How to interpret the post-operative pathology report of breast cancer?

  The pathology report after breast cancer surgery is one of the most important parts of the medical record. The symbols, numbers and letters in the report form often confuse patients and families. To address this situation, here is a brief description of the components and significance in the pathology report.  Correct pathological diagnosis is the first step to correct treatment. A complete postoperative pathological report of breast cancer should include the following: 1. Histological type: non-invasive breast cancer accounts for 5-10% of the total number of cases, with excellent prognosis and 5-year survival rate of over 95%, and does not require chemotherapy. The histological types of invasive carcinoma include non-specific type of invasive ductal carcinoma (80%), invasive lobular carcinoma (10%), and specific types of breast cancer include (tubular carcinoma, invasive sieve carcinoma, medullary carcinoma, mucus-secreting carcinoma, neuroendocrine carcinoma, invasive papillary carcinoma, invasive micropapillary carcinoma, sweat carcinoma, saprophytic carcinoma, lipid-rich carcinoma, secretory carcinoma, eosinophilic carcinoma, adenoid cystic carcinoma, (adenoid cystic carcinoma, alveolar cell carcinoma, glycogen-rich clear cell carcinoma, sebaceous gland carcinoma, inflammatory carcinoma).  2.Histological grading: reflecting the difference between tumor and normal tissues, it is graded into Ⅰ-Ⅲ. The higher the grading, the worse the biological behavior of tumor and the higher the malignant degree.  3.Tumor location and size: for every 1cm increase in the maximum diameter of tumor, the risk of recurrence and metastasis increases by 12%.  4.Surgical margin: whether there is a combination of carcinoma in situ, atypical hyperplasia and other lesions around the cancer.  5.Whether it invades the vasculature/lymphatics: It helps clinicians to judge the biological behavior of the tumor and guide the adjuvant treatment.  6. Axillary lymph node metastasis: the earliest metastasis site of breast cancer is axillary lymph node. Whether there is metastasis in lymph node and the number of metastasis can guide doctors to formulate reasonable treatment plan, such as whether chemotherapy and radiotherapy are needed. The risk of recurrence and metastasis increases by 6% for each additional lymph node in the axilla. Lymph node metastasis is an important prognostic indicator, expressed as XMY, X represents the number of metastatic lymph nodes, Y represents the number of pathology sent for examination, the larger the X value, the worse the prognosis.  7. Hormone receptor detection. If one of them is positive, it means that endocrine therapy has a good effect, and endocrine therapy can reduce the risk of recurrence of ER+/PR+ patients by 50%.  HER-2 is an oncogene. C-erbB-2 protein is the expression product of HER-2 gene reflecting the malignancy of tumor. If the HER-2 gene is overexpressed, the targeted drug Herceptin can be used to reduce the risk of recurrence by up to 50% in HER-2-positive patients. Immunohistochemical detection of C-erbB-2 protein (C), (+) is judged as negative, C-erbB-2 (++++) is judged as HER-2 positive, direct treatment with Herceptin, C-erbB-2 (+++) need to be further clarified by Fish test whether there is amplification of Her-2 gene to decide whether to use targeted therapy. ki-67 test: cell The most important indicator of cell proliferation, expressed as a percentage. The higher the positive rate, the worse the prognosis.  The pathology report needs to be thoroughly evaluated by an experienced specialist to develop a specific treatment plan and drug selection.