DUCOM BREAST TUMOR PROTOCOL

DUCOM pathology has a standardized comprehensive procedure for gross inspection, microscopic evaluation and diagnostic reporting of mammary resections.  Our approach is based on three dimensional studies Figure 1, that have shown that most breast cancers are derived from the terminal duct lobular unit and follow the distribution of specifically involved ducts and lobules that likely define a breast segment of disease.  In order to best define both the cancer and related margins we fully define the pathology of both the resected lesion and the surrounding breast tissue.  This is accomplished by the following method.

• All breast tissue is serially sectioned at 0.5cm to allow lesion detection
• All breast specimens are kept oriented in the six spatial parameters throughout the process
• Lesions are measured for length, width and depth and relationship to margin is measured in all 6 planes (anterior, posterior, superior, inferior, lateral and medial)
• All breast tissue from lumpectomies are entirely submitted for pathologic evaluation
• Tissue submission is mapped as shown diagrammatically in Figure 2 with each block/slide labeled accordingly to enable each tissue piece to be oriented in relation to adjacent tissue and to the margin
• All margins are oriented perpendicularly rather than parallel to allow accurate measurement of distance of lesion to named margin
• Each margin is inked according to a standard procedure to reduce error in interpretation
• An enhanced College of American Pathologists synoptic report is used to document the findings
• The distance of both in situ and invasive carcinoma are separately reported in relationship to each of the 6 margins Figure 3
• All reports include AJCC Stage and grade
• All reports contain an image of the lesion
• All cases of in situ disease have Estrogen and Progesterone receptor studies performed with quantitative results reported using computer assisted image analysis
• All cases of invasive disease have biomarker studies performed with quantitative results reported using computer assisted image analysis Figure 4. Biomarkers include:
  1. Estrogen receptor
  2. Progesterone receptor
  3. Mib-1 (proliferation marker)
  4. P53 (tumor suppressor marker)
  5. Her2 (reflex to FISH in cases of 2+ (borderline) expression)