[Histonet] Breast core needle biopsy procedure question.

[Anthony F. Boris]

I am sending this on behalf of our Director. Thanks in advance for any and all responses. Tony Boris

I am the Medical Director of Surgical Pathology at St. Joseph Mercy Hospital Oakland, located in Pontiac MI.  I staff our weekly breast cancer treatment planning conference and am responsible for overseeing breast cancer ancillary marker testing.  I am writing to see if you could share your AP procedure for processing core needle biopsies of breast tissue.

I believe that we have a good process for assuring proper fixation on our cores and excisions.  We sometimes run out of tissue in the core when working up a positive case, though.  Our current procedure is to do H&E's at 3 levels on all breast cores.  The reviewing pathologist can then order additional IHC as needed for diagnosis, followed by additional sections for ER, PR and Her2 IHC, followed by additional sections for FISH sendout if necessary.  We try to anticipate what may be needed and cut blanks for ancillary markers as soon as possible so as not to exhaust diagnostic tissue, but occasionally fail at that.  This morning one of my associates was faced with just that situation, leading to reconsideration of our SOP for the breast cores.  Should we look at just one H&E section, for instance, and based on that either get deeper H&E to exclude something significant that is not present in the first section, or get additional diagnostic and prognostic studies done beginning at level 2 followed by an H&E at the end of the deck?

At any rate, I wanted to know what the routine procedure is for handling these cores at U of M.  I would appreciate it if you could forward a copy of your AP procedure, or outline the same in an email

Thank you for your time.

Sincerely,

Jim Furlong, MD