How Does a Pathologist Make A Diagnosis From A Biopsy?

Daisey4522

Hello. My name is Ginger and I am 28 years old. I recently had a Stereotactic Biopsy of my Right Breast (Mammogram-guided Biopsy) and a Core Needle Biopsy of my Left Breast (Sonogram-guided Biospy).

The Final Pathology Report is pretty straight forward for the Left Breast's mass, but the diagnosis is very unclear to me for the Right Breast's mass (Please see Pathology Report Below)

FINAL PATHOLOGY DIAGNOSIS: (Left Breast)

Left breast mass, five o'clock 3 cm from the nipple, ultrasound-guided biopsy: Fibrocystic changes (cystic apocrine metaplasia and papillary apocrine change)

FINAL PATHOLOGY DIAGNOSIS: (Right Breast)

Right breast, stereotactic guided biopsy:

1. Benign fibroepithelial proliferation with fibroadenomatiod features (see comment)

2. Florid adenosis.

3. Apocrine metaplasia.

4. Microcysts.

Comment(s):

These findings may represent fibrocystic changes or a fibroadenoma with secondary adenosis. Some areas are suggestive of tubular adenoma.

I was hoping someone may be able to give me more information on the Right Breast Pathology Diagnosis. What is the mass? When I was 22 years old I had a Core Needle Biopsy of the Right Breast, I believe it is the same exact mass. At that time the pathology report stated "Tubular Adenoma", which I understand to be something very rare and also showed up on this new Pathology report.

How does a pathologist make a diagonosis from a biopsy? Can you explain the process -- does he/she look at the cells under a microscope? How do they determine it is benign vs malignant? Do they do any tests to see if it is malignant or is it just based off of the look of the cells?

Is it possible that the pathologist could have gotten this wrong and it might malignant? Apparently Tubular Adenoma is very rare. I was reading published scientific studies regarding Tubular Adenoma and it says that the only way to know if it's Tubular Adenoma for sure is by excision... and although it's normally benign, in the cases studied one was large with microcalifications and turned out to be malignant (similar in size to mine and I also have the microcalficiations). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC404905...

I have seen a breast surgeon and they recommend that I have the mass removed immediately, but any information regarding pathology diagnoses would be greatly appreciated!

Thanks so much for your help!
Ginger

Daisey4522

Hello Kayb. Thank you so much for this information!

I have to tell you, when I got the pathology report I was extremely relieved... but I have had this thought in the back of my mind of how the pathology diagnosis is actually made and that it is possible that it is malignant. My mother died of Breast cancer at age 41 (she was diagnosed with stage 4 and only lasted 18 months) so I think you can understand my extra concern. I'm not going to allow myself to get as worked up as I was before being told it was benign, but I still want to understand the possibilities because the doctors just seem to say "it's benign" but give no explanation or thought to the report.

I understand that my case seems to be so rare and tubular adenoma is typically benign, but what concerns me the most (and concerned my radiologist) is that the mass had calcifications within the mass. Also, according to the study, the case that was malignant was the tubular adenoma that has calcifications and was the same size as mine, the ones without calcifications were found to be benign.

I had a stereotactic biopsy so that they could capture the calcifications in the biopsy. Can you (or anyone else) explain how the calcifications were looked at by the pathologist? I am thinking the calcifications were looked at alone and found to be benign? If so, how was that done?

Thanks again!
Ginger

Daisey4522

That's a great idea Kayb!

I think I would feel better if the calcifications were determined to be benign independently of the rest of the tissue in the biopsy. Instead of just stamping an overal "benign" because of the other tissue. Anyways, I guess I will have a final answer once the mass is removed, since it needs to be removed regardless, on the pathology report at that point... I'm hoping they will do a pathology report.

Thanks again!

Daisey4522

I ended up having the mass (actually it was 2 large masses) removed last week. The final pathology was benign. I have not seen a copy of the pathology report, but my doctor said it was Nodular Adenosis.