Pattern and spectrum of morphology referrals in breast pathology consultation.
Pathology
; 40(6): 564-72, 2008 Oct.
Article
en En
| MEDLINE
| ID: mdl-18752122
ABSTRACT
AIMS:
We aimed to identify common reasons for second opinion breast pathology referrals at the Pathology Department, Singapore General Hospital, focusing on queries and diagnostic issues raised by referring clinicians and pathologists.METHODS:
Request forms for breast pathology consultations were retrieved from a specialist's correspondence files consisting of pathologists' referrals, and from centralised laboratory records, comprising clinician-initiated referrals. Clinical and histomorphological queries raised by the referrals were collated.RESULTS:
Of 299 cases evaluated, clinician-initiated referrals (n = 137, 46%) included requests for review of overall histopathology to confirm carcinoma subtype (n = 47), grade (n = 2), size (n = 4), lymphovascular invasion (n = 1) and confirm hormonal receptor and c-erbB-2 assays (n = 33). Also required were comparison of recurrent with previous lesions (n = 8); settling discrepant diagnoses between two or more prior pathology reports (n = 4); verification of microinvasion (n = 6), in situ carcinomas (n = 6) or atypical ductal hyperplasias (n = 4); delineation of benign (n = 8) and spindle cell lesions (n = 3); to establish a breast origin of metastatic lesions (n = 5); and distinction of carcinoma from lymphoma (n = 2). Pathologist-initiated referrals (n = 162, 54%) sought arbitration between borderline proliferative lesions (n = 46) and papillary lesions (n = 34); verification of microinvasion (n = 23), stromal lesions (n = 16), and carcinoma subtype (n = 13), especially if the patient was young (n = 5); clarification of metaplastic changes (n = 4) and lobular neoplasia (n = 8); and comparison of fibroepithelial lesions (n = 11).CONCLUSIONS:
Clinicians sought a second opinion mainly to verify histological diagnoses and report important pathological details for staging and confirmation of hormonal receptor and c-erbB-2 status prior to therapy. Borderline breast lesions are worrisome for both clinicians and pathologists in view of implications for management.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Patología Clínica
/
Patología Quirúrgica
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Derivación y Consulta
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Neoplasias de la Mama
Límite:
Female
/
Humans
Idioma:
En
Año:
2008
Tipo del documento:
Article