Download Breast cancer pathology

OVERVIEW OF BREAST PATHOLOGY
Shahin Sayed, MMed, FCPath(ECSA)
Assistant Professor,
Department of Pathology,
Aga Khan University Hospital, Nairobi
OUTLINE OF PRESENTATION

Overview of Normal Breast Anatomy and
Cytology

Role of Pathology in Breast Cancer Diagnosis
PATHOLOGY – “Pathos” and “Logos”
THE STUDY OF DISEASE
HISTOLOGY
CYTOLOGY
Study of tissues
 Complex
 Costly


Study of cells
 Simple
 Cheaper
NORMAL ANATOMY OF BREAST

Two major structures ( ducts and lobules)

Two types of cells (luminal and
myoepithelial) and stroma

6-10 ducts open into areola

Branching of the large ducts leads to
terminal duct lobular unit (TDLU)

Breast cancers arise from the TLDU
WHAT IS THE ROLE OF PATHOLOGY IN
BREAST CANCER ?

Establish an accurate diagnosis in case of a mass lesion
(Benign , Malignant)

Confirm a diagnosis of suspected breast cancer

For prognosis (grade and stage of tumour, risk of
metastases, relapse of cancer)

For prediction of response to therapy

For choosing appropriate treatment ( hormonal therapy,
Herceptin)
ACCURATE DIAGNOSIS OF BREAST
DISEASE

History and Physical exam

Screening mammogram

Ultrasound for palpable breast masses

Ductography (for nipple discharge)

Fine Needle Aspiration Cytology (FNAC) for palpable
masses and image guided FNAC for non palpable/ small
masses

Image guided core needle biopsy (CNB)
TECHNIQUES FOR FNAC
FREE HAND
SYRINGE HOLDER
MULTIPLE
DIRECTIONS
SYRINGE AND NEEDLE
IMAGE DIRECTED
FAT CELLS IN ASPIRATE
FROM NORMAL BREAST
BENIGN DUCTAL CELLS IN
FNAC OF NORMAL BREAST
MALIGNANT DUCTAL
CELLS IN FNAC FROM
BREAST MASS
THE TRIPLE TEST IN BREAST DIAGNOSIS
• The TT is the combination of physical
examination(CBE), imaging and cytologic findings of
the FNA
• All breast FNAs need to be evaluated in this context,
and management is based upon the combination of
this information
• Using this as the standard:
 The false-negative rate of TT diagnosis approaches
that of surgical biopsy
IF TRIPLE TEST IS NEGATIVE

Negative FNA should not rule out biopsy if clinical
suspicion of malignancy persists

But negative cytology, negative clinical examination and
negative radiologic findings together have a negative
predictive value close to 100%
(Breast J 2004;10:487)
CORE BIOPSY FOR ACCURATE
DIAGNOSIS
WHAT IS THE ROLE OF PATHOLOGY IN
BREAST CANCER ?

Establish an accurate diagnosis in case of a mass lesion
(Benign , Malignant)

Confirm a diagnosis of suspected breast cancer

For prognosis (grade and stage of tumour, risk of
metastases, relapse of cancer)

For prediction of response to therapy

For choosing appropriate treatment ( hormonal therapy,
Herceptin)
Grading and ER/PR/HER2 testing of
Breast Cancers
WHAT IS THE ROLE OF PATHOLOGY IN
BREAST CANCER ?

Establish an accurate diagnosis in case of a mass lesion
(Benign , Malignant)

Confirm a diagnosis of suspected breast cancer

For prognosis (grade and stage of tumour, risk of metastases,
relapse of cancer)

For prediction of response to therapy

For choosing appropriate treatment ( hormonal therapy,
Herceptin)
Celebrate Life
Thank you