deschutes said:
What do you do with your prophylactic BSO and mastectomies from BRCA-positive patients?
We submitted all of the tubes and ovaries (plus, one particular patient was a nurse and specifically requested that her tubes be sectioned at intervals of 2.5mm).
I'm particularly curious about what is being done out there for the boobs.
Just last week I did a frozen on a BRCA + patient who years before had undergone prophylactic bilateral mastectomy, hysterectomy and unilateral salpingo-oophorectomy. She had developed a cyst on her residual ovary. By imaging, there was no solid component, so clinicians were not worried. On gross, the ovary was replaced by a 16 cm cyst with a single 1.5 cm solid area. Frozen section showed an invasive clear cell CA. Bad luck
Regarding your question, I do not know there is a standardized way to gross prophylactic mastectomies for BRCA positive patients. I think it all depends on your gross findings. It might be important to see what the findings on mammography were. Supposing they did not see any suspicious lesions, and you do not see any suspicious lesions, then 3-4 representative sections per quadrant is reasonable. They key though, I think, is to do a good gross inspection with approx. 1cm thick breadloafing, which is difficult if the specimen is not fixed.
When thinking about these issues you always have to consider the worse case scenario, and what the standard of practice is. Suppose you missed a small cancer that had already metastasized to axillary lymph nodes, and the case went to court. If you processed the specimen as described above, and document that in your gross description, then you would probably not be found liable, as you followed standard practice to the best of your knowledge.