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A pathologist is a physician who
analyzes cells and tissues under a microscope to determine whether they are cancerous,
pre-cancerous, or benign (non-cancerous). The pathologist’s
report helps characterize specimens taken during breast biopsy or
other surgical procedures and helps determine treatment. Usually, the pathology report is
written in highly technical medical language that may be difficult for the patient to
understand. This section deciphers the complex terminology that may appear on a pathology
report of the breast.
The Pathologist’s
Analysis
Breast cell and tissue samples are
usually analyzed by a pathologist after breast biopsy, lumpectomy,
mastectomy, and lymph node removal to determine their
characteristics and help dictate treatment. Specimens are usually prepared for examination
in one of two ways:
- Histologic sections:
Immediately after the cells or tissues are taken from the breast, the specimen is
placed in a fluid called a fixative for several hours. The fixative, often formalin (a 10%
solution of formaldehyde gas in buffered water), causes the proteins in the cells to
become hard and "fixed." The fixed specimen is then placed in a machine that
automatically removes all the water and replaces it with paraffin wax. Several hours
later, a technologist will remove the specimen and place it in melted paraffin, allowing
the specimen to solidify by chilling. The specimen sections are floated out in water and
picked up on a glass slide. The paraffin is dissolved from the tissue on the slide. With a
series of solvents, water is restored to the sections, and the sections are stained in a
mixture of dyes, making it easier to distinguish between the different parts of cells.
Specimens may also be frozen immediately after they are taken from the breast. This
technique allows the pathologist to examine histologic sections within a few minutes, but
the quality of the sections is not as good as those of the permanent section.
- Smear: If the
specimen is a liquid or made up of mostly liquid as with a fine needle aspiration (FNA) biopsy, a smear
analysis made be done. FNA is often used to drain and sample fluid from a cyst
(accumulated packets of fluid). The specimen is smeared on a microscope slide and is
either allowed to dry in air, is "fixed" by spraying or is immersed in a liquid.
The fixed smears are then stained and examined under the microscope. Like the frozen
section, smear specimens can be examined within a few minutes of the time the biopsy was
obtained. This is especially useful in FNA procedures in which a radiologist is using ultrasound or CT scan to find the area
to be biopsied. The pathologist may be present in the room with the radiologist while the
procedure is being performed. The radiologist can make one pass with the needle and
immediately give the specimen to the pathologist, who can determine within a few minutes
whether a diagnostic specimen was, in fact, obtained. The procedure can be terminated at
that point, sparing the patient repeated sticks with the needle.
CONTINUED
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