Introduction[]
There are two scenarios for receiving a breast expected to be benign:
- Resection of the contralateral breast in a patient with breast cancer on the other side.
- Prophylactic bilateral mastectomy in a patient with a hereditary cancer syndrome (BRCA1, BRCA2 mutation)
You are not expecting to find a lesion, but should look for one with some routine sections.
Fresh Handling[]
- Consult radiology reports and clinical history to determine the clinical scenario and guide your gross inspection.
- Measure the breast, skin ellipse, nipple-areola complex and nipple.
- Orient the breast using the surgeon’s sutures.
- Ink the breast:
- Anterosuperior: blue
- Anteroinferior: green
- Deep: black
- Place the breast face-down on the table, oriented.
- Section into quadrants using a Tissue-Tek knife, then section further in a pinwheel fashion (see diagram).
- Look and palpate tissue for any lesions. If present, document.
- Fix specimen in a large quantity of formalin.
Grossing In[]
If the specimen was thoroughly described in the fresh state, then most of the work is already done.
- Submit sections:
- Contralateral breast from cancer patient:
- 2 representative sections from each quadrant
- 1 section of nipple
- Prophylactic breast from BRCA patient:
- 3 representative sections from each quadrant
- 1 section of nipple
- Contralateral breast from cancer patient:
Submit the case in a bucket designated for “breast”, “fat”, or “16 hour” processing (all of these mean the same thing).
Review and Signout[]
1. Breast, right, mastectomy:
2. Breast, right, prophylactic mastectomy:
- A. Breast, no carcinoma identified.
- B. Non-proliferative fibrocystic changes.
- C. ___ lymph nodes, no carcinoma identified (0/___).
Return to Breast Grossing