The role of radiological–pathological correlation in diagnosing early breast cancer: the pathologist’s perspective

Abstract

Early breast carcinoma, defined as purely in situ cancer and invasive carcinomas < 15 mm, represents the most frequent category of breast carcinomas in diagnostic routine in a regularly screened population. These tumors are usually detected with mammography screening and are preoperatively characterized with radiological imaging. The role of pathology in preoperative settings is to help understand the subgross morphology and to confirm malignancy in biopsy material. Postoperatively, the pathologist needs to verify the size of the cancer (defined as the largest dimension of the largest invasive focus), the extent of the disease (defined as the area or the volume of the breast tissue containing all the malignant foci), the distribution of the in situ and invasive lesions (as unifocal, multifocal, or diffuse), and intratumoral and intertumoral heterogeneity (in addition to determining margin status, histologic tumor type, hormone receptor status, and other parameters). Despite their small size, early breast carcinomas often exhibit complex morphology as they are multifocal/diffuse in about 60% and extensive (occupying an area ≥ 4 cm) in 40% of the cases. Routine use of large-format histopathology technique is a prerequisite for detailed correlation of the radiologic and histopathologic findings and for the correct assessment of these parameters. Breast pathologists must be aware of the advantages and disadvantages of the different imaging modalities and have detailed information about the radiological findings before work-up of the operative specimen. Multidisciplinary preoperative and postoperative tumor board meetings are essential in guiding the pathologists and in confirming the radiological findings. Interdisciplinary diagnosis is inevitably becoming the new gold standard in the diagnosis and management of early breast carcinomas.

BI-RADS 3-5 microcalcifications: prediction of lymph node metastasis of breast cancer

“…Mammography is the gold standard modality for detecting microcalcifications [19]. BI-RADS 3–5 microcalcifications are a characteristic appearance of breast cancer at mammographic imaging and a well-known criterion in the diagnosis of the disease.…”

“…The characteristics of breast microcalcifications continue to attract interest. Hashimoto and coworkers found that patients with microcalcifications were significantly more likely to have LN metastases [19]. Li and coworkers found that malignant-appearing microcalcifications were significantly associated with a LN (+) status and that they always presented in breast cancer patients who were non-menopausal as well as with a family history of carcinoma [22].…”

The Role of Large-Format Histopathology in Assessing Subgross Morphological Prognostic Parameters: A Single Institution Report of 1000 Consecutive Breast Cancer Cases

“…Modern multimodality breast radiology is very accurate in determining the subgross morphological prognostic parameters [7]. It uses different imaging modalities for the same lesion, which when combined can compensate for the limitations of the results of the individual methods.…”

Conventional and non-conventional pathologic workup of specimens with early breast carcinomas

“…Th e method of large-format histology sections is not per se suffi cient for adequate assessment of the radiological-surgical parameters. Detailed and systematic radiological -pathological correlation is also necessary [14][15][16][17]. Th e radiological imaging methods, especially if used in combination (multimodality approach) are very sensitive in preoperative assessment of tumour size, lesion distribution, disease extent and position of the lesions, but histological confi rmation of the radiological fi ndings is essential because the radiological methods are somewhat less specifi c than sensitive in diagnosing breast lesions [16,17], as illustrated in Fig.…”

“…Th is is the reason why many breast experts are reluctant to recognise the importance of breast cancer multifocality and disease extent; the principal that the things we (or our pathologists) do not see -do not exist. Th is destructive attitude is not acceptable in the era of modern radiological investigations and alternative histological methods able to demonstrate the real distribution of the lesions and the real disease extent of breast carcinomas [14][15][16][17][18][19].…”