Training activity information
Details
Dissect a range of breast specimens received for breast cancer:
- Mastectomy
- Wide local excision
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Considerations
- Local SOPs
- Specimen preparation, orientation, inking, block sampling and macroscopic description
- Quality of blocks
- RCPath cancer datasets
- Macroscopic pathological features specific to the disease entity
- NICE guidance
- Breast cancer screening programme
- Molecular testing strategies and national guidance
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What are the key features to document in both mastectomy and wide local excision specimens?
- What are your goals in terms of accurately determining tumour size, margin status, and assessing lymph nodes (sentinel and axillary)?
- Discuss the different types of breast cancer and their potential macroscopic appearances with your training officer.
- Review the standard dissection protocols for mastectomy and wide local excision specimens, including margin inking, serial slicing, and lymph node dissection or retrieval.
- What is the importance of specimen orientation in determining margin status, particularly in wide local excisions?
- Consider the specific insights you hope to gain regarding the macroscopic features of different grades and types of breast cancer.
- Think about your existing knowledge of breast anatomy and the lymphatic drainage of the breast, and how this relates to the dissection process.
- What specific skills in handling breast tissue, identifying tumour and normal structures, assessing margins, and dissecting lymph nodes do you aim to develop?
- Discuss this training activity with your training officer to ensure you understand the expected dissection techniques for both mastectomy and wide local excision specimens, as well as the approach to sentinel lymph node examination if applicable.
- Consider potential challenges such as large or multifocal tumours, or specimens with previous surgical intervention, and how you might address these.
- Reflect on your understanding of breast cancer staging and the role of macroscopic examination in this process.
In action
- What is your method for orientating, inking, and dissecting mastectomies and wide local excisions for breast cancer?
- Why are you following these specific steps for margin assessment and tumour evaluation?
- What decisions are you making about sampling the tumour, margins (including radial, deep, and circumferential), lymph nodes (sentinel and axillary dissection), and any other identified lesions?
- What is guiding your block selection strategy?
- How intuitive does the process of serially slicing the specimen and identifying different tissue components feel?
- What aspects, such as identifying tumour extent or assessing distance to margins, are requiring more focused effort?
- How effectively is your dissection revealing the size, shape, and relationship of the tumour to the surrounding breast tissue and margins?
- Are there any unexpected findings (e.g., multifocality, satellite lesions)?
- What immediate learning points are arising as you dissect different types and grades of breast cancer?
- How does the gross appearance correlate with your understanding of breast pathology and imaging findings?
- Are there alternative dissection techniques you could use to better assess margin involvement or the relationship to nipple-areola complex?
- Would discussing your approach with a senior colleague be beneficial?
- Are you ensuring that your dissection and sampling adhere to national guidelines for breast cancer specimens?
On action
- What were the key macroscopic features observed in the mastectomy and wide local excision specimens?
- How did the size, shape, and consistency of the lesions vary?
- What specific techniques did you employ for orientating, inking margins, and sampling these breast specimens?
- How did the pre-operative information (e.g., imaging, clinical findings) correlate with the macroscopic findings?
- What challenges did you face during the dissection process, such as identifying margins or specific structures?
- What did you learn about the critical aspects of breast cancer dissection, including assessment of tumour size, type, grade, margin status, and lymph node involvement?
- How did this experience improve your understanding of breast anatomy and the pathological features of breast cancer?
- How will this experience inform your future dissection of breast specimens?
- Are there any specific breast specimen dissection techniques you need to practice further, such as lymph node dissection or margin inking?
- How will you ensure you are consistently and accurately assessing the relevant prognostic factors in breast cancer specimens?
- Do you need to review any specific guidelines or protocols for breast cancer dissection and reporting?
Beyond action
- How did dissecting different types of breast specimens (e.g., mastectomy vs. wide local excision) enhance your understanding of the surgical approaches and the potential extent of disease?
- Review your reflections on breast specimen dissection. What did you learn about the importance of inking margins and identifying key features for predicting prognosis?
- Have you discussed the complexities of breast cancer dissection with senior colleagues? Did this deepen your understanding of best practices?
- How has the experience of dissecting breast malignancy specimens contributed to your understanding of the TNM staging system? How has this informed your approach to other cancer types?
- What clear actions will you take to further refine your skills in dissecting breast malignancy specimens?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Dissect the most common malignant specimens from a range of organ systems. |
| # 3 |
Outcome
Employ the appropriate specimen preparation, orientation, inking, block sampling and dissection rationale based on the clinical history for malignant specimens. |
| # 5 |
Outcome
Practice safely in accordance with quality management and accreditation standards. |