Enhancement of Mammographic–Pathologic Correlation Utilizing Large Format Histology for Malignant Breast Disease

doi:10.1053/j.sembd.2006.07.005

Seminars in Breast Disease

Volume 8, Issue 3, September 2005, Pages 152-162

https://doi.org/10.1053/j.sembd.2006.07.005 Get rights and content

The use of large format histology in the pathological examination of breast specimens offers many advantages over traditional histological processing, one of which is enhanced radiologic–pathologic correlation. The utility of this technique in malignant breast disease with emphasis on those lesions presenting with a mass or architectural distortion on breast imaging will be discussed. We have utilized the large format histology technique in our independent pathology laboratory servicing a two-campus community hospital system in Lynchburg, VA for 6 years, incorporating it into our routine handling of excisional breast specimens since early 2000. In the period from March 2000 to March 2006, we have processed 1091 blocks from 618 breast cancer cases. This includes 19% of all infiltrating ductal carcinomas, 25% of all invasive lobular carcinomas, and 43% of all cases of pure ductal carcinoma in situ diagnosed in Lynchburg during the period.

Section snippets

Radiologic–Pathologic Correlation

Radiologic–pathologic correlation in this paper will be approached by comparing some of the most commonly seen mammographic and ultrasound abnormalities with corresponding pathologic findings. Breast imaging abnormalities can be roughly divided into three main categories: mass lesions, calcifications, and architectural distortion. There is significant overlap among demonstration of these abnormalities and three main pathologic malignant breast lesions: infiltrating ductal carcinoma (IDCA),

Case Discussions

In this section, we will use some of our cases with large format histology to demonstrate the radiologic pathologic correlation for the different patterns of lesions described above.

Case #1 (Fig. 2) is a 71-year-old woman who presented with a palpable mass in her left breast and crushed stone and casting type calcifications on her mammogram (Fig. 2A). An associated widespread area of altered echogenicity and calcifications on breast ultrasound (Fig. 2B) correlated with the palpable mass and

Conclusion

Large format histology has proven to be a useful technique to enhance radiologic-pathologic correlation of malignant breast disease. The large format technique offers advantages related to the contiguous sampling of large areas of tissue and subsequent correlation with radiologic images. This activity may enhance multidisciplinary understanding of breast cancer and promote the team approach to optimum patient care.

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Large-section (macrosection) histologic slides
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Cited by (16)

