Best Practice Guidelines for the Pathological Evaluation of Reduction Mammoplasty Specimens A Surgical Conundrum
R Kanthan, JL Senger, R Chibbar. University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Background: Surgical specimens of breast reduction mammoplasties generates a laboratory report from the histopathological examination of a few adhoc random sections.This practice was critically reevaluated to establish best practice guidelines for the handling of such specimens.
Design: A ten year (1996-2007) computer based data search for reduction mammoplasty specimens at the Saskatoon Health Region was undertaken. The cases were reviewed for the following parameters: patients age, number of tissue sections submitted, average weight of the breast specimen and the pathological findings.
Results: The ten year search identified 1334 cases (30-140 cases/year). 65.8% of the 1320 female patients ranged from 20-40 years of age; 40-60 were 30.3% and 3.9% were >60 years of age. In contrast 71.4% of the 14 males were under the age of 30. The weight of a single female breast specimen, right or left, ranged from less than 100g (4.35%) to more than 1 Kg (11.65%), while the average weight of male breast tissue removed ranged from 30-400g with less than 100g in 42.9%. In the female breast specimens (94.53%) the average number of blocks submitted per breast were 3.19 (1-29) with 2 sections taken in 46.8% and 4 sections in 40.5%. The average number of blocks submitted per male breast was 2.071 with 2 sections taken in 42.9% and four sections in 35.7%. 65% of the female breast cases had no pathological abnormalities. Pathological changes in 467 cases included fibrocystic change, apocrine metaplasia (19.4%), fibrosis (1.27%), fibroadenomatoid, fibroadenoma (1.05%), ductal hyperplasia-usual/typical (0.3%), sclerosing adenosis (0.37%), DCIS (0.07%), atypical hyperplasia (0.1%) and microcalcification (0.15%). In the male breast specimens 28.6% had no abnormalities. Pathological findings included: gynaecomastia (57.1%), fibrocystic change, apocrine metaplasia and epithelial hyperplasia in 6.1%. More than one pathology was seen in 7% (males) and 11% (females).
Conclusions: Our findings recommend continued pathological evaluation of reduction mammoplasty specimens in males and females. We recommend 3 section sampling for younger patients and 5 section evaluation in older patients (40 years or older) as best practice guidelines. Additional sections are recommended in identified breast cancer risk cases. Further understanding of epithelial/stromal changes in breast carcinogenesis may necessitate increased breast sections in younger breasts as additional tools for predictive breast cancer risk assessment in the future.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 31, Wednesday Afternoon