Toluidine Blue – Formalin Mixture: A Useful Tool To Enhance Detection of Benign and Malignant Breast Lesions for Gross Submission of Breast Specimens
Zahra Jlayer, Yun-An Tseng, Elena Selbs, George K Turi. Winthrop University Hospital, Mineola, NY
Background: Submission of breast tissue for pathologic evaluation currently relies on both visual and palpation findings and radiographic images without knowledge of where mammary epithelium lies in the breast. A more optimal method for detection of breast epithelial lesions could utilize a supravital stain applied to breast specimens that identifies where terminal duct lobular units (TDLU) and their pathologic alterations are within breast tissue. We studied the utility of a toluidine blue – formalin mixture (TB-FM) for enhanced identification of pathologic breast lesions.
Design: 115 cases were studied, most of which were excisional biopsies. Fresh breast specimens were serially sliced at 3 – 5 mm thickness, and fixed at room temperature for 3 hours in TB-FM. TB-FM was prepared fresh for each case, by using 1 cc of 1% toluidine blue per 200 cc of neutral buffered formalin (NBF). After 3 hours fixation in TB-FM, breast specimen slices were photographed. The entire breast specimen was submitted for histologic evaluation for all cases. TB–FM stained breasts show dark blue dots which highlight mammary epithelium and proliferative lesions against white to light blue stroma. Blue dots from TB-FM specimen photographs were correlated with H & E stained sections for each blue stained area.
Results: TB-FM identified all benign epithelial proliferations, regardless of their nature, and all DCIS and LCIS lesions greater than 1mm. The size of the TB-FM stained areas correlated well in proportion to lesion size and cellularity. There were 70 benign lesions, 18 carcinoma in situ (9 DCIS, 9 LCIS), 25 invasive ductal carcinomas, 1 invasive lobular carcinoma, and 1 atypical ductal hyperplasia. The size ranges of epithelial proliferations identified by TB-FM staining were as follows: benign proliferations including fibroadenoma (0.1- 3.1 cm), carcinoma in situ, mostly DCIS (0.1-10 cm), and invasive carcinoma (0.1-5.5 cm).
Conclusions: TB-FM non-specifically stains all foci in the breast where increased cells per unit area occur. TB-FM identifies normal breast epithelium, ductal and lobular proliferations greater than 1 mm, and all invasive carcinomas, including pT1a and pT1b stages. This novel technique, although non-specific, is a highly sensitive method which enhances the gross detection of important breast pathologic alterations.
Monday, March 19, 2012 11:00 AM
Platform Session: Section B, Monday Morning