Role of pathology in the management of breast disease

The involvement of pathologists in the management of breast disease falls into four main areas: Diagnosis; Assessment of adequacy of treatment and prognosis, effective communication and research.

Diagnosis of Breast Diseases


• Pathological techniques - FNA & Core biopsy
• Diagnosis is always multidisciplinary
• Mismatches between "Clinical", "Imaging" & "Pathology"
  must always be resolved

Symptomatic Clinic


• Two thirds discharged on basis of clinical +/- mammography
• One third need additional investigation:
• Fine needle aspiration cytology (FNA) and/or
• Core biopsy
• Of this latter group one third will have cancer

The following lists give an indication of the proportion of clinic patients requiring pathological investigation:

Screening population


• For every 1000 screened:




	Further investigation	Cancer detection rate
Prevalent	7 - 10%	1.8 - 3.6
Incident	<7%	1.1 - 2.1

Assessment of adequacy of treatment and prognosis


• Confirmation of FNA/Core diagnosis
• For cancers, assessment of:
• Grade
• Stage
• Lymphatic invasion
• Margins
• Node status
• Hormone receptors and Her2

Communication