Breast Pathology Services

The Department of Pathology works closely with our Breast Surgeons, Medical Oncologists, Radiation Oncologists, Breast Radiologists, Plastic Surgeons and Nurse Navigator. We provide the best possible breast pathology services to our physicians and patients.

Optimum Tissue Processing

At Stamford Hospital, breast tissue specimens (core biopsies, lumpectomies, mastectomies, etc.) are all processed by certified Pathologist Assistants (individuals with Masters Degree training at certified PA training programs). We do not use "homegrown" individuals to handle patient tissues. The Pathologist and the PA's work closely together and we maintain strict guidelines for specimen orientation, margin identification and processing of sentinel lymph nodes. We closely monitor breast tissue fixation time, and do not use rapid tissue processors which often hamper quality tissue evaluation and immunohistochemical studies. We follow the ASCO-CAP guidelines for tissue fixation to make sure that our tumor immunophenotyping for estrogen and progesterone receptors, proliferation marker, and Her2 are performed in the best possible way.

Optimum Tissue Slide Preparation

Stamford Hospital was the first community hospital in the nation (Dec. 2006) to implement an advanced tissue staining system for histology (Symphony Discreet Slide Staining System made by Ventana Medical Systems). This new technology allows for the preparation of tissue slides stained in such a way that it enables the pathologist to better evaluate proliferative and pre-malignant conditions of the breast.

Breast Cancer Immunophenotyping

Because accurate determination of hormone receptor status, proliferation rate, and Her2 is of paramount importance in patient therapy, we utilize advanced technology for immunostaining and reporting. At Stamford Hospital, we utilize the Benchmark platform (Ventana Medical Systems) and monoclonal antibodies for evaluation of estrogen and progesterone receptors, and Her2 by immunohistochemistry. Furthermore, immunosignal is evaluated using Image Analysis (we have two Vias Image Analyzers), which assures the most reproducible and accurate reporting. Her2 gene amplification is also evaluated using Fluorescence In-Situ Hybridization (FISH) routinely. In difficult cases, we also implement Her2 Silver In-Situ Hybridization (SISH). Stamford Hospital is one of 12 institutions in the country with Her2 SISH validation - a method widely used in Europe and now before the FDA for approval in the United States. We utilize Her2 CISH in those tumors that may have a dual cancer population, and where IHC and FISH results are equivocal. The objective is to provide the most accurate information possible to the Surgeons, the Medical Oncologists, and ultimately the patient.

Intraoperative Margin Evaluation

The pathologists at Stamford Hospital routinely perform intraoperative margin evaluation using touch-prep imprint cytology. The objective is to assure that the surgeon achieves negative margins at the time of surgery. To this end, there are two MD Anderson Cancer Center fellowship trained, board certified Cytopathologists (only facility in the state of Connecticut).

Sentinel Lymph Node Evaluation

We perform the most rigorous evaluation of sentinel lymph nodes possible. Our fellowship-trained, dedicated breast surgeons are expert in obtaining sentinel lymph nodes. These lymph nodes are then thoroughly evaluated by the pathologist. We perform intraoperative touch-preps on each sentinel lymph, confirming malignancy with frozen section. We serial section each lymph node for a thorough H&E evaluation, and on alternative levels, we perform pankeratin immunostains. Our intraoperative evaluation false negative rates are below national standards, a fact we are very proud of.

Weekly Breast Tumor Board

All breast cancer cases are reviewed in a multi-disciplinary conference at Stamford Hospital. This is not true of most places, which selectively present breast cancer patients at Breast Tumor Boards. At Stamford Hospital, we believe that each and every patient should receive the benefit of a multi-disciplinary review so that best decisions can be made to benefit the patient. This multi-disciplinary conference is held every Wednesday at 7:30 am and is attended by our Breast Surgeons, Medical Oncologists, Radiation Oncologists, Breast Radiologists, Pathologists, Plastic Surgeons, Geneticists, Tumor Registrar (and includes many observers, including residents for teaching purposes). At this conference, all radiology material and pathology material is presented in an open forum, and cases are openly discussed so the best medical decisions can be made.

Core Biopsy Radiology-Pathology Correlation Conference

Stamford Hospital is the only institution in the state to implement a rigorous Pathology-Radiology correlation conference, held every week immediately following the Breast Tumor Board. All core biopsies obtained at Stamford Hospital through the Department of Radiology are reviewed in the presence of the Radiologist, Pathologist, Breast Surgeon, and Nurse Navigator. In this conference, radiology images and the pathology are reviewed, which represents true radiologic/pathologic correlation, and which assures that no mistakes are made.

Expert Surgical Pathologists

The Department of Pathology consists of experienced, fellowship trained, board certified pathologists with expertise in evaluation of breast disease and breast cancer. For the evaluation of breast lymphomas, there is a fellowship trained Hematopathologist. Breast and lymph node cytology material is evaluated by MD Anderson Cancer Center fellowship trained Cytopathologists.

For more information or to make an appointment please call
1-877-233-WELL (9355).