Tricky Breast Lesions

Nancy Johnson
0:00

Welcome to Path News Network Daily Edition from the College of American Pathologists. I'm Nancy Johnson. It's Monday, August 17th. In today's top story, breast pathology can be especially challenging when rare lesions mimic more common cancers. We'll show you how one expert is helping pathologists recognize these tricky cases and get the diagnosis right. Then we'll preview a few of the stories that we're reporting this week with expert insights from CAP members.

Nancy Johnson
0:33

But first in today's story, some of the biggest challenges in diagnosing breast disease are identifying uncommon lesions. For pathologists who don't regularly see a high volume of breast cases, recognizing those rare lesions can be even more difficult. At CAP 26 in Las Vegas, Dr. Liza Quintana will lead a course on identifying infrequent lesions, avoiding diagnostic pitfalls, and applying the latest guidance from the World Health Organization.

Dr. Liza Quintana
1:05

So I think one of the things is the rarity of the lesion. So there are a number of breast lesions, carcinomas, tumors that are uncommon, and I think that makes it difficult to diagnose. So difficult to kind of recognize that that's what you're dealing with.

Nancy Johnson
1:23

Dr. Quintana is a breast pathologist and cytopathologist at Beth Israel Deaconess Medical Center in Boston. She works at a major breast center where uncommon and difficult cases are often sent for consultation.

Dr. Liza Quintana
1:38

There's also certain things that can mimic other things, and so you have to keep a broad differential. And as one of my mentors always used to say, if you don't think of the diagnosis, you won't make the diagnosis. And so you have to keep your differential broad. And so if you aren't thinking of certain entities, especially if they're uncommon or if there's a mimic, then you could potentially miss that.

Nancy Johnson
1:59

The sixth edition of the World Health Organization Classification of Tumors, published in July, offers fresh guidance on the diagnosis and classification of uncommon breast lesions, as well as the difficulties when working with small biopsy samples.

Nancy Johnson
2:17

Adenomyoepitheliomas are one of the types of lesions that can be really difficult to diagnose, especially in corneal biopsy. I think usually on excision it's a little bit easier because you have a lot more real estate to look at. But when you're dealing with a small sample and a corneal biopsy, it can be difficult to recognize and classify these lesions. And even when the pathologist suspects the diagnosis, the stains used to characterize a tumor don't always behave as expected.

Dr. Liza Quintana
2:45

I've seen some adenomyoepitheliomas in cases that have been sent in for consultation that were misdiagnosed as invasive carcinoma because they tend not to stain the way we'd always expect them to.

Nancy Johnson
3:00

That kind of diagnostic distinction has important consequences for the patient.

Dr. Liza Quintana
3:05

We're trying to make a decision if it looks kind of benign, does it need to be excised, or is it atypical, or are we worried about something malignant, does that need to be excised? That's an important kind of branch point for clinical treatment. And because that is so critical, again, sometimes it can be a little bit of a delayed diagnosis, or it's more descriptive. So if a patient sees their results and they Google it, they might not get the like exact answer or diagnosis that they're expecting.

Nancy Johnson
3:40

Dr. Quintana keeps the language in her pathology reports clear and easy to understand, especially for complex cases, knowing there's a patient waiting on the other end. Her breast pathology course is on Tuesday, October 6th at CAP 26 in Las Vegas.

Nancy Johnson
3:58

Now, here are other stories that the team is working on this week. The FDA's approval of the first mRNA-based flu vaccine could mean better protection for older Americans. We'll take a closer look. Balancing the daily load of a pathology career can take a toll. We look at the burden of burnout with CAP wellness leaders, Dr. Marisa St. Martin and Dr. Michael Cohen. And when you suspect vitamin B12 or folate deficiency, knowing when to test and when not to, the CAP's Dr. Chuck Eby explains the do's and the don'ts. That does it for the daily edition. Share this newscast with your social media network. And if you're watching this video on YouTube, hit the like button and leave us a comment. And if you've got a story we should be covering, write to us at stories at CAP.org. We're back tomorrow at 5 a.m. Eastern for another episode of the Daily Edition. I'm Nancy Johnson. Have a wonderful day.