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Chapter 1:
The Subgross Morphology of Normal and Pathologically Altered Breast Tissue
Abstract
Breast cancer is a heterogeneous group of diseases with varying progression capacity and malignant potential. Histopathology is still the standard method of diagnosing, typing, and grading these tumors, which also provides the morphologic prognostic parameters needed for planning the adequate therapy. However, as a result of the rapid developments in diagnostic radiology and molecular medicine during the last decades, interdisciplinary diagnosis and treatment of breast cancer is slowly but irrevocably becoming the new gold standard. In this modern era of the interdisciplinary team approach, the role of pathology has not diminished, but rather has expanded. Providing a firm morphologic basis for the development of various imaging modalities in breast radiology has never been as important as it is today. By better understanding the heterogeneity and dynamic nature of the normal and pathologically altered breast tissue and by generating images that are easy to correlate to radiologic and operative findings, pathologists can actively influence the trends in the ongoing radiological research. The conventional histopathology technique used in most laboratories is based on sampling of small fragments of the breast specimen. Although adequate to properly type and grade the tumors, this method is clearly insufficient in the above-mentioned role. Radiologic imaging methods have a limited resolution capacity compared to microscopy, but regularly provide an overview of the diseased area of the breast tissue, including all the existing lesions in different projections and in three dimensions. Thus, the pathologist needs to demonstrate the morphology of the breast tissue in its entire width, length, and depth in a contiguous tissue slide, as large as possible, if aiming to take part in a successful radiopathologic correlation. Paraffin blocks measuring 10 x 8 cm are large enough to include an entire contiguous transection of the majority of breast conserving surgery specimens and to include representative areas in cases of mastectomy. Preparing 3-€“4mm thin histologic sections from these blocks allows microscopic examination of the details and, if the whole section is projected as an overhead, one-to-one comparison of the subgross morphology to the radiological findings. Preparing 1-mm thick sections from the same blocks and viewing them after special clearing in a stereomicroscope gives a three-dimensional perspective, bridging the gap between the low-resolution overview (radiology) and the high-resolution details (microscopy). This method of large-section histopathology and its advantages are described in details elsewhere. In this chapter 20 year's experience with routine diagnostic use of this method, corresponding to more than 5000 operated breast lesions documented on two-dimensional large histologic sections, more than 400 of them also examined in 3D thick sections is summarized. The statistical work-up was carried out on this material during the period of 1996-€“2003, corresponding to more than 1700 breast carcinoma cases.
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CHAPTER 1
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