It is absolutely imperative for the pathology service to communicate effectively
with radiologists and surgeons to ensure that appropriate and timely clinical care is
delivered. This is not a glib statement - many of the errors that are made
in medicine are due to poor communication and the breast service is no exception.
Main areas of communication:
Pre-operative diagnosis - two way between imaging, surgery and pathology
Post-operative reporting - diagnosis, prognostic indices, pointers for future management
In practice this is not much of a problem area. B3 and B4 will usually be followed by a diagnostic biopsy
although a B4 call may encourage the surgeon to take a wider margin than for a
B3 call. B4 should signal to the surgeon that there are very serious concerns about DCIS
and may prompt a repeat core rather than a diagnostic biopsy so that definitive surgery can be planned.
Most B4s will turn out to be DCIS +/- invasive cancer on excision. Once again
communication with the surgeon and radiologist is vital so that the next step is the right step
in the management of the case.
The B4/B5 boundary
This is a very difficult area of practice. It is essential that any core biopsy result is correlated with the radiology to ensure
that the correct procedure follows. The following potential problems need to be kept in mind:
An inappropriate diagnosis of DCIS can result in a mastectomy
If there are benign and malignant calcs in sections SAY SO to avoid the misconception that ALL the calcs on a mammogram are malignant
If you are not sure of your diagnosis show the sections to a colleague - don't allow yourself to be rushed or pressured
Cut more levels - it is astonishing how a difficult case can get easier with more material to look at
There is no substitute for verbal communication with the surgeon or radiologist
about a case but this is not possible all the time. Furthermore if this route is overused
it will simply clog this channel of communication.
Communication in Breast Pathology
The MDM - this should not just be reading the report but an interactive correlation of all the information available
The Phone Call - use the phone - mobiles are great in this regard if your hospital allows them - consider texting
The written report - see below
Pathology reports are required to deliver and record permanently key diagnostic and management information.
Examples of reports are given in Specimen types and tissue handling
Key points in the pathology report
The FNA and core biopsy report need to be sufficiently clear to guide further management unambiguously
If the pathology is equivocal say so and if possible reinforce by verbal discussion/MDM
The non-cancer excision biopsy report needs to be reported so that there is no doubt about whether a patient needs to be followed up e.g. benign v atypical
The cancer excision report (mastectomy or wide local excision) requires clear statements about grade, size etc, margins and nodes in addition to prognostic/management information e.g. ER, Her-2 status