In a re-excision, the surgeon goes back to the site of a prior partial mastectomy to take more tissue from a margin that was close. This does not guarantee that you will see tumor in the specimen—nor are you required to. Most of the specimens are flat “sheets” of tissue carved out of the biopsy cavity, with one side designated as the new final margin.
- The specimen should be oriented with a suture, usually marking the new (final) margin.
- Ink the marked side black and the other side in some other color.
- Fix in formalin.
- Section the specimen perpendicular to the black ink to look for gross evidence of disease. The area under the green ink may be fibrotic; this usually represents reaction to the previous procedure. It would be unusual to have gross tumor left behind.
- Small re-excisions (up to four or five cassettes) can be submitted in toto.
- Larger re-excisions can be representatively sampled with four representative blocks.
Submit the case in a bucket designated for “breast”, “fat”, or “16 hour” processing (all of these mean the same thing).
Specimen #1 is received fresh for frozen section, designated “right breast anterior margin, stitch marks new margin,” and consists of a portion of breast tissue measuring ___ x ___ x ___ cm, oriented with a stitch in one side. The marked side is inked black and the remainder of the specimen is inked green. The tissue is serially sectioned to reveal unremarkable tan-yellow parenchyma. Four representative sections are submitted in 1A through 1D.
Review and SignoutEdit
Pull the patient’s previous biopsy or resection from the archive so you know what you are looking for.
1. Left breast, anterior margin, re-excision:
- Benign breast tissue, no tumor seen.
- Breast tissue with giant cell reaction, no tumor seen.
- Residual ductal carcinoma in situ, present 0.5 cm from designated new margin.
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