A Proposed Technique for Topographical Mapping of Cancer Burden in Breast Resection Specimens
Nick Shillingford, Evgeny Yakirevich, Diana Treaba, Sonja Chen, Martha Mainiero, Ralph Sams, Maureen Chung, Ronald A DeLellis, Shamlal Mangray. Rhode Island Hospital, Providence, RI
Background: In the era of conservative breast surgery, cancer burden and resection margin status are key factors in the management of breast cancer patients. Yet major challenges exist in delineating and reporting the cancer burden such that the distribution of ductal carcinoma in-situ or invasive mammary carcinoma can easily be gleaned from the report by treating physicians. Herein, we describe a technique for topographical mapping using conventional histologic sections as an alternative to whole mount sections.
Design: On receipt of previously inked and needle localized, the specimen is oriented in the same manner as the accompanying x-ray (Fig. 1). Based on localization and/or bracketing of the tumor, the specimen is sectioned in a plane perpendicular to the closest apparent margin. Sections are done optimally at 4-6 mm intervals. After sectioning the full slices are photographed (Fig. 2A) prior to overnight fixation in formalin. Whole slices are submitted for histologic examination and a map is made on the photographed slices. Small specimens are entirely submitted while bracketed areas are entirely submitted as full slices along with alternate slices beyond those areas in larger specimens.
On examination of the hematoxylin and eosin sections, tumor is mapped on individual glass slides with a marking pen. Biopsy site and calcifications are also noted. Each section is then traced onto a plastic transparency reconstructing the whole slices from the mapped sections (Fig. 2A & Fig. 2B).
Results: By this method a whole mount representation is obtained of individual slices from conventional histologic sections (Fig. 2B).
Conclusions: These images can be incorporated into pathology reports with appropriate annotation giving span of tumor and involved margins. In cases of neoadjuvant chemotherapy the percentage of residual tumor in the original tumor bed can be estimated with the use of 1 or 2 mm grids (Fig. 2C), or by digital image analysis, for assessing residual cancer burden. Transparency maps can be superimposed on the original photographs for reporting (Fig. 2D). This technique also has potential for three dimensional reconstruction as is done with CT scans or to enhance breast MRI interpretation by correlative studies.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 40, Monday Morning