New Era Pathologic Techniques in the Diagnosis and Reporting of Breast Cancers

The adoption of mammographic service screening has led to decreased mortality from breast cancer due primarily to the detection of smaller, earlier stage cancers. Advances in breast imaging technology have contributed significantly to the presurgical evaluation of women, including use of the image-guided biopsy and interdisciplinary pre-treatment planning. The presurgical imaging and final pathologic reporting of tumor characteristics are often discordant. Modern imaging techniques, including functional MRI and 3-D ultrasound provide a spatial depiction of breast cancer extent not reportable using conventional pathologic techniques dating from an era when a minority of breast cancers were screen-detected. By incorporating imaging data into a large-format pathologic evaluation of surgically resected breast tissue, it is possible to improve correlation of tumor size and extent, multifocality, and the evaluation of surgical margins. The importance of pathologic tumor characteristics in guiding therapy mandates optimization of imaging-pathologic correlation in this era of screen-detected breast cancer.