LiveWorld Transcripts

iBreast presents

Dr. Marisa Weiss and Dr. Stuart Schnitt
Understanding Your Pathology Report

September 21, 2000

Dr. Marisa Weiss and Dr. Stuart Schnitt discuss how to understand a breast cancer pathology report and the women’s health issues involved in dealing with breast cancer.

Page 1 of 8

Ibreast.com: Welcome, everyone, to our third ibreast.com(TM) Nighttime Chat, held in collaboration with Living Beyond Breast Cancer(r), a nonprofit education organization, and The Health Library of Stanford Hospital and Clinics (healthlibrary.stanford.edu). Our moderator this evening is Dr. Marisa Weiss, a breast cancer specialist with an active practice in the Philadelphia area. In addition, Dr. Weiss is president and founder of ibreast.com(TM), and of Living Beyond Breast Cancer(r). She is author of the book "Living Beyond Breast Cancer." Before Dr. Weiss introduces tonight's special guest, I'd like to remind you that for specific personal medical advice, you need to speak with your own healthcare team. Also, if you sign up for free email at the site www.ibreast.com/res news signup.html you will receive advance notice of all live events. Now, Dr. Weiss.

Dr. Weiss: Thank you and welcome everyone. There is hardly anything more mystifying and potentially more unsettling than a breast cancer pathology report. And your full pathology report may be the single most important evaluation you get. So I am thrilled that we have with us tonight one of the leading breast cancer pathologists in medicine today. Dr. Stuart Schnitt has been personally responsible for changing the nature of the breast cancer pathology report, giving doctors more and better information, so that they can choose the very best treatment options for each woman's unique situation. I would like to just repeat that we will do everything we can tonight to help you understand the technical terms and the medical concepts dealt with in the standard pathology report. However, Dr. Schnitt cannot make individual diagnoses or treatment recommendations in this chat, nor can we predict individual prognoses. Now, we have a full hour and a half to answer your questions and help you with your concerns.

Dr. Schnitt: Thank you, Marisa. I'm delighted to be here and am looking forward to questions from our audience.

Ginny: When speaking about cellular differentiation, please explain whether a well-differentiated tissue with many tubulars is good or bad. Does well-differentiated mean that the specimen resembles 'normal' tissue or is it different? The terminology is confusing.

Dr. Schnitt: Well, differentiated cancers appear under the microscope to more closely resemble benign or normal breast tissue than other types of cancers. In general, well-differentiated cancers or cancers that have lots of tubules have a better prognosis than other cancers.

Joan: What does SBR Grade II infiltering ductal carcinoma and no evidence of angiolymphatic invasion mean?

Dr. Schnitt: The SBR Grade stands for Scarff Bloom Richardson Grade. This grade is a way of determining how well differentiated a tumor is. Invasive cancers can be Grade I, which is the best differentiated or looks the most close to normal. Grade III is the most poorly differentiated and is the most aggressive type of tumor and Grade II is in the middle. In general, the prognosis is best for Grade I tumors, poorest for Grade III tumors and somewhere in the middle for Grade II tumors. Angiolymphatic invasion indicates that tumor cells are seen by the pathologist in blood vessel or lymphatic vessel spaces in the breast. The presence of cells in these vessels is associated with a poorer prognosis than if the cells are seen in these vessels. Therefore, the absence of angiolymphatic invasion is a favorable prognostic sign.

Dr. Weiss: We needed to look at all of the different tumor characteristics together to understand a particular woman's cancer and how it might behave. Please don't focus only on one thing about your tumor. It's sort of a 'package deal'.

Dr. Schnitt: I would agree with that. All of the pathologic factors in the pathology report need to be taken into consideration in determining the behavior of the tumor.

Ibreast.com: Key Tumor Characteristics-Many tests and analyses will be done to figure out your 'big picture'. The most critical results - for your treatment and your long-term health - are the ones that answer these questions- Is the cancer non-invasive or invasive? Are lymph nodes involved and, if so, how many?

Page 1 of 8