STANDARDIZED PATHOLOGICAL EXAMINATION OF BREAST BIOPSY SPECIMENS

The long-term disease free survival in patients treated by breast cons erving therapy is similar to that of patients treated by mastectomy. I n breast conserving therapie there is a significant risk of local recu rrence. Although local recurrence does not appear to effect survival, there is certainly associated morbidity and attendant emotional trauma . Microscopic evaluation of the margins of lumpectomy specimens is the only way to define the extent of the tumour and the adequacy of resec tion. We intended to check the influence of standardized handling inst ructions for pathological examination on the results of histological m argin assessment. These instructions are part of a practice protocol f or all branches involved in BCT. We compared the results of our standa rdized margin investigation of 100 cases with the analysis of the marg in status of 100 Lumpectomy specimens each from two other periods of t ime with different handling. Before 1989 only margins where tumor tiss ue was suspected when checked with the naked eye were investigated mic roscopically. From 1990 till 1991, margins were evaluated more intensi vely, but the evaluations were not standardized and did not consider t he orientation of the ductal system, wich was the base of examination after 1992. In 28 % of cases, tumour tissue was found upon the investi gation under the microscope, in the margins of lumpectomies where the margins looked clear to the naked eye. In the other periods tumour cou ld be found in the margins in only 2 % respectively 12 %. Our results verify a strong influence of our practice protocol on the results of t he examination of LE specimens: At first there is a higher sensitivtit y for tumor bearing margins compared with random sampling of margin ti ssue. Moreover, based on the consideration of the ductal orientation o ur protocol offers a better chance to detect in situ components of tum or in the margins. Finally with our method we are able to design exact ly the tumor bearig margin and therefore we could take part in quality assurance of BCT.