Multifocal and diffusely infiltrating breast cancers are highly fatal subgroups needing further improvement in diagnostic and therapeutic strategies
2023, European Journal of Radiology
Physicians treating breast cancer patients often wonder why this dreaded disease is still fatal in some women despite our best diagnostic and therapeutic efforts. Our own studies on prospectively documented cases spanning several decades have given us new insights for approaching this problem. By using imaging biomarkers to classify breast cancer subtypes according to their apparent site of origin, we found that a majority of breast cancer deaths (71%) occur in a minority of breast cancers (45%). Breast cancer deaths are significantly more likely to occur in women with multifocal acinar adenocarcinoma of the breast, AAB (13.1%), diffusely invasive breast cancers of ductal origin, DAB (24 %) and breast malignancies of mesenchymal hybrid cell origin, BCMO (33.7%) compared with women having unifocal invasive breast cancers (6.1%). Preventing more of these fatal events will require a re-evaluation of the current imperfect histopathologic terminology of breast cancer with special attention to the diffuse breast cancer subtypes, intensification of multimodality imaging and multidisciplinary management, as well as application of image guided large format histopathology.
Can we improve breast cancer management using an image-guided histopathology workup supported by larger histopathology sections?
2023, European Journal of Radiology
Breast radiologists examine the entire breast in full-size images, while breast pathologists examine small tissue samples at high magnification. The diagnostic information from these complementary imaging approaches can be difficult to integrate for a more clinically relevant evaluation of malignancies spanning several centimetres. We have explored the advantages and disadvantages of imaging guided larger section pathology techniques compared with the standard 2 × 2.5 cm. small section technique.
We compared the ability of conventional small section histopathology with larger section histopathology techniques to examine surgical resection margins and full disease extent. We evaluated the pre-surgical imaging workup and use of microfocus magnification radiography of sliced surgical specimens in the histopathologic evaluation of disease extent and status of surgical margins.
Image assisted large section histopathology of excised breast tissue enables comprehensive examination of an approximately tenfold larger contiguous tissue area than is provided by conventional small section technology. Attempting to cover the full area of each consecutive slice of resected tissue is more labour-intensive and expensive with the small section approach and poses challenges in reconstituting three-dimensional tumour architecture after morcellation and sectioning. Restricting histopathologic examination to a limited number of samples provides an incomplete evaluation of surgical margins.
A considerably improved documentation of breast cancer and a more reliable assessment of tissue margins is provided by using larger sized histopathology samples to correlate with breast imaging findings. These in turn can enable more appropriate treatment planning, improved surgical performance, fewer recurrences, and better patient outcome. Uncertainty of surgical margin evaluation inherent to the standard small section technique can lead to inappropriate decisions in surgical management and adjunctive therapy. Progress in breast diagnosis and treatment will largely depend on whether histopathology terminology and technique will undergo a revolution similar to the one that has already occurred in breast imaging.
Breast cancer multifocality, disease extent, and survival
2011, Human Pathology
Citation Excerpt :
Large-format histopathology, used routinely in only a few laboratories, has gained increasing attention as the only histopathology method addressing the need for radiologic/pathologic correlation in this era of multimodality breast imaging. In addition, large-format histopathology documents the subgross morphology of breast carcinoma much more accurately than the conventional histopathology approach [10-12]. In this article, we present long-term follow-up results from a series of breast carcinoma cases, describing the prognostic significance of lesion distribution and disease extent documented in large-format histopathology slides.
The prognostic information implied in subgross morphologic parameters such as lesion distribution (unifocal, multifocal, or diffuse) and disease extent in breast cancer has remained largely unexplored in the literature. We aimed to test whether these parameters influence survival in breast carcinoma. The parameters were assessed in a series of 574 cases, all documented in large-format histology sections. We used Cox proportional hazards regression accompanied by Kaplan-Meyer survival curves, with P < .05 regarded as significant. The invasive component was unifocal in 62% (311/499), multifocal in 24% (122/499), and diffuse in 5% (26/499) of the cases. Combining the in situ and invasive tumor components resulted in 48% (274/574) unifocal, 25% (141/574) multifocal, and 20% (117/574) diffuse tumors. Sixty percent (347/574) of the tumors were categorized as having limited extent (occupying an area <40 mm in largest dimension) and 29% (164/574) as extensive. Highly significant (P < .0001) differences were observed in 10-year disease-specific cumulative survival among the cases with unifocal, multifocal, and diffuse invasive (89.6%, 76.0%, and 63.6%, respectively) and combined (92.3%, 82.3%, and 75.7%, respectively) lesion distribution. Patients with extensive tumors exhibited a significantly lower cumulative survival (P < .0001) compared with those with limited extent (91.6% and 75.5%) and a statistically significantly 1.89-fold (95% confidence interval, 1.07-3.37; P = .03) risk for breast cancer death after controlling for tumor attributes, type of surgery, and adjuvant therapy. The hazard ratio for breast cancer death for mutifocal and/or diffuse tumors versus unifocal ones was 1.96 (95%; 1.11-3.48; P = .02) after controlling for the same factors. Lesion distribution and disease extent represent important independent survival-related prognostic parameters in breast carcinoma.
