Skip to main content

Advertisement

Log in

Radiological–Pathological Correlation in Diagnosing Breast Carcinoma: The Role of Pathology in the Multimodality Era

  • Review
  • Published:
Pathology & Oncology Research

Abstract

Breast carcinoma is a lobar disease, as the simultaneously or asynchronously appearing often multiple tumor foci originate from a single sick breast lobe. In its initial phase, the spatial pattern of malignant transformation may be lobar (targeting the entire lobe), segmental (targeting a segment) or terminal (targeting distant terminal ductal-lobular units) within the sick lobe. All these variations are properly characterized by the following parameters: the extent of the disease (the volume of the tissue containing all the actually present malignant structures within the breast), the distribution of the lesions within this tissue (unifocal, multifocal or diffuse, separately for in situ and invasive component), the size of the tumor (corresponding to the largest diameter of the largest invasive focus) and the exact localization of the lesion(s). In addition, intra- and intertumoral heterogeneity have to be noticed, if evident. Combining the results of different imaging modalities (mammography, ultrasound, magnetic resonance imaging) the radiologist may compensate the limitations of individual methods. This multimodality approach leads to more accurate radiological size measurement, more accurate assessment of the distribution of the lesions and disease extent. This represents a challenge for pathologists as the traditional histopathology method based on fragmentation and sampling of macroscopically suspicious lesion(s) is clearly insufficient for modern postoperative radiological–pathological correlation. There is a clear need for more complete examination of the excised tissue and for a three-dimensional reconstruction of the finding, preferably using continuous large tissue slices and two and three-dimensional large-format histological sections. Discordant results may still appear as a consequence of failure in radiological–pathological correlation or related to certain tumor subtypes as invasive lobular carcinoma of diffuse type, low grade in situ lesions or micropapillary ductal in situ carcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tot T (2005) DCIS, cytokeratins and the theory of the sick lobe. Virchows Arch 447:1–8

    Article  PubMed  Google Scholar 

  2. Tot T (2007) The theory of the sick lobe and the possible consequences. Int J Surg Pathol 15(4):369–375

    Article  PubMed  Google Scholar 

  3. Tot T (2007) The clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large-format histological sections. Cancer 110:2551–2560

    Article  PubMed  Google Scholar 

  4. Going JJ, Mohun TJ (2006) Human breast duct anatomy, the ‘sick lobe’ hypothesis and intraductal approaches to breast cancer. Breast Cancer Res Treat 97:285–291

    Article  PubMed  Google Scholar 

  5. Foschini MP, Flaminio F, Miglio R et al (2007) The impact of large sections on the study of in situ and invasive duct carcinoma of the breast. Hum Pathol 38:1736–1743

    Article  PubMed  Google Scholar 

  6. Tot T, Tabár L, Dean PB (2002) Practical breast pathology. Thieme, Stuttgart—New York

    Google Scholar 

  7. Tabár L, Tot T, Dean PB (2005) Breast cancer: the art and science of early detection with mammography: perception, interpretation, histopathologic correlation. Thieme, Stuttgart—New York

    Google Scholar 

  8. Tot T, Tabár L (2006) Radiologic–pathologic correlation of ductal carcinoma in situ of the breast using two- and three-dimensional large histologic sections. Semin Breast Dis 8:144–151

    Article  Google Scholar 

  9. Holland R, Hendricks JH, Vebeek AL et al (1990) Extent, distribution, and mammographic/histological correlation of breast ductal carcinoma in situ. Lancet 335:519–522

    Article  PubMed  CAS  Google Scholar 

  10. Faverly DRG, Hendricks JHCL, Holland R (2001) Breast carcinoma of limited extent. Frequency, radiologic–pathologic characteristics, and surgical margin requirements. Cancer 91:647–659

    Article  PubMed  CAS  Google Scholar 

  11. Van Goethem M, Schelfout K, Dijkmans L et al (2004) MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 14:809–816

    Article  PubMed  Google Scholar 

  12. Berg WA, Gutierrez L, NessAiver MS et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MRI imaging in preoperative assessment of breast cancer. Radiology 233:830–849

    Article  PubMed  Google Scholar 

  13. Tabár L, Tot T, Dean PB (2007) Breast cancer: early detection with mammography. casting type calcifications: sign of a subtype with deceptive features. Thieme, Stuttgart-New York

    Google Scholar 

  14. Bosch AM, Kessels AG, Beets GL et al (2003) Preoperative estimation of the pathological breast tumor size by physical examination, mammography and ultrasound: a prospective study of 105 invasive tumors. Eur J Radiol 48:285–292

