Breast grossing

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.

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).

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 suggests: black = posterior, blue = superior, green = inferior, yellow = anterior, red = medial & lateral.

Staging

Main article: Breast cancer staging

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

See also

• Breast pathology.