant (cancerous).
  • Tumor: A mass of tissue or lump. May be caused by swelling, hyperplasia, or anything that causes an increase in volume. Tumors may be either cancerous or non-cancerous.

Additional Resources and References

  • Pathologist J.B. Askew, Jr., MD helps women decipher their breast surgical pathology reports by providing detailed written explanations of all sections:
  • The Biopsy Report: A Patient's Guideis maintained by Edward O. Uthman, MD, a board certified pathologist (Diplomat, American Board of Pathology). The site discusses pathologic examination and provides a glossary of important diagnostic terms:

Updated: May 4, 2008