Breast grossing

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A breast mastectomy. (WC/Emmanuelm)
An inked breast lumpectomy specimen. (WC/Ed Uthman)

This article deals with breast grossing.

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.[1]

Specimen opening

  • Orientation:
    • Lumpectomies are usually oriented with a short and long suture as per the surgeon; short is typically superior (aspect) and long is typically lateral (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.

Protocol

Identification:

  • Specimen label: [description as per label].
  • Specimen label and requisition: [match/do not match].

Specimen - type/size/characteristics:

  • Specimen type: [total mastectomy/partial mastectomy].
  • Specimen orientation: [short-superior, long-lateral, double deep].
  • Surgical guidewire: [present/absent].
  • Specimen size (superior-inferior, medial-lateral, anterior-posterior): [___ x ___ x ___] cm.
  • Surface disruption/intactness: [intact/disrupted at (location) - defect measures ___ cm].
  • 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].‡

Slices:

  • Slicing: [medial-to-lateral, parasagittal cuts].
  • Number of slices: [number].
  • Slices sent to x-ray: [yes/no].
  • Calcifications: [present/not identified].

Tumour:

  • Tumour location in slices: [___ to ___].
  • Tumour size (superior-inferior, medial-lateral, anterior-posterior): [___ x ___ x ___] cm.
  • Closest margin and distance: [___ margin, ___ cm].
  • Distance to other margins: [anterior: [___ cm/not applicable], posterior: [___ cm/not applicable], superior [___ cm/not applicable], inferior [___ cm/not applicable], medial: [___ cm/not applicable], lateral: [___ cm/not applicable].

Other:

  • Uninvolved parenchyma - appearance: [fibrous/fatty].
  • Other findings: [none/description of other findings].

Sections:

  • Margins - on edge if section can be taken with tumour and margin.
  • Tumour - in total if small (<2 cm[2]).

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.
    • Hua[2] suggests: black = posterior, blue = superior, green = inferior, yellow = anterior, red = medial & lateral.

Staging

The important cut-points (at the time of gross) for tumour staging are: 5, 10, 20, 50 mm.

Alternate approaches

See also

Related protocols

References

  1. Yu, P. (Aug 2016). "Breast reconstruction at the MD Anderson Cancer Center.". Gland Surg 5 (4): 416-21. doi:10.21037/gs.2016.05.03. PMID 27563563.
  2. 2.0 2.1 Huo, L. (Aug 2011). "A practical approach to grossing breast specimens.". Ann Diagn Pathol 15 (4): 291-301. doi:10.1016/j.anndiagpath.2011.03.005. PMID 21745648.

External links