Breast core biopsy
Core biopsies of breast are commonly undertaken to investigate symptomatic and mammographically-detected lesions.1-3
For mammographically detected microcalcifications, radiologists routinely X-ray the cores prior to submission to the laboratory to ensure calcium has been sampled. It is helpful for the microscopic examination of the tissue for calcium-bearing cores to be submitted for processing in a separate cassette to the remaining cores. Examination of multiple levels through the tissue is required, particularly for subtle screen-detected lesions.
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.
- Non-routine fixation (not formalin), describe
- Special studies required, describe
- Ensure samples are taken prior to fixation.
Fixation of breast specimens is a critical factor in the reporting of hormone receptor status.1,4-6 Fixation should not be delayed; specimens should be transferred to 10% neutral buffered formalin within 1 hour of biopsy.6 A minimum fixation time of eight hours is recommended.1,4-6
Hormone receptor and HER2 status assays are undertaken on core biopsies at some centres. There are data that show a high level of concordance in biomarker assessment performed on core biopsies and resection specimens. Assays on core biopsies may be necessary in patients where surgery is not planned, specimens are from metastatic sites or when neoadjuvant therapy is required. Biomarker assessment may be repeated on the resection specimen if there are concerns that the tumour on the core biopsy is morphologically not representative of the resected tumour, or if there are clinical indications for re-assessment.1,6,7
Follow best practice procedures to minimise cross-over contamination of small fragments to other specimens.8
See general information for more detail on specimen handling procedures.
Inspect the specimen and dictate a macroscopic description.
Describe the following features of the specimen:
- Number of pieces
- Size (mm)
- Any accompanying X-ray
Submit all tissue transferred directly into cassettes for processing. Separating calcium-bearing blocks from the remaining tissue may focus examination and additional stains.
Lens paper, biopsy pads or similar are required to prevent loss of tissue during processing.
Ensure adequate fixation and process on appropriate short cycle.
Routine examination of multiple levels is required.
Record details of each cassette.
An illustrated block key similar to the one below may be useful.
Block allocation key
||No. of pieces
||Breast bx, calcium-bearing core(s), if applicable
||Breast bx, remaining tissue
A/Prof Gelareh Farshid for her contribution in reviewing and editing this protocol.
Farshid G, Ahern V, Chirgwin J, Lakhani S, Pike C, Provenzano E, et al. Invasive breast cancer structured reporting protocol
, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2012.
Goldstein NS, Ferkowicz M, Odish E, Mani A and Hastah F. Minimum formalin fixation time for consistent estrogen receptor immunohistochemical staining of invasive breast carcinoma. Am J Clin Pathol. 2003;120(1):86-92.
Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol
Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31(31):3997-4013
Chou S, Pathmanathan N. High concordance rate of HER2 status assessed via silver in situ hybridisation (SISH) between core biopsy and excision specimens: a 4 year retrospective review from a single institution. Pathology - Journal of the RCPA. 2014;46(3):240-1
Lester SC. Extraneous Tissue. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;33-34.