Hutter R V
Monogr Pathol. 1984(25):175-85.
The pathologist has critically important responsibilities as a consultant in the management of patients with breast cancer. The clinical evaluation of the anatomic extent of cancer before treatment, the clinical-diagnostic stage, crudely estimates whether the cancer is localized to the breast, or whether there are regional or distant metastases. The pathologist establishes the diagnosis of cancer microscopically in a biopsy and reports the significant characteristics which can be used in the selection of therapy. The pathologist's additional gross and microscopic examinations after mastectomy, which more precisely document the anatomic extent of the cancer, are the basis of the postsurgical treatment-pathologic stage and provide additional information used to estimate prognosis and determine whether adjunctive therapy is needed. The pathology information used in staging includes the tumor size, histologic type, histologic grade, and presence or absence of axillary of other metastases. These and other pathological factors of significance which are discussed include the gross contour of the tumor as well as the presence or absence of necrosis, and any of the spectrum of cancers that we categorize as "minimal breast cancer" (in situ lobular carcinoma, intraductal carcinoma, invasive carcinoma smaller than 0.5 cm). Furthermore, the prognostic implications of the various histologic types are considered, as well as histologic and cytologic differentiation (grade), multicentricity, vascular invasion, cellular infiltration, and various other factors such as mucin or lipid production, steroid hormone receptors, and the nature of the tumor bed. The presence or absence of axillary lymph node metastases remains the single most significant variable in estimating prognosis for most breast cancers. In addition, combinations of the parameters noted above may have greater prognostic significance than any considered individually. Therefore, the pathologist, through the routine examination and documentation of breast biopsies and mastectomies, can provide important information which can be used to aid in the selection of treatment and in the estimation of prognosis.
病理学家作为乳腺癌患者管理方面的顾问，肩负着极其重要的责任。在治疗前对癌症的解剖范围进行临床评估，即临床诊断分期，大致估计癌症是否局限于乳腺，或者是否存在区域或远处转移。病理学家通过活检在显微镜下确诊癌症，并报告可用于选择治疗方法的重要特征。乳房切除术后病理学家进行的额外大体和显微镜检查，能更精确地记录癌症的解剖范围，是术后治疗病理分期的基础，并提供用于估计预后和确定是否需要辅助治疗的额外信息。分期所用的病理信息包括肿瘤大小、组织学类型、组织学分级以及腋窝或其他转移灶的有无。所讨论的这些及其他重要病理因素包括肿瘤的大体轮廓以及坏死的有无，以及我们归类为“微小乳腺癌”（小叶原位癌、导管内癌、小于0.5厘米的浸润性癌）的任何一种癌症。此外，还考虑了各种组织学类型的预后意义，以及组织学和细胞学分化（分级）、多中心性、血管侵犯、细胞浸润以及其他各种因素，如黏液或脂质产生、类固醇激素受体以及肿瘤床的性质。腋窝淋巴结转移的有无仍然是大多数乳腺癌预后评估中最重要的单一变量。此外，上述参数的组合可能比任何单个参数具有更大的预后意义。因此，病理学家通过对乳腺活检和乳房切除术的常规检查及记录，可以提供重要信息，用于辅助治疗选择和预后评估。
