Liza Quintana, MD Profile picture
Sep 28, 2020 11 tweets 7 min read Read on X
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? ImageImage
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! ImageImage
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). ImageImageImageImage
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). ImageImageImageImage
Forgot to include links to the articles!
bit.ly/3lctY1B
bit.ly/3jC5ePW

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More from @LizaMQuintana

Nov 20, 2020
1/ #BreastRadPath with @DrJordanaP

For this tweetorial we are going to talk about how we evaluate the biomarkers ER, PR, and HER2.

@BIDMCpath @BIDMC_BreastImg @CollinsLauraC @ADamronMD @GuzmanArocho @XeniaParisi @MarcosLepeMD @DrGeeONE @smlungpathguy
2/ The biomarkers provide predictive information (how a patient may respond to targeted therapy) as well as prognostic information. It helps to organize patients into treatment groups that follow different algorithms and guidelines.
3/ Biomarkers are evaluated in routine clinical mgmt of patients with breast cancer. The 3 routinely tested:

Hormone receptors (HR): Estrogen receptor (ER) and Progesterone receptor (PR)
&
Human epidermal growth factor receptor 2 (HER2)

(chart from: bit.ly/3lPbqoY)
Read 18 tweets
Oct 14, 2020
#breastradpath with @DrJordanaP

For #BreastCancerAwarenessMonth month we want to review the process from imaging to diagnosis of breast cancer. 1/ Image
It starts when a patient comes in for a screening or diagnostic mammogram. Here is @DrJordanaP reviewing #mammograms in the reading room. 2/ Image
Please review screening modalities in this amazing tweetorial from last week from @DrJordanaP! 3/

Read 24 tweets
Sep 17, 2020
Hi #pathology tweeples! I just realized that the callus I have on my pinky is from using it to steady my hand as I dot 😂(with my green pen of course 😉). I must dot A LOT! 💪🔬

I have some #path (mostly) dotting related questions out of curiosity.

@BIDMCpath Image
The #pathology tweeples have very strong opinions about dotting pen color! My tweet is inspired by this from @Chucktowndoc
Does anyone else have a dotting pen-induced callus? (Just me? I hope I'm not alone. 🤞😊)
Read 11 tweets
Sep 15, 2020
#breastradpath with @DrJordanaP

We are excited to share the first case in our #breastimaging and #breastpath correlation series! This case highlights challenges of imaging/management and the pathologic diagnosis.

@BIDMC_BreastImg @BIDMCpath #radres #radfellows Image
56 yo woman with left breast focal asymmetry and calcifications. Screening mammogram. @DrJordanaP Image
Diagnostic mammogram and ultrasound were performed. A presumed ultrasound correlate was found with calcs and vascularity. What is the next step? What BI-RADS would give? @DrJordanaP ImageImage
Read 17 tweets
Mar 19, 2020
Breast biopsy for calcs. What is your diagnosis? Would you do stains? Since I’m asking that means I did 😉🔬 #breastpath @BIDMCpath @CollinsLauraC @jennpincus @RanaAldreesMD @tlabiano @lara_pijuan @ADamronMD @ariella8 @kis_lorand @TheISBP ImageImageImageImage
Thanks for all the comments! Here are the stain. All (including p120, not pictured) were consistent with a lobular phenotype. ImageImage
There were some hints in the background with areas of classical LCIS. ImageImage
Read 6 tweets
Mar 10, 2020
Breast excision. What is your diagnosis? Would you do stains? #breastpath ImageImageImage
Thanks everyone! This is LCIS involving collagenous spherulosis. I did IHC. The e-cad was stronger than I expected but showed granular staining so I followed up with p120 and beta-catenin to illustrate the different stains.
ImageImageImageImage
Read 5 tweets

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