Breast Pathology

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. We also accept wet tissue consult cases from clients outside of the Stanford system.

• Careful correlation of the pathology findings with the available clinical and imaging findings, including digital X-ray evaluation of most surgical cases grossed at Stanford to ensure that all lesions are appropriately sampled.
• Synoptic reporting for all primary diagnoses and breast cancer prognostic/predictive markers according to CAP/ASCO and Stanford guidelines.
• Correlation of all ancillary tests with primary histology to ensure that the results are concordant and accurate. 
• A policy requiring that 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 in order to ensure diagnostic agreement on these challenging diagnoses.
• Quality assurance policies on diagnostic agreement for breast cancers  and for ancillary testing (including for unusual HER2 FISH testing results and Low Positive ER results).

Consult Cases

To submit slides for case review, the following materials are required:

1. Fully completed Stanford Anatomic Pathology requisition form, including the requesting provider’s full name and NPI.
2. Pathology report (final or preliminary).
3. Glass slides and/or FFPE block.
4. Ancillary testing results or materials.
5. Patient demographics (so Epic Care Everywhere can be activated, if applicable).

For cases with paraffin-embedded tissue, providing unstained slides or the paraffin block will expedite the work-up for ancillary studies.

Fresh/Fixed Tissue Specimens

To submit fresh/fixed tissue for processing and review, the following materials are required:

1. Fully completed Stanford Anatomic Pathology requisition form, including the requesting provider’s full name and NPI.
2. Patient demographics (so Epic Care Everywhere can be activated, if applicable).
3. Submit specimen in proper transport media and seal container closed. See Test Directory for specimen collection instructions and stability information.

All specimens and additional paperwork must be labeled with:

• A minimum of 2 patient identifiers (first and last name, date of birth, medical record number, pathology case ID)
• Specimen type and anatomic site

Consult and Fesh/Fixed Specimens should be shipped or delivered via courier to:

Molecular Pathology

• Selection by a breast pathologist of the most appropriate tissue block for requested send-out tests such as OncotypeDX.
• The Stanford Molecular Diagnostic Laboratory also offers additional assays for the detection of potentially actionable mutations in cancer.

Cytogenetics/FISH

• HER2 testing: HER2 testing performed by both immunohistochemistry and fluorescence in situ hybridization (FISH) on invasive breast cancers to assess the likelihood of benefit from HER2 targeted therapies.