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Breast Pathology

Accurate and Fast Results

Ensuring the accuracy of your pathology results is of utmost importance. Knowing the exact type of breast cancer and the specifics of its prognostic factors is critical to creating a treatment plan that will provide you with the best opportunity for defeating this disease.

Our team of breast specialists includes pathology faculty members who specialize in breast cancer and have extensive experience evaluating and accurately classifying breast tissue specimens. Our pathologists are so trusted that it’s common for women to bring their slides from another facility to us for a second opinion. On occasion we discover abnormalities, including breast cancer, which may have been previously overlooked.

Learn more about breast pathology at Johns Hopkins Medicine.

Common Breast Cancer Pathology Terms

The following terms were developed by pathologists to describe the types and kinds of breast cancers. These descriptions help the breast surgical oncologist, medical oncologist and radiation oncologist design an individualized treatment plan for each patient.

  • HR-positive/negative (hormone receptor status) – If breast cancer cells are stimulated by hormones, then they are considered hormone receptor (HR) positive. This is a favorable prognosis; your cancer will probably respond to hormonal therapies, which will also be used as a part of your treatment. There are two types of female hormones the tumor is tested with: estrogen and progesterone. When a tumor is positive for estrogen, or positive for estrogen and progesterone, hormonal therapy (the opposite of hormone replacement therapy) may be recommended as part of the treatment. It can greatly aid in preventing recurrence of the disease and can help control breast cancer that has spread to other organs.
  • HER-2/neu receptor – The human epidermal growth factor receptor 2 (HER-2/neu) is a prognostic factor used to measure how quickly a breast tumor is growing and how erratic it is. Using an oncogene measurement, which measures cell growth, pathologists can determine if the cells contain extra protein that makes them grow out of control. If the HER-2 test is positive it means the cancer cells have too much HER-2 receptor protein on the surface of the cell, or there are extra copies of the HER-2 gene that can lead to HER-2 overexpression.

If your tumor is found to have the HER-2/neu receptor, special recommendations for targeted biological therapy might be recommended as part of your treatment. HER-2 negative is a favorable prognostic factor; being positive is not favorable. Positivity is usually recorded as being “3+” or “+++.” Negativity is recorded as “0,” “negative” or “+or++.”

There is also something commonly referred to as triple negative breast cancer, which refers to the prognostic factors of breast cancers whose cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER) and progesterone receptors (PR).

  • Grade – This is a measurement of cell growth. Pathologists use a classification of 1, 2 or 3. If the cells are 1 they are slow growing; 2, average growing; and 3, rapidly growing.
  • Benign breast diseases – Around 80 percent of suspicious masses found on mammograms or breast exams are benign, meaning they are not cancerous and pose no health risk. If our pathologists examine your slides and find no evidence of cancer, the surgeon will determine if the benign tumor, usually a fibroadenoma, needs to be removed. If they are large, increasing in size or causing pain, the surgeon will remove them.
  • Malignant tumors – Malignant tumors are cancerous tumors and need to be treated as such. Our pathologists will carefully evaluate all biopsies and slides to give the treating surgical, medical and radiation oncologists information about the size, type and prognostic factors of the tumor. Armed with these precise facts, our team can create an individualized treatment plan that targets the exact nature of your breast cancer.

Frequently Asked Questions about Pathology Results

Many patients have posted questions related to their pathology results and have received responses from our expert pathologists. Please visit our Ask an Expert section to ask your own question and review similar questions.

Navigate our Pathology FAQs and Images

  1. Benign Breast FAQ
  2. Benign Diseases - Atlas of Images
  3. Atypical Hyperplasia
  4. Breast Cancer In-Situ
  5. Breast Cancer
  6. Malignant Tumors - Atlas of Images
  7. Ask an Expert - Understanding Pathology Results