Histological is the examination of tissue under the microscope by the pathologist. The tissue is taken as a sample before surgery or in the surgical preparation after surgery.

When suspicious findings are presented in Mammography or Breast Ultrasound such as calcifications or lumps, they need histological identification to determine the therapeutic manipulations. In the case of calcifications, a Stereotactic biopsy (mammographic guidance) is performed, while in the case of lumps, a biopsy with a cutting needle (Corebiopsy) is performed under ultrasound guidance. This is the preoperative diagnosis.

Depending on the result of the histological examination, we choose whether the patients need additional treatments such as chemotherapy or hormone therapy and in what order they will be done in relation to the surgery.

In early breast cancer, we are interested in the analysis of the histological examination of the type of cancer and its characteristics (biological subtype).
There are two histological types of cancer, porogen (90% of cancers) and lobular (10% of cancers).

We also examine whether it expresses estrogen receptors (ER), progesterone (PR), the proteins of the Her2/neu gene and the proliferation marker Ki67.
Cancers that do not express any of the previous markers, i.e. triple negative (ER-, PR-, Her2/neu negative), or Her2 gene positive always receive chemotherapy. In volumes greater than 2 cm. (and according to the latest data more than 1 cm) or even with positive lymph nodes, we suggest that they do chemotherapy first and then the surgery. As shown above, these data are given by the pre-operative histological examination. In addition, another group, locally advanced cancers, first start treatment, usually XMT, to shrink the tumor and follow surgery.

Therefore the role of preoperative histological examination is very important.

Most early cancers are hormone-dependent, Her2/neu(-), so the surgery is done first, we wait for the histology and usually we send the tumor for further analysis with some gene signature (such as Oncotype, Endopredict, Mamaprint) to assess whether it should be chemotherapy or not.

In metastatic cancer as well, the histological examination helps us to choose the appropriate treatment because in this case no surgery is performed or we only do systemic treatment.

The histological examination gives us very useful information, in order to make the correct personalized planning of the appropriate therapeutic manipulations for each patient so that she receives the best treatment that will have a positive effect on the outcome of the disease.

October is dedicated to breast cancer awareness, let’s highlight the importance of prevention and early diagnosis! Take care of your body, because health starts with you!