Breast Pathology

Understanding your report:

When your breast was biopsied, the samples were examined under a microscope by a pathologist, a specialist clinician with years of training. Your doctor receives a report from the pathologist that includes a diagnosis for each sample taken. This report’s contents will be utilized to aid in the management of your care. The following questions and answers are intended to assist you in comprehending medical terminology included in a pathology report from a breast biopsy, such as a needle biopsy or an excision biopsy.

A needle biopsy is a procedure in which a sample of an abnormal region is removed using a needle. An excision biopsy removes the whole abnormal region, as well as some normal tissue from the surrounding area.

An excision biopsy is similar to a lumpectomy, a form of breast-conserving surgery.

What is the difference between carcinoma and adenocarcinoma?

Carcinoma is a word for cancer that starts in the lining layer (epithelial cells) of organs such as the breast. Breast cancers are almost all carcinomas. Adenocarcinomas are the most common kind of carcinoma that begins in glandular tissue.

What happens if cancer infiltrates or becomes invasive?

These terms indicate that the disease is genuine cancer rather than a pre-cancer (carcinoma in situ).

The typical breast is made up of a series of small tubes (ducts) that lead to a collection of sacs (lobules). The cells that line the ducts or lobules are where cancer begins.

Based on how they appear under the microscope, invasive ductal carcinoma and invasive lobular carcinoma are the two types of invasive carcinoma. In certain situations, the tumor has both ductal and lobular characteristics and is referred to as a mixed ductal and lobular carcinoma. Because it is the most frequent kind of breast cancer, invasive ductal carcinoma is also known as invasive mammary carcinoma of no particular type.

Invasive ductal carcinomas and invasive lobular carcinomas are cancers that develop in the cells that line the ducts and lobules of the breast. Invasive lobular and invasive ductal carcinomas of the breast are treated similarly in most cases.

What does it signify if E-cadherin is included in my report?

The pathologist may perform an E-cadherin test to identify whether the tumor is ductal or lobular. (E-cadherin-negative cells are common in invasive lobular carcinomas.) If E-cadherin is not included in your report, it implies that this test was not required to determine the type of cancer you have.

What do “well-differentiated,” “moderately differentiated,” and “poorly differentiated” mean?

When a pathologist examines cancer cells under a microscope, he or she looks for specific characteristics that might indicate how likely the disease is to develop and spread.

Well-differentiated carcinomas have cells that appear to be reasonably normal, are not quickly developing, and are organized in tiny tubules for ductal cancer and cords for lobular cancer. These tumors have a better prognosis since they develop and spread slowly (outlook).

Poorly differentiated carcinomas lack typical characteristics, develop and spread more quickly, and have a poor prognosis.

Moderately differentiated carcinomas have characteristics and a prognosis that fall somewhere in the middle.

What is the difference between histologic grade, Nottingham grade, and Elston grade?

These grades are comparable to the distinction stated in the previous question. 

Different characteristics (gland formation, nuclear grade, and mitotic count) visible under the microscope are assigned numbers, which are then summed up to assign the grade.

The cancer is grade 1 if the numbers sum up to 3-5. (well-differentiated).

If the numbers sum up to 6 or 7, the cancer is grade 2. (moderately differentiated).

If the numbers sum up to 8 or 9, the cancer is grade 3. (poorly differentiated).

What does it indicate if my report mentions Ki-67?

Ki-67 is a method of determining how quickly cancer cells divide and develop. Ki-67 levels above 30% indicate that numerous cells are proliferating, implying that cancer will develop and spread more quickly.

What does the presence of tubular, mucinous, cribriform, or micropapillary characteristics in my carcinoma mean?

Under the microscope, there are several kinds of invasive ductal carcinoma that may be distinguished.

Tubular, mucinous, and cribriform carcinomas are “special kinds” of well-differentiated malignancies with a better prognosis than invasive ductal carcinoma, which is the most frequent variety (or “invasive mammary carcinoma of no special type”).

A micropapillary carcinoma is an aggressive form of breast cancer with a poor prognosis.

What is the difference between vascular, lymphovascular, and angiolymphatic invasion? What if D2-40 (podoplanin) or CD34 are mentioned in my report?

Vascular, angiolymphatic, or lymphovascular invasion occurs when cancer cells are detected in tiny blood vessels or lymph vessels (lymphatics) under a microscope.

Tubular, mucinous, and cribriform carcinomas are “special kinds” of well-differentiated malignancies with a better prognosis than invasive ductal carcinoma, which is the most frequent variety (or “invasive mammary carcinoma of no special type”).

A micropapillary carcinoma is an aggressive form of breast cancer with a poor prognosis.

What is the difference between vascular, lymphovascular, and angiolymphatic invasion? What if D2-40 (podoplanin) or CD34 are mentioned in my report?

Vascular, angiolymphatic, or lymphovascular invasion occurs when cancer cells are detected in tiny blood vessels or lymph vessels (lymphatics) under a microscope.

What is the importance of a tumor’s stage?

The cancer stage refers to the size of the tumor and how far it has spread. TNM is the conventional breast cancer staging method, which consists of the following elements:

  • The letter T denotes the main (primary) tumor.
  • The letter N indicates lymph nodes spread to adjacent lymph nodes.
  • The letter M stands for metastases (spread to distant parts of the body)
  • The letter p (for pathologic) may appear before the T and N letters if the stage is based on surgical excision of cancer and examination by a pathologist.
  • The size of t determines the T category (T0, Tis, T1, T2, T3, or T4).

It has spread to the breast skin or the chest wall beneath the breast. A bigger tumor and/or greater dissemination to tissues around the breast are indicated by a higher T number. (This is a case of in situ carcinoma.) Because the complete tumor must be removed to determine the T category, needle biopsies do not provide this information.

The N classification (N0, N1, N2, or N3) shows if cancer has spread to nearby lymph nodes and, if so, how many lymph nodes have been impacted. Higher numbers following the N imply that cancer has spread to more lymph nodes. The report may indicate the N category as NX if no adjacent lymph nodes were excised to screen for cancer spread.

What if lymph nodes are mentioned in my report?

Lymph nodes beneath the arm may be removed during breast cancer surgery. Under a microscope, these lymph nodes will be inspected to discover if they contain cancer cells. The number of lymph nodes removed and how many of them had malignancy might be reported as the outcomes (for example, 2 of 15 lymph nodes contained cancer).

The spread of lymph nodes has an impact on staging and prognosis (outlook). Your doctor can discuss the implications of these findings with you.

What if I mention isolated tumor cells in a lymph node in my report?

This implies there are cancer cells dispersed throughout the lymph node, which may be detected by a regular microscopic examination or through specific testing. Isolated tumor cells have no impact on your stage or therapy.

What if pN0(i+) is mentioned in my report?

This implies that utilizing specific staining, the separated tumor cells were discovered in a lymph node.

What if my report indicates lymph node micrometastases?

This indicates that cancer cells larger than isolated tumor cells but smaller than typical cancer deposits can be found in lymph nodes. The N category is referred to as pN1mi if micrometastases are present. This may have an impact on the stage.

What does it imply if my doctor requests that a specific molecular test be run on my sample?

Although molecular tests like Oncotype DX® and MammaPrint® can help predict the outcome of some breast cancers, they are not required in all patients. The findings of any of these tests should be reviewed with your treating physician. The results will have no bearing on your diagnosis, but they may have an impact on your therapy.

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