The Role of Large-Format Histopathology in Assessing Subgross Morphological Prognostic Parameters: A Single Institution Report of 1000 Consecutive Breast Cancer Cases
Breast cancer subgross morphological parameters (disease extent, lesion distribution, and tumor size) provide significant prognostic information and guide therapeutic decisions. Modern multimodality radiological imaging can determine these parameters with increasing accuracy in most patients. Large-format histopathology preserves the spatial relationship of the tumor components and their relationship to the resection margins and has clear advantages over traditional routine pathology techniques. We report a series of 1000 consecutive breast cancer cases worked up with large-format histology with detailed radiological-pathological correlation. We confirmed that breast carcinomas often exhibit complex subgross morphology in both early and advanced stages. Half of the cases were extensive tumors and occupied a tissue space ≥40？mm in its largest dimension. Because both in situ and invasive tumor components may exhibit unifocal, multifocal, and diffuse lesion distribution, 17 different breast cancer growth patterns can be observed. Combining in situ and invasive tumor components, most cases fall into three aggregate growth patterns: unifocal (36%), multifocal (35%), and diffuse (28%). Large-format histology categories of tumor size and disease extent were concordant with radiological measurements in approximately 80% of the cases. Noncalcified, low-grade in situ foci, and invasive tumor foci <5？mm were the most frequent causes of discrepant findings. 1. Introduction Breast cancer is a heterogeneous group of diseases which deviate from each other in natural history, morphology, molecular phenotype, clinical and radiological manifestations, and prognosis. Prognostic parameters are essential for predicting the outcome and response to therapy in individual cases. The long list of more or less powerful prognostic parameters that includes patient age, mode of detection, tumor size, histologic grade, lymph node status, and presence or absence of distant metastases was recently widened with molecular tumor phenotypes assessed with either genetic tests or immunohistochemistry. Since the number of therapeutic options is rather limited, the parameters for which assessment is routinely required for therapeutic decisions are also few. Whereas hormone receptor status, HER-2 status, and proliferative activity are the major determinants of oncological therapy, proper characterization of the subgross morphology of breast carcinoma is essential for planning appropriate surgery and radiation therapy [1–4]. The prognostic significance of subgross parameters is also observed [1,
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