Breast biopsy

Last updated: Wednesday, 28, November, 2007

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Item Process
Specimen

Fine needle aspirate biopsy, needle core or open surgical biopsy.

X-ray of excised tissue may also be required to confirm complete excision of the lesion and as an aid to tissue sampling.

Method

Fresh tissue: frozen section, flow cytometry, growth factors. 

Fixed tissue: light microscopy, immunohistochemistry, electron microscopy (special fixative), image analysis, proliferation index. 

Core biopsy should be submitted in formalin, wide local excision/mastectomy specimens should ideally be submitted fresh on ice. However, if significant delay in specimen transportation is anticipated then formalin fixation is acceptable. 

Sentinel lymph nodes should be submitted fresh.

The surgical specimen should be orientated and marked by the surgeon with a description on the surgical request form of the protocol used.

Interpretation

Tumour type, grade, size, vascular invasion, excision margins, extent of in situ disease and receptor status are important prognostic indicators. 

Levels of oestrogen and progesterone receptors in tumour tissue assist in prediction of the response to hormonal therapy. 

HER2 immunohistochemical expression is used to predict likely response to trastuzumab (Herceptin) treatment. 

Tumours equivocal or weakly positive for HER2 Immunohistochemistry will require FISH confirmation.

See HER-2 (c-erb B-2) Immunostaining

See Breast Biopsy - Oestrogen receptors (ER) and Progesterone receptors (PR)

Reference

Bilous M. Pathology 2001; 33: 425-327.

Australian Cancer Network Working Party. The Pathology Reporting of Breast Cancer. 2nd ed. Intramed 2001.