Breast Pathology

The Breast Pathology Service provides comprehensive expertise for the diagnosis and evaluation of breast diseases. It is the provider of breast disease diagnoses for Brigham and Women's Hospital and for the Dana-Farber Cancer Institute's Susan F. Smith Center For Women's Cancers. The Breast Service also provides national and international consultations for difficult and challenging breast diseases with diagnoses provided by a team of internationally recognized, highly experienced breast pathologists.

Available resources for diagnosis include breast pathology experts with over 90 years of combined experience between them, access to an unparalleled range of immunohistochemical studies, and prognostic fluorescence in situ hybridization for HER2. In addition, for patients seen in consultation at DFCI's Susan F. Smith Center For Women’s Cancers, breast cancers can also be tested for a wide range of genetic changes in the Department's Center for Advanced Molecular Diagnostics. The Breast Service currently handles over 6000 cases a year, 3500 of which are second opinion diagnoses and over 2000 are core needle biopsy primary diagnoses.

The Breast Pathology Service is an integral and critical part of the care of breast cancer patients being seen at DFCI's Susan F. Smith Center For Women's Cancers, which provides consultations in medical oncology, surgical oncology, breast reconstruction, radiation oncology, and breast imaging. BWH/DFCI Breast pathology cases are discussed at weekly tumor boards to obtain consensus for treatment by treating clinicians. Bi-weekly radiology/pathology correlation conferences are an essential part of quality assurance in breast disease diagnosis. Patients undergoing breast imaging with subsequent biopsy procedures performed can be confident their biopsy specimen findings are carefully reviewed by the expert radiology and pathology teams for concordance between imaging and pathology findings.

Consultations / Second Opinion

The Breast Service provides an integrated approach to the pathologic assessment of breast disease, which expands far beyond the glass slide diagnosis and takes into consideration clinical factors, prior treatment, multimodality imaging findings, and ancillary testing results. The final report reflects a global understanding of the breast disease for each individual patient.

The Breast Service works as a tightly knit team routinely sharing challenging diagnostic cases, so when you consult with BWH Breast Pathology for your difficult breast case, you frequently receive the opinion of several breast experts and not just one.

If you are a patient and wish a second opinion on your pathology only, please contact your current clinician and ask them to follow the instructions here for submitting a case for consultation. We regret but we cannot accept consultation requests directly from a patient, they must come through a clinician (MD).

If you are a patient and wish to have a second opinion with a BWH or DFCI physician in addition to pathology review (Medical and/or Radiation Oncology, Breast Surgery including Plastic Surgery, or Breast Radiologist), contact the DFCI/BWH Patient Call Center and they will guide you through the process of making an appointment for a second opinion. Tel: 1-877-332-4294. Website: Dana Farber Cancer Institute.

Pathologists Requesting Diagnostic Assistance and Clinicians Requesting Second Opinions

If you are a physician at an institution other than Brigham and Women's Hospital and you would like a consultative review of breast pathology performed and diagnosed at your institution, please include the following in your submission of pathology materials:

• Pathology Consult Request Form. The entire form must be completed and signed by a physician.
• Glass slides, either stained or unstained. Paraffin blocks may also be submitted for special studies, and may be subsequently requested if required for accurate diagnosis.
• A copy of the referring pathologist's final report, or at least a preliminary report. If the case has been previously seen by other consultants, copies of those reports should also be included.
• A Consult Letter from the referring physician or pathologist which identifies the patient by name, gives a brief clinical history, identifies the slides and/or blocks by accession number, and identifies the tissue source for each accession number.
• Reports of additional studies should be submitted including prior relevant pathology reports, imaging findings, and ancillary tests already performed (e.g. immunohistochemistry, HER2 FISH results or Oncotype DX results).
• If you are submitting a consultation request from outside the United States of America, please include credit card payment information for billing to prevent delay in case review by pathology. Ensure the original Pathology Report has been translated into English. For information on national and international consultation charges and billing, please contact the breast pathology administrator at 617-732-8938.

