Breast Pathology Service
Breast Pathology in Patient Care:
Establishing the most accurate pathologic diagnosis is the key to determining the most appropriate management. This is particularly evident in breast cancer, where every detail in the pathology report can impact major treatment decisions. Whether the diagnosis is invasive breast cancer or a risk lesion, pathology expertise matters. The Stanford Breast Pathology Service provides specialized diagnostic and consultative services for the entire spectrum of breast pathology. The faculty on our service all have subspecialty expertise in breast pathology and are nationally and internationally recognized for their contributions to the field of breast cancer and breast pathology.
The Stanford breast pathology team provides diagnostic services for all breast biopsies and surgeries taking place at Stanford Hospital as well as second opinions and consultations. Our service includes specialized testing and interpretation of breast cancer ancillary studies that determine treatment options for breast cancer patients (estrogen and progesterone receptors, HER2 testing by both IHC and FISH and Ki67 studies). All of our faculty participate in the Stanford Women’s Cancer Center multidisciplinary breast cancer service, including presenting pathology findings at weekly tumor boards. Our breast pathology team also provides specialized advanced training in breast pathology to pathologists-in-training through our fellowship program.
Services:
The Stanford Breast Pathology Service includes the following services:
- Primary pathology diagnosis: All breast biopsies and surgeries taking place at Stanford Hospital undergo gross and microscopic pathology examination and reporting by the breast pathology service.
- Second opinions/reviews: Patients who are at Stanford for a second opinion or transfer of care/treatment have their pathology material that was originally performed at another laboratory reviewed and reported out by a member of the Stanford Breast Pathology faculty.
- Consultative opinions: When a pathologist, clinician or patient not being treated at Stanford has a challenging breast pathology case, specific question or just want confirmation of the diagnosis, their pathology material can be sent for review to the Consult Service at Stanford Pathology and one of our breast pathologists will provide their consultative opinion on the case. This service includes assignment of a specialty pathology fellow to each case for individualized service, including call-backs with updates and final results.
The Stanford Breast Pathology Service sets high standards to ensure the most accurate diagnosis. In addition to having faculty with specialty expertise in breast pathology, some of the ways we ensure this including the following:
- Careful correlation of the pathology findings with the available clinical and imaging findings, including X-ray evaluation of most surgical cases grossed at Stanford to ensure all lesions are appropriately sampled.
- Synoptic reporting for all primary diagnoses and breast cancer prognostic/predictive markers according to CAP and Stanford guidelines.
- Correlation of all ancillary tests with primary histology to ensure results are concordant and accurate.
- A policy requiring two breast pathologists review all breast biopsies in which a diagnosis of atypical ductal hyperplasia or low grade ductal carcinoma in situ is being considered as the primary diagnosis to ensure diagnostic agreement on these challenging diagnoses.
- Quality assurance policies on diagnostic agreement for breast cancers and for ancillary testing.
- Turn-around time standards adhered to for the fastest, most accurate reporting.
- In addition to many cases being reviewed by multiple members of the faculty, cases get multiple reviews by pathologists-in-training including resident and fellow-level trainees, with preliminary fellow-level “hot-seat” diagnoses available before final reporting.
- Adherence to CAP guidelines for hormone receptor and HER2 testing, including proficiency testing by all faculty on the breast service.
- Annual quality improvement projects to continue improving our service.
Ancillary Testing in Breast Pathology available at Stanford: (could put this in another section )
- Hormone receptor testing: Estrogen and progesterone receptor testing on both ductal carcinoma in situ and invasive breast cancers to determine the phenotype, prognostic information and likelihood of response to hormone-based drug therapies. Androgen receptor testing is also available on request.
- HER2 testing: HER2 testing performed by both immunohistochemistry and fluorescence in situ hybridization (FISH) on invasive breast cancers to determine likelihood of benefit from HER2 targeted therapies.
- Ki67: Provides an estimate of the proliferation index of invasive cancers.
- Immunohistochemistry stains to aid in diagnosis including: myoepithelial markers (invasion vs non-invasive lesions), histologic subtype markers, metastatic carcinoma markers, etc.
- Selection by a breast pathologist of the most appropriate tissue block for send-out tests such as OncotypeDX.
- The Stanford Molecular Diagnostic Laboratory also offers additional Next-Generation Sequencing assays for the detection of additional mutations in cancer. See website…
Current faculty with specialty expertise in breast pathology:
- Kimberly H Allison, MD, Director of Breast Pathology
- Kristen Jensen, MD (VAPAHCS)
- Richard Kempson, MD
- Richard Sibley, MD
- Robert West, MD, PhD
