Abstract
Modern imaging tools, breast magnetic resonance imaging included, are of great value in preoperative mapping of the true extent of breast cancer, and they are an essential component of treatment planning. Adequate correlation of imaging findings with underlying histology requires large thin section and large thick section, subgross (three-dimensional) histological examination. Large section histology permits the examination of about 65 cm2 of contiguous tissue; in comparison, standard glass slides cover an area of only about 5 cm2, greatly limiting reliable evaluation of tumour size and extent. The piecemeal reconstruction of a tumour's size, shape and margins, which every pathologist must do mentally, can hardly be considered to have a realistic 1:1 correlation with modern imaging methods, such as mammography, breast ultrasound and magnetic resonance imaging. Also, less than 20% of the specimen's margin is examined when the conventional, small block histology technique is used (Tucker L, personal communication). Large section histology leads to a more accurate documentation of the main tumour and the surrounding tissue, which may contain additional invasive and/or in situ cancer foci and permits more accurate assessment of the margins [5]. Summary The correlation of modern imaging techniques with large section histology will lead to a considerably improved mapping of disease extent, which in turn will result in more appropriate treatment, fewer recurrences, and consequently better patient care.
Highlights
Axillary node status and histological malignancy grade are established and reliable prognostic factors in tumours larger than 20 mm, the predictive value of these factors is reduced at sizes under 15 mm
When searching for features that are common to these rare fatal cancers, neither axillary node status nor histologic malignancy grade could reliably discriminate fatal cancers from those with excellent prognosis
We have found the mammographic image to be a reliable reflection of breast structure, it tends to simplify the histological heterogeneity of breast cancer to five mammographic tumour features (Figure 1) [2]
Summary
Axillary node status and histological malignancy grade are established and reliable prognostic factors in tumours larger than 20 mm, the predictive value of these factors is reduced at sizes under 15 mm. Summary The mammographic screening trials have clearly demonstrated the life-saving effect of early breast cancer detection and removal, combined with reduced need for adjuvant treatment regimens. Analysis of these features shows them to be reliable additional prognostic tools for predicting the long-term outcome of early breast cancers [2,3,4].
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