By Frances P. Malley, Sarah E. Pinder, Anna Marie Mulliga
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In addition to this “radial” sampling technique, some laboratories process additional tissue from the circumferential edge of the specimen, which is “shaved,” allowing more thorough examination of relevant surgical resection margins. , within the thickness of the block). In this system, all the radial (inferior, superior, medial, and lateral) peripheral aspects of the specimen can be shaved off in portions approximately 2 to 3 mm thick and embedded cut side down in the cassettes, which are labeled as superior, superomedial, medial, inferomedial, inferior, etc.
This allows accurate assessment of the extent of the DCIS and complete evaluation of the margins and also allows one to exclude unsuspected associated invasive disease with greater accuracy. There are several methods for measuring extent of nonpalpable DCIS; these are described in detail in the College of American Pathologists’ protocol for the FIGURE 2-1 “Bread-slicing” of specimen samples excised for microcalcification. This is the most frequent technique for handling samples excised for microcalcification (either therapeutic or diagnostic operations).
Arrangement is not apparent in a limited sample (see Figure 3-3); if there is associated lobular neoplasia or apocrine change, the mimicry can be marked. Immunohistochemical assessment with markers (such as smooth muscle myosin or p63) will show the myoepithelial layer and can be extremely valuable in cases of concern. Similarly, radial scars with entrapped tubular structures may mimic tubular carcinoma and the same immunohistochemistry will be helpful in difficult cases; the fibroblastic stroma usually present in tubular carcinomas should also be sought on routine H&E stains.