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Difference between revisions of "Breast grossing"
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[[Image:Inked Lumpectomy Specimen (6464023675).jpg|thumb|An ink breast lumpectomy specimen. (WC/Ed Uthman)]] | [[Image:BreastCancer.jpg|thumb|A breast mastectomy. (WC/Emmanuelm)]] | ||
This article deals with ''' | [[Image:Inked Lumpectomy Specimen (6464023675).jpg|thumb|An [[ink]]ed breast lumpectomy specimen. (WC/Ed Uthman)]] | ||
This article deals with '''breast grossing'''. | |||
==Introduction== | ==Introduction== | ||
*Lumpectomy = a common procedure for breast lesions that are small, typically have no skin. | |||
*Mastectomy = removal of the breast, may include skeletal muscle (not common) or be skin sparing.<ref name=pmid27563563>{{Cite journal | last1 = Yu | first1 = P. | title = Breast reconstruction at the MD Anderson Cancer Center. | journal = Gland Surg | volume = 5 | issue = 4 | pages = 416-21 | month = Aug | year = 2016 | doi = 10.21037/gs.2016.05.03 | PMID = 27563563 }}</ref> | |||
==Specimen opening== | ==Specimen opening== | ||
*Orientation. | *Orientation: | ||
*Inking. | **Lumpectomies are usually oriented with a short and long suture as per the surgeon; '''s'''hort is typically '''s'''uperior (aspect) and '''l'''ong is typically '''l'''ateral (aspect). | ||
**Mastectomies typically have tissue extending toward the axilla known as the "tail". | |||
**The deep aspect in larger specimens can often be identified by the (flat) fascial plane. | |||
*Inking - colours usually as per an institutional standard - see ''Protocol notes'' section. | |||
*Slicing - medial to lateral. | *Slicing - medial to lateral. | ||
==Protocol== | ==Protocol== | ||
Identification: | |||
*Specimen label: [description as per label]. | |||
*Specimen label and requisition: [match/do not match]. | |||
Specimen - type/size/characteristics: | Specimen - type/size/characteristics: | ||
*Specimen type: partial mastectomy. | *Specimen type: [total mastectomy/partial mastectomy]. | ||
*Specimen orientation: [short-superior, long-lateral, double deep]. | *Specimen orientation: [short-superior, long-lateral, double deep]. | ||
*Surgical guidewire: [present/absent]. | *Surgical guidewire: [present/absent]. | ||
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*Surface disruption/intactness: [intact/disrupted at (location) - defect measures ___ cm]. | *Surface disruption/intactness: [intact/disrupted at (location) - defect measures ___ cm]. | ||
*Skin: [___ x ___ cm/absent]. | *Skin: [___ x ___ cm/absent]. | ||
*Axilla: [___ x ___ x ___ cm, [mass lesion ___x___x___ cm/mass lesion absent]/axillary tissue absent]. | |||
*Nipple: [___ length cm x ___ diameter cm, [unremarkable appearance/retracted]/nipple absent]. | |||
*Skeletal muscle: [present, [unremarkable appearance/fibrotic/suspicious for tumour/involved by tumour]/skeletal muscle absent]. | |||
*Inking code: [posterior-black, anterior-yellow, superior-blue, interior-red].‡ | *Inking code: [posterior-black, anterior-yellow, superior-blue, interior-red].‡ | ||
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*Slicing: [medial-to-lateral, parasagittal cuts]. | *Slicing: [medial-to-lateral, parasagittal cuts]. | ||
*Number of slices: [number]. | *Number of slices: [number]. | ||
*Slices sent | *Slices sent to x-ray: [yes/no]. | ||
*Calcifications: [present/not identified]. | *Calcifications: [present/not identified]. | ||
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*Tumour - in total if small (<2 cm<ref name=pmid21745648>{{Cite journal | last1 = Huo | first1 = L. | title = A practical approach to grossing breast specimens. | journal = Ann Diagn Pathol | volume = 15 | issue = 4 | pages = 291-301 | month = Aug | year = 2011 | doi = 10.1016/j.anndiagpath.2011.03.005 | PMID = 21745648 }}</ref>). | *Tumour - in total if small (<2 cm<ref name=pmid21745648>{{Cite journal | last1 = Huo | first1 = L. | title = A practical approach to grossing breast specimens. | journal = Ann Diagn Pathol | volume = 15 | issue = 4 | pages = 291-301 | month = Aug | year = 2011 | doi = 10.1016/j.anndiagpath.2011.03.005 | PMID = 21745648 }}</ref>). | ||
===Protocol notes=== | ===Protocol notes=== | ||
*‡ There is no universally accepted inking protocol. Blue for superior and green for inferior is common, as ''the sky is blue and the grass is green''. | *‡ There is no universally accepted [[inking]] protocol. Blue for superior and green for inferior is common, as ''the sky is blue and the grass is green''. | ||
**Hua<ref name=pmid21745648/> suggests: black = posterior, blue = superior, green = inferior, yellow = anterior, red = medial & lateral. | **Hua<ref name=pmid21745648/> suggests: black = posterior, blue = superior, green = inferior, yellow = anterior, red = medial & lateral. | ||
====Staging==== | ====Staging==== | ||
{{Main|Breast cancer staging}} | |||
The important cut-points (at the time of gross) for tumour staging are: 5, 10, 20, 50 mm. | |||
===Alternate approaches=== | ===Alternate approaches=== | ||
==See also== | ==See also== | ||
*[[Breast pathology]]. | |||
===Related protocols=== | ===Related protocols=== | ||
==References== | ==References== | ||