Initial Procedure

Mastectomy (total/partial) and quadrantectomy specimens:

obtain all relevant histories of preoperative investigative procedures, e.g., FNAC, cores biopsy, etc. especially in cases of multifocal disease.

weigh (g) and measure (cm) the specimen. Measure any ellipse of skin and note the presence or absence of the nipple-areolar complex and orientation sutures. Note the laterality (right or left).

differentially paint all margins using artists' pigments or similar dyes according to an agreed protocol.

serially slice transversely at 0.5-1cm intervals (Figure 11.3a) from the deep aspect to the skin using it as a spine to hold the specimen together.

identify invasive tumour or DCIS areas (oozes toothpaste-like material in comedo type) and measure the largest diameter (mm).

measure distances (mm) of the tumour edge to the excision margins.

Needle localisation and wide local excision specimens:

obtain all relevant histories of preoperative investigative procedures, e.g., FNAC, cores biopsy, etc.

make sure that laterality is stated (left or right) and orientation sutures are correctly placed before commencing. Note any accompanying specimen radiograph (obligatory for localisation specimens) and the presence and location of any guide wire(s).

Figure 11.4. Blocking a breast localisation/wide local excision specimen.

• orientate the specimen with sutures or surgical clips as per protocol agreed with the surgeon (e.g., long suture for lateral margin, dark suture for deep, etc.).

• differentially paint all margins using artists' pigments according to an agreed protocol.

• serially slice the specimen at 0.3 cm intervals (Figure11.4a), lay out and number the slices in sequence. Inspect with reference to the radiograph and guide wire tip (if applicable) and note any macroscopic lesion(s).

• needle localisation specimens for microcalcification may show no obvious abnormality grossly. The laid out and numbered tissue slices should be X-rayed by a Faxitron machine to help locate the area(s) in question for block selection. If an X-ray facility is not available, block especially fibrous parenchyma rather than fatty tissue. Small specimens less than 20 grams, however, may be processed in their entirety.

• stromal deformity and mass lesions are identified grossly, the size and distances to the excision margins are measured.

• cavity shavings from various margins are weighed, painted and labelled accordingly before submitting for processing.

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