December 23, 2024
What Is a Breast Pathology Report and How Does It Impact Your Next Steps?
If your physician requested a breast biopsy after imaging showed there was an area of concern in one or both breasts, the doctor who evaluates the sample, called a pathologist, will create a report. The resulting document outlines the pathologist’s findings and will make a final determination on whether cancer is present. Data from this report, called a pathology report, plays a primary role in diagnosing the type of breast cancer and determining the most effective next steps for treatment.
General Information about the Breast Biopsy Sample
Pathologists sometimes describe their findings using scientific phrases that can make pathology reports tricky to understand. This breakdown of a pathology report should help give you a better understanding of the results when talking with your doctor:
Specimen Description
This section details the tissue sample's origin (e.g., breast, lymph nodes).
Clinical History and Diagnosis Before the Pathology
This section includes the doctor's initial diagnosis, the patient's medical background, and details about the biopsy or surgery.
Gross (Macroscopic) Description
The report outlines the characteristics of breast tissue that can be seen before the microscopic examination, such as size, color, texture, and other distinctive features.
Description of Biopsied Breast Cancer Cells
So far, the report includes general descriptions of what occurred before and during the biopsy. Next are several determinations that largely guide the treatment process.
Type of Breast Cancer
There are several types of breast cancer, also called carcinomas. About 90% of breast cancers are classified as adenocarcinoma because cancer starts developing in glandular tissue. The specific type you have will be specified in the report. Within this broad class of breast cancer are several sub-types. The particular type you have will be specified in the pathology report.
Common breast cancer types mentioned in pathology reports can include:
Ductal Carcinoma In Situ (DCIS): Cancer is present but remains in the milk ducts and is non-invasive.
Invasive Ductal Carcinoma (IDC): Cancer begins in the milk ducts and invades surrounding breast tissues. IDC is the most common breast cancer type.
Invasive Lobular Carcinoma (ILC): Cancer starts inside the lobules and spreads into the nearby breast tissues.
If lobular carcinoma in situ (LCIS) is reported, it is not considered cancer. Instead, LCIS is an overgrowth of abnormal cells in the milk glands or lobules and increases the risk of developing invasive breast cancer in the future. Your doctor may recommend more frequent breast cancer screening.
Less common types of breast cancer include:
Paget’s disease
Angiosarcoma
Phyllodes tumor
Inflammatory breast cancer
Non-invasive or invasive
Non-invasive cancer (in situ carcinoma): This type remains confined to the breast's milk ducts or lobules where it started.
Invasive (infiltrating) carcinoma: This describes cancerous cells that have spread beyond the ducts or lobules where the cancer started and has grown into surrounding tissues.
Tumor Grade
The grade tells us how closely the cancer cells resemble healthy breast cells and how quickly they may grow and spread. The grading is typically based on tumor cell features and uses scales like the SBR system or well-differentiated, moderately differentiated, or poorly differentiated descriptions.
Grade 1 (Well-Differentiated): Cells closely resemble normal breast cells and have a slower growth rate.
Grade 2 (Moderately Differentiated): Cells show some abnormality, with a mixture of well-differentiated and poorly differentiated cells.
Grade 3 (Poorly Differentiated): Cells are highly abnormal and tend to grow quickly.
Vascular Invasion and Lymph Node Involvement
The spread of cancer cells through the lymph channels or blood vessels is referred to as vascular invasion. Lymph node involvement indicates that the cancer is likely to spread to other areas. Cancer cells detected in the lymph nodes are categorized as:
Microscopic: A few cancer cells can only be seen under a microscope.
Gross: Many cancer cells can be seen or felt. A microscope is not needed to see them.
Extracapsular Extension: This term refers to cancer cells that have spread beyond the capsule or wall of a lymph node.
Hormone Receptor Status
The hormone receptor status of breast cancer indicates whether the cancer cells are driven by estrogen and/or progesterone based on the presence of hormone receptors on the cells. This status is represented in one of the following ways:
A percentage between 0 and 100% indicates the proportion of receptor-positive cells out of 100 tested cells.
An "Allred score" combines the percentage of receptor-positive cells with their intensity, ranging from 0 to 8. Higher scores indicate a greater presence of hormone receptors.
The terms "positive" or "negative" may indicate whether receptors that attract estrogen, progesterone, or both are present on the cancer cells.
HER-2 Status
HER2 is a protein that appears on the surface of breast cells and may be overexpressed in certain types of cancer. When present, the report will specify a HER2-positive status. In some cases, an amount of HER2 overexpression is present but not enough to be considered positive. In that case, the cancer may be categorized as HER2-low.
Related reading:
HER2-low Breast Cancer Treatment Breakthrough for Inoperable or Metastatic Breast Cancer
Triple-Negative Breast Cancer
If the pathology report shows that the cancer is negative for estrogen receptors, progesterone receptors, and HER2, the tumor is classified as triple-negative. This result will guide the oncologist towards a different treatment plan than if any of these indicators are positive.
Read more about triple-negative breast cancer.
Final Diagnosis
This summarizes the key characteristics of the breast cancer diagnosis, including the type of cancer, tumor grade, lymph node involvement, hormone receptor status, and HER2 status. This information helps guide the next steps in patient care.
Pathology Report Guides the Process for Staging Breast Cancer
Breast cancer staging guides treatment decisions and provides more insight into a patient's potential prognosis. Although the breast pathology report does not directly include a cancer stage, it provides information for the oncologist to determine a stage.
The TNM system is used for staging breast cancer. TNM represents:
T = Tumor size
N = Lymph Node status (the quantity, number, and location of lymph nodes affected by cancer)
M = Metastases (whether the cancer has spread to other parts of the body)
Numbers or letters listed after T, N, and M offer details about each characteristic. Higher values indicate a more advanced stage of cancer.
Breast cancer is typically classified on a scale from 0 to IV (4) based on the T, N, and M. Stage 0 refers to non-invasive cancer confined to the breast. Stage IV indicates invasive cancer that has spread beyond the breast to other parts of the body, known as metastatic breast cancer.
What is NOT Included In the Biopsy Report?
Additional testing may be needed to determine other aspects of your breast cancer and how to treat it most effectively. The oncologist may recommend separate tests.
Inherited BRCA Gene Mutation
Genetic testing is not generally conducted on biopsy samples for inherited genetic mutations because only 5-10% of all breast cancers are linked to BRCA1 or BRCA2 gene mutations. If there is a family history of breast cancer, consider discussing the possibility of further genetic testing with the oncologist.
Related reading:
Ways to Reduce Your Breast Cancer Risk When You're BRCA Mutation-Positive
Speed of Cell Division
Also known as the mitotic rate or Ki-67, this measurement assesses how quickly cancer cells grow and divide. A higher value generally indicates a more aggressive form of cancer. A test can be run to determine this.
Genomic Testing
Cancer researchers have determined that some genes mutate over time, leading to the development of breast cancer. Your oncology team may recommend running biomarker tests on the biopsied tissue to see if any of these specific gene mutations are present. Targeted therapy drugs are now available for several gene mutations that specifically block the growth of cancer cells.
Breast Cancer Treatment in Brevard County, Florida
The breast cancer doctors at Cancer Care Centers of Brevard offer the latest breast cancer treatments and are here to answer your questions and provide an individualized treatment plan.
If you were recently diagnosed with breast cancer, schedule a consultation with one of our oncologists at a location convenient to you in Palm Bay, Rockledge, Melbourne, and Merritt Island, Florida. Second opinions are also available.
Categories: Breast Cancer