Disclosure. Learning Objectives. Standardized Grossing N.A. Ursani & N.J. Liu OAP Pathologist Assistant Meeting September 19 Niagara Falls
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1 Proposal for A Protocol of Reduction Mammoplasty Specimens: A Retrospective Review of 1295 Cases N. A. Ursani, MBBS, FRCP(C) N. J. Liu, MD, FRCP(C) Department of Laboratory Medicine, Halton Healthcare Oakville, ON Disclosure We have no conflict of interest with this event because we have no affiliations, sponsorships, honoraria, monetary support or conflict of interest from any commercial source. Learning Objectives To evaluate the incidence of invasive cancer and cancer risk lesions in reduction mammoplasty (RM) specimens To compare the two different grossing protocols with respect to pathological findings To explore the need of a standard grossing protocol for RM specimens 1
2 Introduction Reduction mammoplasty: Commonly performed surgical procedure Indications: - Bilateral symptomatic macromastia - Asymmetry: congenital or post-surgical Grossing protocol: - Varies among institutions - No standard guidelines Gross RM Specimen in RM Specimens Clinically considered benign and grossed as potentially benign May contain a spectrum of mammary pathology 2
3 and Relative Risk Non-proliferative Proliferative w/o atypia Low risk x Fibrocystic Fibroadenoma changes with complex Duct ectasia features Cysts Radial scar Fibroadenoma Moderateflorid Mild hyperplasia hyperplasia Adenosis Sclerosing Columnar cell adenosis change Papilloma Proliferative w/ atypia Moderate risk x Atypical ductal hyperplasia Atypical lobular hyperplasia Flat epithelial atypia Carcinoma insitu High risk x Ductal carcinoma in situ Lobular carcinoma in situ Invasive carcinoma Ductal Lobular Mixed Other types Kumar et al, Robbins and Cotran Pathologic Basis of Disease. 9 th ed Hoda et al, Rosen's Breast. 4 th ed Grossly Identifiable Lesions Fibrocystic changes Radial scar Papilloma Invasive ductal carcinoma Invasive mucinous Ductal carcinoma in-situ Hicks and Lester, Diagnostic : Breast. 2 nd ed
4 Malignant Lesions in RM Specimens In 1959, Crikelair and Malton first reported a case of incidental carcinoma in RM specimens Literature Review Year Study Case# DCIS Invasive Total 2013 Desouki (0.2) 2( <0.1) 6(0.2) 2005 Pitanguy (0.1) 7(0.3) 10(0.4) 2012 Freedman 700 4(0.6) 2(0.3) 6(0.9) 2011 Slezak 629 3(0.5) 3(0.5) 6(1.0) 2004 Colwell 611 2(0.3) 2(0.3) 4(0.7) 2009 Clark 562 6(1.1) 0 6(1.1) 2003 Ishag 560 1(0.2) 3(0.5) 4(0.7) 2008 Dotto 516 1(0.2) 1(0.2) 2(0.4) DCIS: %; Invasive: < %; Total: up to 1.1% 10 Years Retrospective Study ( ) 4
5 Grossing Protocol for RM Specimens at Halton Healthcare Original grossing protocol (OGP) tissue block including skin Revised grossing protocol (RGP) 2010-present > 50 years 3 tissue blocks including skin < 50 years 1 tissue block including skin Materials and Methods 10 years retrospective study ( ) Parameters Weight Laterality Number of blocks Risk Stratification Normal Nonproliferative Low risk Moderate risk High risk Invasive carcinoma Significant Lesions (SL) Hoda et al, Rosen's Breast. 4 th ed
6 Results Total =1295 Macromastia /asymmetry 1253 Cancer reconstruction 42 Bilateral 1221 Unilateral 74 Total Non-SL SL Mean Range Average weight (g) Total Non-SL SL Right Left Total Cases (1295) Normal Non-pro Low Risk Moderate risk HighInvasive Risk and Invasive In-situCa Significant Lesions Carcinoma 570 (44.01) 555 (42.85) 131 (10.11) 28 (2.16) (0.30) (3.01) (0.84) (0.54) 3% 3% 10% 10% 2% 43% 44% Normal Benign Low risk Significant lesions OGP and RGP Case Distribution % of cases 13% 3% 4% OGP: 492 cases, RGP: 803 cases RGP group: More low risk and significant lesions 6
7 Significant Lesions in Patients 50 Years 5.0% 0.0% 1.3% 0.7% 0.7% 1.1% OGP RGP Comparison of OGP and RGP Correlation of SL and in All Cases 14.0% Relative percentage of SL (in each age group) 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% MR HR CA 0.0% < of patients Patients 40 years: More significant lesions in both grossing protocols Invasive and In Situ Carcinoma 7
8 Invasive and In Situ Carcinoma Invasive and In Situ Carcinoma Invasive and In Situ Carcinoma 8
9 Invasive and In Situ Carcinoma Invasive and In Situ Carcinoma Conclusion First and largest Canadian study Revised grossing protocol identified more significant lesions in patients 50 years An age based standardized ( 40 years ) grossing protocol is needed 9
10 Acknowledgement Nusrat Hussain MD, FRCP(C) Fatima Ursani B.Sc Martine Campagna MLT, PA THANK YOU 10
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