Thread by @LizaMQuintana

Case 3 #breastradpath with @DrJordanaP

44 yo woman. On req: "faint grouped microcalcs." #breastimagers separate calcs and no calcs cores into separate containers (so helpful!). There was only one block of cores with calcs. Here are the #breastpath images. Thoughts? Next steps?

You are all thinking the way I did! For cases with calcs, I always review the imaging, and in particular the specimen radiograph, to see the morphology of the calcs I should look for. Check out the imaging from @DrJordanaP 👇

The tiny calc in the initial levels of the CNB are not the same as the calcs seen on imaging. We need to find those calcs --> LEVELS! (I haven't heard it called steps before! I like!) #breastradpath correlation is so important here!

I'm curious, for the pathologists, do you call it "steps" or "levels"?

We get levels x 3 upfront. Here are additional levels (level top left of each image).

Path discussion: The span of atypia is 4.5 mm. For me, the quality of the prolif falls short of LG DCIS. In these cases we diagnose as: severely atypical intraductal proliferation bordering on LG DCIS arising in association with FEA; calcs are associated with the atypia.

This highlights how important it is for pathologists to review imaging/spec radiograph esp for calcs! We need to ensure that our levels are rep of imaging. In this case initial levels only showed a bit of focal ?FEA with a small calc. You all knew to get levels/steps 😊🔬

Here are some teaching points about this case and a few papers highlighting importance of #breastradpath concordance and utility of a multidisciplinary conference (including one by our very own @BIDMC_BreastImg group).

Forgot to include links to the articles!
bit.ly/3lctY1B
bit.ly/3jC5ePW

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