The pathologist's role in minimal breast cancer

Minimal breast cancer is defined as a lesion smaller than 5 mm. The pathologist's first task is to distinguish minimal cancers from benign lesions. Certain histologic types of infiltrating cancers are “minimal” in the sense that they are associated with a favorable prognosis. These include: medullary carcinoma with lymphocytic infiltrate, tubular carcinoma, gelatinous carcinoma, primary axillary carcinoma, noninfiltrating Paget's disease of the nipple, and carcinoma in a fibroadenoma. The pathologist should report at least the three-dimensional size of gross tumors, histologic type, and grade of differentiation. Specimen radiography can localize lesions which may otherwise be missed. A clinical pathological weighted numerical profile may be the future means of assessing patient risk for developing breast cancer.