There is a lot of common ground between this page and
Specimen types and tissue handling and it is planned to rationalise these two pages in a future version of the website. The page is incomplete
and is the continuing subject of further 'work in progresss'.
Principles for developing BMS Trimming of Breast Specimens
Follow same basic protocol as laid down by the IBMS/RCPath
Agree learning objectives
Receive and discuss background educational material
Observe Consultants and Trainees cutting specimens
Supervised BMS trimming of less complex specimens
Unsupervised trimming with preview and Consultant back-up/review
Graduate through range of more complex specimens
Common breast specimens by level of cut-up complexity
As a general rule if the lesion is < 40mm and the patient < 40yrs these lesions are not problematic
For a lesion < 20mm take two representative blocks, if larger 1 block per 10mm as a rule of thumb
Always sample areas that are focally different
If clinically suspicious or previous suspicious core biopsy take additional blocks - up to 40mm block everything
Large fibroadenoma showing a smooth slightly lumpy surface, cut surface is unusual in that it looks more like a lipoma than a fibroadenoma
Large fibroadenoma (left) showing a smooth external contour, cut surface is variable in appearance (arrows) and requires thorough sampling.
Lesion on Right is a borderline phyllodes tumour. Note size and irregular, focally poorly demarcated margin.
The specimen is oriented according to local custom using the pre-agreed clip convention
We slice the specimen with the posterior margin flat on the trimming bench giving sagittal slices
The slices are examined for macroscopic lesions
Correlate macroscopic abnormalities with specimen x ray shadows where possible
Review block taking requirements with pathologist according to level of experience
Always be prepared to halt block-taking if difficulties arise and discuss case further with pathologist
A 'standard' set of blocks would include:
Anterior and posterior 'cruciates'
Four blocks each with one of the radial margins - see images below:
At least one to include lesion - depends on size and position of lesion
Extra blocks of the lesion if tissue available - with or without specified margin as appropriate
All margins to be inked - use more than one colour if more than one margin present on a block
'Fix' ink by dipping block briefly in 5% acetic acid before placing in cassette
If you are taking a block for a margin without a macroscopic lesion try
to ensure it is at least 5mm wide, prefrerably 10mm, so that a comment such as
the following becomes possible when no tumour is present in the section:
'Medial margin > 10mm'
Be prepared to be flexible about block-taking - it should be an intelligent process tailored to the individual specimen