- As a general rule if the lesion is < 40mm and the patient < 40yrs these lesions are not problematic
- For a lesion < 20mm take two representative blocks, if larger 1 block per 10mm as a rule of thumb
- Always sample areas that are focally different
- If clinically suspicious or previous suspicious core biopsy take additional blocks - up to 40mm block everything
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Duct excisions (Microdochectomies)
Duct excisions are usually carried out for the investigation and treatment of single-duct
nipple discharge.
Specimens are usually roughly conical 20 - 40 mm in length, 20 mm or so in maximum width often with a suture
marking the (narrow) nipple end.
Serially slice the specimen across its long axis and block in its entirety with pieces in sequence from
deepest (the base of the cone) to the most superficial. Do not ink the margins unless the specimen is oriented as a wide local
excision with clips (see below).
Capsulotomy
- Capsulotomies are rather ragged sac-like specimens approximately 100 mm maximum dimension that are removed when they contract around a breast implant.
- They are removed primarily to improve the appearance of the breast but also to relieve discomfort.
- The pathology revealed is usually limited to fibrous scarring +/- evidence of implant-contents leakage.
- Take three or four blocks including the most ragged part of the specimen.
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See also Case of the Month, April 2007
See also Image of the week 2009 - 2; FNA of silicone granuloma
Level 2 specimens
These specimens are covered at the present time in Specimen types and tissue handling.
Axillary Node Samples
Sentinel Node Biopsies
Level 3 specimens
Selected Wide Local Excisions (WLE)
These are oriented specimens at the more straightforwrd end of the spectrum. They would usually include:
- Excisions of well centred carcinomas > 10mm
- Excisions of core biopsy-indicated radial scars
Specimen orientation:
- A specimen x ray should, ideally, accompany the specimen
- The specimen is oriented according to local custom using the pre-agreed clip convention
- We slice the specimen with the posterior margin flat on the trimming bench giving sagittal slices
- The slices are examined for macroscopic lesions
Block selection:
- Correlate macroscopic abnormalities with specimen x ray shadows where possible
- Review block taking requirements with pathologist according to level of experience
- Always be prepared to halt block-taking if difficulties arise and discuss case further with pathologist
- A 'standard' set of blocks would include:
- Anterior and posterior 'cruciates'
- Four blocks each with one of the radial margins - see images below:
- At least one to include lesion - depends on size and position of lesion
- Extra blocks of the lesion if tissue available - with or without specified margin as appropriate
- All margins to be inked - use more than one colour if more than one margin present on a block
- 'Fix' ink by dipping block briefly in 5% acetic acid before placing in cassette
- If you are taking a block for a margin without a macroscopic lesion try to ensure it is at least 5mm wide, prefrerably 10mm, so that a comment such as the following becomes possible when no tumour is present in the section:
- 'Medial margin > 10mm'
- Be prepared to be flexible about block-taking - it should be an intelligent process tailored to the individual specimen
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