Breast Pathology

What Is Breast Pathology?

Breast pathology is a medical sub-specialty focusing on diseases of the breasts and nearby lymph nodes, including cancers and non-cancerous conditions.

A breast pathologist is a type of doctor with highly specialized training who analyzes tissues and focuses on diagnosing lesions of the breast. They work with other specialists like oncologists, radiation oncologists, radiologists, and surgeons to determine the best treatment plan for each patient. Breast pathologists specialize in the interpretation and evaluation of:

Core needle, incisional, and excisional biopsies
Lumpectomy
Partial and total mastectomy tissue samples
Sentinel lymph nodes
Axillary lymph nodes
Prophylactic and oncoplastic reduction mammoplasty
Neoadjuvant therapy

Breast pathologists examine tissue from biopsies and surgeries using techniques like histopathology, immunohistochemistry, and molecular pathology to diagnose various conditions.

What Do Breast Pathologists Do?

Breast pathologists use microscopes and other specialized tools and tests to examine tissue samples from lesions, tumors, and lymph nodes. They have extensive schooling and training to identify cancers and non-cancerous breast diseases. If cancer is found, a breast pathologist can also provide individualized information about the cancer to help establish a treatment plan.

What’s The Difference Between Your Doctor and a Breast Pathologist?

For regular preventive care, testing, and diagnosis of breast issues, you might begin by seeing your gynecologist or primary care physician. They can assess, diagnose, and treat many conditions. It’s important to see a doctor if you notice any of the following:

A new lump
Breast pain
Changes in the look or feel of your breast or skin
Inverted nipple
Nipple discharge

Your doctor may order a biopsy when a diagnosis can’t be made or further information is needed. In this case, tissue samples from the biopsy can be sent to a breast pathologist for further study. A pathologist typically works in a laboratory rather than directly with patients. But they will work closely with your doctor to diagnose your condition and recommend the best treatment.

What Types of Tissues Do Breast Pathologists Study?

Breast pathology is a study of changes in the male or female breast tissue due to disease. Some conditions a breast pathologist may study include tissue samples taken from:

Bleeding nipples
Lesions
Lymph nodes
Nipple discharge
Non-lymphoid masses
Rashes
Tumors
Ulcerations

A breast pathologist is an expert in conditions like:

Cancers
Benign breast disease
Cysts
Fibroadenomas
Fibrocystic breast changes
Hyperplasia
Intraductal papilloma
Mammary duct ectasia
Mastitis
Traumatic fat necrosis

Techniques to Identify Breast Conditions

After a tissue sample is obtained and processed, a pathologist uses specialized techniques, tools, and processes to investigate its condition.

If the microscopic examination doesn’t provide clear answers, pathologists are experts in other testing techniques that may provide more information. Some methods and tools they use include:

Stains. Chemicals or stains can be applied to tissue samples to highlight signs of disease or cell abnormalities. Different stains are used to identify causes, foreign substances, and other markers that identify characteristics of the specimen.
Direct immunofluorescence. This type of testing uses a special type of staining that helps identify autoimmune diseases.
Frozen section. A sample can be frozen and examined immediately if a diagnosis is needed quickly, like during surgery.
Immunohistochemistry. This technique uses the body’s antibodies to help identify the interaction between the antibodies and antigens triggering the immune system.
Flow cytometry. In order to analyze the identity and quantity of a type of cell or particle, samples are suspended in fluid and passed through different light sources, lenses, and filters to generate wavelength data. Flow cytometry can measure characteristics like cell size and total DNA.
Biomarker testing. A sample is analyzed for genes, proteins, or other biological substances typically present with cancer to provide information that can affect treatment.

What Do Results Look Like?

The breast pathologist will document the results of a pathological examination in a biopsy or pathology report, which is sent to the treating doctor and includes information like:

A diagnosis
A description of the tissue sample
A microscopic description of the disease process discovered
Clinical data that helped support the diagnosis
Additional information to help determine treatment
If cancer is found, it may also include information to help form a treatment plan
Comments from the pathologist