FAQs: Benign Breast: BRB9

UNDERSTANDING YOUR PATHOLOGY REPORT: A FAQ SHEET

When your breast was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathology report tells your treating doctor the diagnosis in each of the samples to help manage your care. This FAQ sheet is designed to help you understand the medical language used in the pathology report.

1. What does it mean if my report says any of the following terms: "adenosis", "sclerosing adenosis", "apocrine metaplasia", "cysts", "columnar cell change", "columnar cell hyperplasia", "collagenous spherulosis", "duct ectasia", "columnar cell change with prominent apical snouts and secretions (CAPSS)", "papillomatosis", or "fibrocystic changes"?

All of these terms are non-cancerous things that the pathologist sees under the microscope and are of no importance when seen on a biopsy or lumpectomy.

2. What does it mean if my report says "fat necrosis"?

Fat necrosis can result from injury to the breast although it may also be seen without any history of trauma. It is totally benign (non-cancerous) and not related to cancer.

3. What does it mean if my reports says "usual duct hyperplasia (UDH)"?

UDH is a benign finding that is associated with a slight increase in the subsequent risk of carcinoma (cancer) of the breast. However, as the risk is low, typically no further excision of the area is needed.

4. What if my report says "radial scar" or "complex sclerosing lesion"?

These findings are benign (non-cancerous). However, if they are found on needle biopsy, excision of the area may be recommended, as in some cases they may be associated with a worse lesion in the breast. If these findings are seen in an excision (lumpectomy), no further action is needed and there is no increased risk of cancer.

5. What does it mean if my reports says "papilloma"?

A papilloma is a benign (non-cancerous) growth. In some cases if the lesion is small and the mammogram findings are consistent with a papilloma, and the diagnosis of papilloma is made on needle biopsy, no further excision may be suggested. However, in many cases, an excision may be recommended to exclude a worse lesion. The management of a papilloma on needle biopsy is best discussed with your treating physician. If papilloma is found on an excision (lumpectomy), typically no further treatment is needed.

6. What does it mean if my reports says "flat epithelial atypia"?

By itself, flat epithelial atypia is not cancer. However, as a minority of cases has worse findings on subsequent excision, surgical excision is often recommended following its finding on needle biopsy. If flat epithelial atypia is present on an excision (lumpectomy), then typically no further action is needed. However, this area is controversial and you should discuss this finding with your treating physician.

7. What if my report says "fibroadenoma", "fibroepithelial lesion", "phyllodes tumor"?

Fibroadenoma is the most common benign (noncancerous) growth in the breast. If it is seen on needle biopsy and the mammographic finding is consistent with a fibroadenoma, typically it is just watched. In some of these cases it may be removed for cosmetic reasons. Phyllodes tumor is a growth that depending on the findings seen under the microscope may either have a risk of coming back (recurring) or a low risk of spreading beyond the breast (metastasizing). If a phyllodes tumor is seen on needle biopsy, your treating physician will typically recommend complete removal of the growth. In some cases on needle biopsy it may be difficult for a pathologist to determine if the growth is a fibroadenoma or phyllodes tumor and terms such as "cellular fibroepithelial lesion" may be used. In these cases, subsequent complete removal is typically recommended.

8. What does it mean if my report mentions "microcalcifications" or "calcifications"?

Microcalcifications or calcifications are minerals that are found in the both noncancerous and cancerous breast lesions and can be seen both on mammograms and under the microscope. They are reported by the pathologist to show that the abnormal area seen in the mammogram was successfully sampled by the biopsy. By themselves, they do not have any significance.

9. What does it mean if my biopsy report mentions special studies such as high molecular weight cytokeratin (HMWCK), ck903, ck5/6, p63, muscle specific actin, smooth muscle myosin heavy chain, or calponin?

These are special tests that the pathologist sometimes uses to help make the correct diagnosis of a variety of breast lesions. Not all cases need these special tests. Whether your report does or does not mention these tests has no bearing on the accuracy of your diagnosis.