Accurate determination of breast cancer size: The role of histopathology and imaging

One critical role played by the pathologist in contemporary breast cancer management is that of providing accurate tumour measurements for staging and prognosis. Numerous factors have the potential to affect the final pathologist-recorded tumour size including diligence in measurement, tumour histology and growth pattern, tissue fixation and processing, prior biopsy and prior therapy. The pathologist should strive to provide three-dimensional tumour measurements in 0.1 cm increments from the gross specimen and then confirm these measurements microscopically whenever possible. In the era of breast conservation and emerging ablative therapies, the pathologist should also be familiar with the size-determining capability of various breast imaging techniques and their correlation with pathology. In determining final dimension, the pathologist is in a favourable position to verify or modify the size of a breast tumour based on the sum of information from all pathology specimens and, if appropriate, to correlate size with the patient's imaging studies.