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Neoadjuvant therapy
Some patients with known breast cancer will have chemotherapy
before surgery in order to shrink the tumour – it is important to
accurately identify and sample the tumour bed in these cases as
the presence of any residual tumour has important prognostic
implications. For now, leave these cases for the registrar to cut.
BRCA 1 or BRCA 2
An inherited genetic mutation that predisposes to breast cancer
and some other gynaecological cancers. These women may be
having prophylactic mastectomies or may already have
developed tumours
Breast specimens are often received fresh.
Fresh mastectomy specimens require serial
slicing to permit adequate fixation (WLEs are
usually not sliced when fresh).
http://www.rcpa.edu.au/Library/Practising-
Pathology/Macroscopic-Cut-
Up/Specimen/Breast/Breast-tumour-resection
If the tumour is multifocal, sample each focus plus all the intervening macroscopically normal breast tissue so
that it can be ascertained as to whether the tumours are multifocal or in continuity.
For cavities, sample macroscopic tumour or suspicious areas, otherwise 1 section from each wall and include
any close margins; take additional sections if likely site of residual tumour is known from the previous pathology
report.
In cases of DCIS, thoroughly sample pale or grossly abnormal areas guided by clinical information, including
adjacent areas of close margin.
For sampling of skin, take 1 section from any scar or lesion, more if there is a clinical history of inflammatory
carcinoma. In cases of inflammatory carcinoma, areas of cutaneous abnormality and sections from 3, 6, 9 and
12 o’clock skin margins should be sampled.
Deep margin, take 1 section at the closest point to the tumour or directly beneath a cavity; always take the
section in a perpendicular fashion.
Sample other margins if the tumour is very close.
One section from each quadrant should be taken, from firm, white or fibrous areas of breast NOT adipose
tissue.
Any identified lesions must be blocked.