Breast core biopsy — a structured reporting approach
Author: Faruk Skenderi, MD, PhDReviewed by: Semir Vranić, MD, PhDLast reviewed:
- Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer. Histopathology. 1991;19(5):403-410. https://doi.org/10.1111/j.1365-2559.1991.tb00229.x (opens in new tab)
- Allison KH, et al. Estrogen and progesterone receptor testing in breast cancer: ASCO/CAP guideline update. J Clin Oncol. 2020;38(12):1346-1366. https://doi.org/10.1200/JCO.19.02309 (opens in new tab)
- Wolff AC, et al. Human epidermal growth factor receptor 2 testing in breast cancer: ASCO–CAP guideline update. J Clin Oncol. 2023;41(22):3867-3872. https://doi.org/10.1200/JCO.22.02864 (opens in new tab)
- Pinder SE, et al. NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol. 2018;73(8):682-692. https://doi.org/10.1016/j.crad.2018.04.004 (opens in new tab)
How to work through a breast core biopsy: invasive vs in-situ, grading, receptor status, and the items the MDT actually needs.
- Confirm lesion type: invasive carcinoma (NST, lobular, special types), DCIS, atypical lesion, or benign.
- Grade invasive carcinoma using the Nottingham (Elston–Ellis) system: tubule formation, nuclear pleomorphism, mitotic count.
- Always report ER, PR, HER2 (and Ki-67 when used locally) on invasive disease.
- DCIS: grade (low/intermediate/high), architecture, necrosis, microcalcifications, ER status.
- Flag B3 lesions (ADH, flat epithelial atypia, LCIS, papillary lesions, radial scar) for MDT review and possible excision.
- Always correlate with imaging (BI-RADS) — discordance prompts re-biopsy or excision.