    Article  PubMed  Google Scholar 

  15. Skaane P, Skjorten F (1999) Ultrasonographic evaluation of invasive lobular carcinoma. Acta Radiol 40:369–375

    Article  PubMed  CAS  Google Scholar 

  16. Moon WK, Noh DY, Im JG (2002) Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology 224:569–576

    Article  PubMed  Google Scholar 

  17. Selinko VL, Middleton LP, Dempsey PJ (2004) Role of sonography in diagnosing and staging invasive lobular carcinoma. J Clin Ultrasound 32:323–332

    Article  PubMed  Google Scholar 

  18. Winstein SP, Orel SG, Heller R et al (2001) MR imaging of the breast in patients with invasive lobular carcinomas. Am J Roentgenol 176:399–406

    Google Scholar 

  19. Schelfout K, Van Goethem M, Kersschot E et al (2004) Preoperative breast MRI in patients with invasive lobular breast cancer. Eur Radiol 14:1209–1216

    Article  PubMed  CAS  Google Scholar 

  20. Neubauer H, Li M, Kuhne-Heid R et al (2003) High grade and non-high grade ductal carcinoma in situ on dynamic MR mammography: characteristic findings for signal increase and morphological pattern of enhancement. Br J Radiol 76:3–12

    Article  PubMed  CAS  Google Scholar 

  21. Szabó BK, Aspelin P, Kristoffersen Wiberg A et al (2003) Invasive breast cancer: correlation of dynamic MR features with prognostic factors. Eur Radiol 13:2425–2435

    Article  PubMed  Google Scholar 

  22. Deurloo EE, Klein Zeggelink WFA, Teerstra HJ et al (2006) Contrast-enhanced MRI in breast cancer patients eligible for breast-conserving therapy: complementary value for subgroups of patients. Eur Radiol 16:692–701

    Article  PubMed  Google Scholar 

  23. Tot T, Tabár L, Dean PB (2000) The pressing need for better mammographic–pathologic correlation of many variations in normal breast anatomy. Virchows Arch 437:338–344

    Article  PubMed  CAS  Google Scholar 

  24. Carlson JW, Birdwell RL, Gombos EC et al (2007) MRI-directed, wire-localized breast excisions: incidence of malignancy and recommendations for pathologic evaluation. Hum Pathol 32:1754–1759

    Article  Google Scholar 

  25. Luttges J, Kalbfleisch H, Prinz P (1987) Nipple involvement and multicentricity in breast cancer. A study of whole organ sections. J Cancer Res Clin Oncol 113:481–487

    Article  PubMed  CAS  Google Scholar 

  26. Fochsini MP, Tot T, Eusebi V (2002) Large section (macrosection) histologic slides. In: Silverstein MJ (ed) Ductal carcinoma in situ of the breast. 2nd edn. Lippincott, Williams and Wilkins, Philadelphia, pp 249–254

    Google Scholar 

  27. Jackson PA, Merchant W, McCormick CJ et al (1994) A comparison of large block macrosectioning and conventional techniques in breast pathology. Virchows Arch 425:243–248

    Article  PubMed  CAS  Google Scholar 

  28. Biesemier KW, Alexander CM (2005) Enhancement of mammographic–pathologic correlation utilizing large format histology for malignant breast diseases. Semin Breast Dis 8:152–162

    Article  Google Scholar 

  29. Mechine-Neuville A, Chenard MP, Gairard B et al (2000) Large sections in routine breast pathology. A technique adapted to conservative surgery. Ann Pathol 20:275–209

    PubMed  CAS  Google Scholar 

  30. Potter S, Govindarajulu S, Cawthorn SJ et al (2007) Accuracy of sonographic localization and specimen ultrasound performed by surgeons in impalpable screen-detected breast lesions. Breast 16:425–428

    Article  PubMed  CAS  Google Scholar 

  31. Tot T (2006) The limited prognostic value of measuring and grading small breast carcinomas: the whole sick lobe versus the details within it. Med Sci Monit 12:170–175

    Google Scholar 

  32. Tot T (2003) The diffuse type of invasive lobular carcinoma of the breast: morphology and prognosis. Virchows Arch 444:718–724

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tibor Tot.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tot, T., Gere, M. Radiological–Pathological Correlation in Diagnosing Breast Carcinoma: The Role of Pathology in the Multimodality Era. Pathol. Oncol. Res. 14, 173–178 (2008). https://doi.org/10.1007/s12253-008-9061-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12253-008-9061-9

Keywords

Navigation