The Breast Pathology Service is part of the Department of Pathology and Laboratory Medicine but is fully integrated with the Breast Multidisciplinary Team and provides a critical role in diagnosis and prognosis for patients attending the Symptomatic Breast Service. All patients are discussed at a weekly breast multidisciplinary meeting which is attended by Consultant Histopathologists who have a subspecialist interest in breast pathology.
Consultant staff with special interest in breast pathology
Dr. Annamarie O'Shea
Dr. Marie Staunton
We provide a diagnosis and in the case of cancers, provide information on prognosis and potential therapeutic targets. The specimens we receive include breast core biopsies, lymph node biopsies, skin biopsies and surgical specimens. When a diagnosis of breast cancer is made, our reports include a tumour sub-type and grade (sub-types are clinically meaningful categories which are associated with different outcomes). We assess adequacy of surgical margins. We provide staging data based on our measurements of tumour size and lymph node involvement.
We also provide information that will identify useful therapeutic targets. In all newly diagnosed breast carcinomas, we assess the hormone receptor status and Her-2 status. If the cancer is oestrogen receptor positive, the patient is likely to derive benefit from anti-oestrogen therapies. For the subset of 15-20% of cancers which are Her-2 positive, the outcome can be dramatically improved by the addition of drugs such as the monoclonal antibody Trastuzumab which targets the Her-2 receptor. While we have a long established record of assessing Her-2 receptor status using Immunohistochemistry and Fluorescent In Situ Hybridisation (FISH), recently, we have introduced Her-2 assessment by DDISH (Dual Dimer In Situ Hybridisation). Since 2011, we have been identifying patients with early stage breast cancer who are suitable for Oncotype Dx Testing. The Oncotype Dx score is derived from a molecular based assessment of patient’s tumour gene profile, which has shown to be clinically useful in identifying patients who are at low risk of cancer recurrence and who can safely avoid chemotherapy after surgery.
We devote considerable attention to the Quality Assurance (QA) of our service.
- Every patient who has a breast pathology specimen will have it reviewed and discussed at one of our weekly Breast Multidisciplinary Team Meetings.
- Our report content and timeliness is constantly monitored and fed to the National Cancer Control Programme.
- As an integral part of the department of histopathology, our breast data also feeds into the Histopathology National Quality Improvement Programme, which was developed and is run by the Faculty of Pathology of the Royal College of Physicians of Ireland (RCPI).
- All pathologists who report breast cancer resections are participants in the Breast Histopathology External Quality Assurance (EQA) scheme which is run by the NHS Breast Screening Programme where our performance is compared with that of our peers nationally and internationally.
- Our immunohistochemical staining performance for hormone receptors and Her-2 are examined regularly by a technical EQA scheme.
- A subset of our Hormone Receptor and Her-2 results are independently validated by being assessed in an external laboratory using molecular methodology.
Teaching and Training
We deliver breast pathology teaching to medical students, doctors on the national histopathology post-graduate specialty training programme and visiting international pathology Fellows as well as to nurses and other Health Professionals.
We actively support ongoing research clinical trials in Breast cancer by providing the required pathological material and pathological information.