Breast benign

Background

Various breast specimens may be received for non-neoplastic conditions.

More detail

Duct dissections can be undertaken to investigate a nipple discharge without a palpable mass. A nipple wedge excision, which includes skin, is performed occasionally to treat a recurrent subareolar abscess. Breast tissue may also be received after breast reduction surgery or prophylactic mastectomy. 1,2

A separate protocol is provided for Breast tumour resection specimens.

Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

Fresh tissue received
  • No
    • Non-routine fixation (not formalin), describe.
  • Yes
    • Special studies required, describe.
    • Ensure samples are taken prior to fixation.

Note that cold ischaemic time should not be prolonged >1 hour post disruption of blood supply.

The specimen should be sent immediately to the pathology laboratory, ideally in the fresh state and transferred to fixative as soon as possible on receipt. If this is not possible, it should be immediately placed in an appropriately sized container with a sufficient amount of formalin. In some institutions (by arrangement with the Pathologist) the surgeon makes a controlled single or cruciate pair of incisions into the lesion, thus preserving the integrity of key margins while allowing immediate penetration of fixation.

Intraoperative consultation
  • Not performed
  • Performed, describe type and result

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External InspectionBack to top


Orientate according to sutures and diagrams provided in the clinical notes and identify the anatomical features of the specimen.

Orientation markers

Record additional orientation or designation provided by operating clinician:

  • Absent
  • Present
    • Method of designation (e.g. suture, incision)
    • Featured denoted

Photograph the intact specimen if required.

Describe the following features of the specimen:

Specimen laterality

  • Right
  • Left
  • Unorientated

Procedure (specimen type)

Record as described by the clinician.

Options
  • Major duct dissection
  • Open diagnostic biopsy
  • Breast reduction surgery
  • Prophylactic mastectomy
  • Other, specify

Specimen integrity

  • Intact
  • Opened or disrupted, describe

Specimen orientation

  • Unorientated
  • Orientated
    • Method of designation
    • Margin/feature(s) denoted

Evidence of previous biopsy or surgery

  • None
  • Present
    • Needle track
    • Scar
    • Sutures

Anatomical components (more than one may apply) and dimensions (mm)

Describe and measure the anatomical components present.

Total specimen

  • Weight (g) 1-3
  • Size in three dimensions1-3

If orientated designate

  • Medial-lateral
  • Superior-inferior
  • Superficial -deep

Skin

  • Absent
  • Present
    • Measure in two dimensions
    • Describe any abnormalities and their dimensions

Nipple

  • Absent
  • Present
    • Normal
    • Ulceration
    • Other

Other features

  • Describe

DissectionBack to top


Nipple skin biopsy specimens

Bisect perpendicular to the skin surface.

Diagnostic biopsies, duct extensions and cavity margins

Diagnostic localisation/open biopsies, major duct extensions and cavity shave margins

Paint relevant surgical margins with ink. Section transversely at 4-5mm intervals along the longest axis. Lay the slices out sequentially.

Photograph the slices with patient identification, print and use as a block key.

Mastectomy

Mastectomy specimens must be sliced as soon as possible to achieve good fixation. Paint any relevant surgical margins with different coloured inks. Slice at 5mm intervals perpendicularly to the deep aspect of the specimen to the skin surface. Formalin-soaked paper towels can be inserted between the slices to improve formalin penetration.


Internal InspectionBack to top


Describe the cut surface appearance including the following items:

Tumour

  • Absent
  • Present
    • If an unexpected benign tumour has been resected, take a representative section
    • If an atypical macroscopic appearance is present, refer to protocol for Breast tumour resection specimens

Other abnormalities

  • Abscess
    • Location
    • Sub-areolar
    • Other, specify
  • Fibrosis
  • Cysts
    • Number
    • Maximum size in mm
    • Contents
  • Calcification
  • Other, describe

Photograph the dissected specimen if required.

Note photographs taken, diagrams recorded and markings used for identification

ProcessingBack to top


Dissect the specimen further and submit sections for processing as applicable for the specimen type.

Nipple skin biopsy specimens

Submit the entire specimen and request three levels for microscopic examination.

Diagnostic biopsies, duct extensions and cavity margins

Diagnostic localisation/open biopsies, major duct extensions and cavity shave margins

Submission of entire specimen in localisation/open diagnostic biopsies may be appropriate. Alternatively, submit representative sections from each serial transverse slice.

When no tumour or lesion is obviously apparent, ensure representative sections are taken from throughout the specimen, sampling fibrous rather than fatty tissue.

Abscess, fat necrosis and/or fibroadenoma

Submit representative sections. The macroscopic lesion should be sampled adequately with adjacent surgical margins if considered appropriate.

Consideration should be given to embedding the entire lesion if there are, or have been previously, any atypical features documented.

Gynaecomastia, prophylactic mastectomy and similar specimens

Gynaecomastia, prophylactic mastectomy, breast reduction and mammoplasty specimens:

Submit representative sections of fibrous parenchyma, with or without nipple and/or skin if present.

Mastectomy

Submit representative sections of:

  • Any lesions or suspicious areas
  • Non-lesional tissue from each quadrant
  • Sections from the nipple and any abnormal skin lesions

When no tumour or lesion is obviously apparent, ensure representative sections are taken from throughout the specimen, sampling fibrous rather than fatty tissue.

Block allocation keys

Nipple skin biopsy specimens
Cassette id
Site
No. of pieces
A
All tissue sections
 
Diagnostic biopsies, ducts and cavity margins

Diagnostic localisation/open biopsies, major duct extensions and cavity shave margins

Cassette id
Site
No. of pieces
A-D
All tissue sections or representative sections as applicable
 
Abscess, fat necrosis and/or fibroadenoma
Cassette id
Site
No. of pieces
A-D
All tissue sections or representative sections as applicable
 
Gynaecomastia, prophylactic mastectomy and similar specimens

Gynaecomastia, prophylactic mastectomy, breast reduction and mammoplasty specimens

Cassette id
Site
No. of pieces
A-D
Representative sections of fibrous parenchyma, nipple and/or skin if present
 
Mastectomy
Cassette id
Site
No. of pieces
A-D
Representative sections of any lesions or suspicious areas or non-lesional tissue from each quadrant if no focal lesions
 
D-F
Sections from the nipple and any abnormal skin lesions
 

Acknowledgements

A/Prof Gelareh Farshid for her contribution in reviewing and editing this protocol.


ReferencesBack to top


  1. Lester SC (ed). Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
  2. Ellis IO. Tissue pathways for breast pathology, The Royal College of Pathologists, London, 2010.
  3. Ellis IO, Pinder SE, Bobrow L, Buley ID, Coyne J, Going JJ, et al. Pathology Reporting of Breast Disease, The Royal College of Pathologists, London, 2005.
  4. Bancroft JD, Gamble M. Theory and practice of histological techniques. Churchill Livingstone Elsevier, Philadelphia, PA. 2008:744.
  5. Huo L. A practical approach to grossing breast specimens. Ann Diagn Pathol 2011;15(4):291-301.