Cost-benefit analysis of using large-format histology sections in routine diagnostic breast care
2010, Breast
Citation Excerpt :
As modified and used in our13–15 and other laboratories,12,16–18 large-format histopathology combines the advantages of whole organ sectioning (with substantially reduced turn-around time and cost) with the advantages of the conventional small block technique, making the large-format technique sufficient for meeting the needs of oncologic therapy planning while allowing proper documentation of “radiological–surgical” parameters. In addition, it is an ideal tool for radio-pathologic correlations13,15,19,20 and for multidisciplinary evaluation of cases during tumor board meetings.13–15,21 Radiology techniques have much lower resolution capacity than do microscopic methodologies, but provide an excellent overview of the normal tissue and the lesions within it and, as such, correspond more to the morphologic method of the whole organ studies than to the conventional small block methods used in most diagnostic pathology laboratories.
Large-format histopathology allows correct documentation of tumor size, lesion distribution, disease extent, and surgical margins, and facilitates better understanding of the complex morphology of breast carcinoma. Large-format histology slides are optimal tools for radiology–pathology correlations. Adapted to the needs of diagnostic routine, this method has the advantages of the conventional small block techniques while being able to analyze large contiguous pieces of breast tissue. The costs connected to implementing and utilizing this technique, analyzed in detail in this paper, exceed those of conventional histopathology only if the conventional sampling is limited and specimen work-up is insufficient. Documenting equally large tissue surfaces with thorough conventional sampling is much more expensive and laborious than when using large-format sections. Thus, large-format histopathology is the only cost-effective histotechnology method that meets the needs of modern multidisciplinary diagnostic breast care.
The metastatic capacity of multifocal breast carcinomas: extensive tumors versus tumors of limited extent
2009, Human Pathology
Citation Excerpt :
The present study also confirmed the high metastatic capacity of these tumors because they exhibited a substantially higher risk of having positive lymph nodes compared with extensive unifocal tumors (odds ratio, 9.9) as well as with unifocal tumors of limited extent (odds ratio, 12.5813). Finally, the present study indicates the suitability of the large-section histopathology technique to document the extent and distribution of lesions in breast carcinomas, similar to a series of previous studies [22-25]. In conclusion, most breast carcinomas are multifocal because of multiple in situ or multiple invasive foci or both.
The extent and distribution of lesions in breast carcinomas are important morphologic prognostic parameters that influence the type and results of surgical intervention, as well as the propensity for metastasis. We investigated how the extent of disease influences the risk of metastasis in a consecutive series of 519 invasive breast carcinomas that were documented in large-format histology sections. Breast carcinomas of limited extent (demonstrable invasive, in situ, and intravascular tumor structures occupied a tissue space <40 mm in the largest dimension) were delineated from extensive tumors; and the proportions of cases with lymph vessel invasion, lymph node macrometastasis, and mastectomy were registered. The risks of lymph vessel invasion and lymph node metastasis were elevated substantially for extensive multifocal invasive cancers and for multifocal tumors of limited extent compared with the risks for unifocal cancers (47%, 44%, and 21%, respectively, for lymph vessel invasion; 53%, 40%, and 20%, respectively, for lymph node metastasis). The odds ratio for having lymph node metastasis was 12.4 when extensive carcinomas with diffuse invasive component were compared with unifocal invasive tumors of limited extent. Although the risks of lymph vessel invasion and lymph node metastasis increased gradually with tumor size, they remained elevated in multifocal carcinomas in every size category. The risk of lymph node metastasis was not elevated in unifocal invasive breast carcinomas with multifocal in situ component. These results confirm that the extent and distribution of lesions in breast carcinomas are important biological prognostic factors and indicate a need for special histopathologic techniques for adequate assessment of these parameters.
Large-format histology in diagnosing breast carcinoma
2020, Vojnosanitetski Pregled

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Enhancement of Mammographic–Pathologic Correlation Utilizing Large Format Histology for Malignant Breast Disease

Section snippets

Radiologic–Pathologic Correlation

Case Discussions

Conclusion

Practical Breast Pathology

Large-section (macrosection) histologic slides

A comparison of large block macrosectioning and conventional techniques in breast pathology

Virchows Arch