A comparison of large block macrosectioning and conventional techniques in breast pathology

Abstract

Two techniques for the histological handling of breast specimens, namely conventional sampling using small blocks (SB) and a large block (LB) macrosectioning technique have been compared, with special emphasis on tumour size and in situ carcinoma, in an attempt to objectively demonstrate the advantages of the latter method. This is considered to be of particular importance in guiding the clinicians in their use of the many treatment modalities available for breast carcinoma. All cases were from the routine surgical caseload; 100 examined by the LB technique and 111 using conventional SB. The LB technique gave a reliable measurement of invasive carcinoma in 100% of cases compared to only 63% of SB cases. Ductal carcinoma in situ (DCIS), was found more frequently (80% versus 64%) and its extent was more easily and reliably measured in the large blocks. The extent of DCIS was significantly greater in all cases using large block techniques. Concurrent carcinomas were found more frequently in the LB series and these tumours were smaller than those in the SB series. Similar differences were noted with radial scars, and other proliferative lesions also had a higher incidence in the LB series. We conclude that the LB technique has sufficient advantages to recommend it as a standard technique in breast pathology.

Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project

“…It is much easier to measure the size of a lesion in a wide local excision specimen because the sections can either be re-assembled like a jigsaw puzzle to give an overall size or large sections can be used that allow direct measurements. Such use of large block histology has been shown to improve the agreement between radiological and pathological lesion size (Jackson et al, 1994), but in this series there were insufficient cases following the various exclusions to be able to confirm this finding. Alternatively, the pathologist can relate the disease to its distance from margins and then calculate the extent from the overall dimensions of the specimen (Lester et al, 2009).…”

Clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large‐format histologic sections

“…12,13 The routine use of large-format histologic sections in diagnostic breast pathology allows the observer to properly document and demonstrate the extent and distribution of the lesions in a case of malignant tumors and to compare these parameters with the surgical margins. [15][16][17] Detailed radiologic/ pathologic correlation in the workup of the specimen further enhances the sensitivity of this method. 18,19 These preparations are currently the best available source for analyzing the histologic distribution of the lesions and the extent of the disease in breast cancer cases.…”

Three-dimensional reconstruction of vessel distribution in benign and malignant lesions of thyroid

“…To date, three-dimensional (3D) histological examination of tissues, using a stereomicroscope, has been mainly applied to the breast, where it provides information about the site of origin of carcinomas, the type of growth, the extension of neoplasm and margin assessment in cases of in situ and invasive carcinomas [3,4,6,12,16]. Recently, a modification of the 3D histological technique led to the direct visualisation of the vascular tree in twin placentas [7], giving noticeable insights to the understanding of the mechanism of twin-to-twin cytomegalovirus infection [10].…”