Breast

Breast biopsy specimens come in several sizes. There is the initial core biopsy, which is a large-bore needle biopsy, and the excisional biopsy, which is like a small lumpectomy. Some institutions perform cytologic studies (fine-needle aspirations), but their usefulness is limited, as many breast diagnoses are more architectural than cytologic. Biopsies are performed, with few exceptions, to rule out malignancy; there are almost no other disease processes that require tissue monitoring. A biopsy specimen with carcinoma will trigger either a lumpectomy, in which a portion of the breast is removed (a partial mastectomy, breast-conserving therapy), or a mastectomy. The mastectomy itself may include sentinel lymph nodes or, if the sentinel node is positive, an entire axillary dissection. Biopsy and most lumpectomy specimens are entirely submitted, and anything that is oriented is inked with four to six colors so we can identify all of the margins later. Mastectomies have only two margins, deep and superficial, and are representatively sampled by quadrant.