Coronal Serial Sectioning of Lumpectomy Specimens: Proposed Technique of Sectioning and Submission of Tissue for Microscopic Examination of Breast Carcinoma
MS Amin, C Bicamampuka, J Swift, BF Burns, KT Mai. University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
Background: Lumpectomy specimens are currently sectioned in a plane perpendicular to the long axis of the sample and skin (random serial sectioning technique -RSS). It is often necessary to correlate areas of tumor with radiological findings, which is often difficult with the RSS technique. We hypothesized that coronal sectioning has better reproducibility and might be a better alternative.
Design: Fifty lumpectomy specimens for breast carcinoma were sectioned in the coronal plane (parallel to the skin/chest wall) at 3-5 mm intervals (coronal serial sectioning technique - CSS). All giant sections of the breast tissue between the superficial and deep margins were divided in a “grid” pattern into routine sections. The superficial and deep margins were cut in the plane perpendicular to the coronal plane. For large specimens, the findings of this protocol were compared with two modified protocols involving fewer sections: Modified protocol 1) for cases with diffuse fibrosis or cystic changes (10 cases), findings on microscopic examination were recorded from entire alternate “giant” cross sections; Modified protocol 2) for cases consisting predominantly of adipose tissue (3 cases), findings of microscopic examination were recorded from fibrotic areas. Additional sections were required for areas suspicious for margins involved by carcinoma.
Results: CSS demonstrated DCIS and invasive carcinoma in its largest area and along the greatest diameter as opposed to the RSS that divided the greatest diameter of the breast lesion in multiple sections. Findings on status of DCIS, resection margins and multi-centricity, and dimensions of DCIS and invasive carcinoma were similar in three protocols of CSS for large specimens. But CSS had the following benefits over RSS: a) easily reproducible panoramic view of different areas and types of neoplasms in the sample, b) accurate measurement of tumor size, c) feasibility for reconstruction of the breast specimen to re-examine areas of interest after the initial microscopic examination, and d) no requirement of special equipment, extra-time of fixation or time-consuming training to achieve better results in comparison with conventional RSS.
Conclusions: We propose that CSS is more scientific and a better approach for processing lumpectomy samples of the breast.
Monday, March 22, 2010 1:00 PM
Poster Session II # 32, Monday Afternoon