We frequently come across spiculated masses of 2-2.5 cm size, with thick spiculations (better seen on tomosynthesis) ; radiating for another 1.5 - 2 cm , In which case total extent of pathology reaches 5-5.5 cm.
In such cases should we include spiculations in tumour size estimation or not ?
Article Breast tomosynthesis: Accuracy of tumor measurement compared...
It is for you to decide.
However, the the final pathology report, what is the tumor size? if it is 2 cm, you can safely ignore it, but if it is 5.5cm, then I would include it...
Best,
Gilad
In my opinion you should ignore it. As it said by Gilad it dépends on the tumor size.
A+
Hayet
The problem arises when the dense tumor nucleus measures 2.5-3 cm, if we include spiculation ,total extent becomes 5-6 cm. This affects management decision for surgeon /oncologist..We need to give our pre-operative ( imaging ) assessment of tumor size; histopatholgy will anyway provide final answer.
I'm a pathologist.
You should try to correlate the pathological size with your two measurments. If you see that pathology is close to the smaller, then this is the right answer.
Take some old cases and review them. pathology vs imaging. This is the only way... this will give you the answer in you clinical and imaging setting.
As another pathologist I'll add my voice to the chorus: the gold standard is the combination of gross and histopathology. Radiological findings, whether from Xray-based technologies (including tomosynthesis) or MRI or ultrasound, ultimately need to be evaluated and validated by comparison with the definitive pathology examination. Decision-making as to staging and subsequent clinical interventions depend critically on the pathological findings and less so on the imaging.
Gross measurements vs sections from suspicious areas= should help. It does matter to the surgeon to decide precise treatment and it does affect prognosis!! Radiology may not be of help in all cases, so gross + HP confirmation is last sort.
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