DFCI/BWH Clinicians Requesting Second Opinions

If the patient is being seen by a Brigham and Women's Hospital and/or a DFCI physician, whether you are the patient or the physician, please contact the DFCI/BWH Patient Call Center so they can guide you through the process.

DFCI/BWH Patient Call Center: Tel: 1-877-332-4294

Online: Dana Farber Cancer Institute - Select appointments and second opinions

Materials that will need to be sent to Central Pathology Processing at DFCI include the following:

• Glass slides, either stained or unstained. Paraffin blocks may also be submitted for special studies, and may be subsequently requested if required for accurate diagnosis.
• A copy of the referring pathologist's final report and reports of any ancillary testing (HER2 FISH results or Oncotype DX results). If the case has been previously seen by other consultants, copies of those reports should also be included.

Results Reporting

We provide Physicians at institutions other than BWH or DFCI with faxed pathology reports on consultations. If you would like a pathology result by PDF in a secure Email, please state so on the Consult Letter as your preferred means of communication, and provide an Email address. If you are a patient and requested a second opinion, we regret but we cannot provide faxed or Emailed reports directly to patients. Please contact your clinician for the Consultation Pathology Report.

We send direct, personal phone call alerts in addition to fax notification, to outside institutions when we report actionable pathology results discordant with outside findings. We provide Pathology Reports within the Mass General Brigham System through the Electronic Medical Record System, with Email alerts available to DFCI and BWH Clinicians when a report is released.

How to Send Materials for Consultation

All materials sent by either standard or express mail must be protected from damage by using proper packaging. It is strongly recommended to send by registered or tracked mail (FEDEX, UPS, DHL etc) to ensure secure receipt and an expeditious review of materials.

• Enclose glass slides in plastic slide boxes (available in most laboratories), which hold up to five slides each.
• Excess space in the box under the lid should be filled with cotton gauze or tissue paper, to avoid breakage due to shaking.
• The lid of the box should be taped closed.
• Slide boxes should be surrounded by the following: relevant pathology reports, a Pathology Consult Request Form, a Consult Letter if relevant, and patient insurance information if relevant.
• The slide box should be enclosed in a rigid mailing container (either a cardboard box or rigid screw-cap mailing tube), and the space around the materials filled with padding (gauze, paper, or styrofoam).
• All materials related to the case should be shipped in the same container, so that they are received together.
• The box or cylinder should be tightly closed and sealed with tape. The mailing label should include a return address as well as the name of the referring clinician or pathologist, and addressed to:

The Breast Pathology Service
Brigham and Women's Hospital
Department of Pathology
75 Francis Street
Boston, MA 02115

Material sent by express mail or from outside the U.S. usually requires identification of the contents. A sample label might read:

Glass slides of Human Tissue for Diagnosis
Non-Infectious
Non-Hazardous
No Commercial Value

Some carriers, such as DHL, may additionally require identification of the body part, e.g., skin.

For questions for proper shipment of specimens other than those described above, please contact the carrier, or our Breast Service Administrator, 617-732-8938.

All original materials will be returned to the referring site on completion of our studies. We will retain any additional slides that we have prepared in our laboratories. A copy of our diagnosis will be sent to the referring physician.

For information on Consultation charges and billing, please contact the Breast Service Administrator, 617-732 8938.

Fellowship and Observership Information

There are currently two breast pathology fellows working full-time on the Breast Service, and additional bi-weekly rotating residents. We offer a competitive one-year fellowship training opportunity in diagnostic breast pathology to both internal and external pathology residents in training. Information on Breast Pathology Fellowships can be found here.

Contact Information

Breast Service Administrator
Phone: (617) 732-8938
Fax: (617) 264-5118

Mailing Address:
The Breast Pathology Service
Brigham and Women's Hospital
Department of Pathology
75 Francis Street
Boston, MA 02115