The interpretive art/science of pathology.
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Biomedical subjects
Publications and source records attributed to R V Hutter.
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The pathologist is a consultant in breast cancer management whose responsibility is to establish the histologic diagnosis of cancer as well as its anatomic extent once sufficient tissue has been provided. The consultation also provides data that may be used to aid in selecting primary or adjuvant therapy, evaluating new therapies, estimating prognosis, and assessing outcome. Examples of such data are the TNM histopathologic classification of the anatomic extent of the cancer used for the stage grouping (T = the extent of the primary tumor, N = the absence or presence and extent of regional lymph node metastasis, and M = the absence or presence of distant metastasis); tumor size, histologic type, and histologic and/or nuclear grade; assessment of blood vessel and lymphatic vessel invasion; analysis of steroid receptors, and other special studies as appropriate.
A national task force consisting of members from the American College of Radiology, the American College of Surgeons, and the College of American Pathologists examined the issues surrounding stereotactic core-needle biopsy for occult breast lesions. Their report includes indications and contraindications, informed consent, specimen handling, and management of indeterminate, atypical, or discordant lesions.
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The pathologist's report on breast cancers should include information that assists the clinician to select therapy, estimate prognosis, and evaluate the efficacy of therapy. Of great significance are the size and contour of the primary cancer, histologic type, differentiation, vascular invasion, the total number of lymph nodes extirpated, the number of metastases, and whether the metastases are micrometastases (less than 2 mm) or macrometastases.
Minimal breast cancer includes noninvasive cancer (Paget's disease, ductal, or lobular) and/or small invasive cancers which measure less than 0.5 cm. These cancers can be multicentric and bilateral, may have regional or distant metastases, and are occasionally lethal. Surgical treatment ranges from none to radical mastectomy, although total mastectomy in continuity with low axillary lymphadenectomy is the most common. Primary radiation therapy is used to a lesser extent.