Pathology

Luma Medical Centre

When a biopsy is performed on your breast, a sample is taken and studied under a microscope by a pathologist. The pathologist is a medical doctor who makes the diagnosis of disease by examining the sample.

A pathology report generated will state the findings and diagnosis for each sample taken. This information will be sent to the doctor who will use the information to manage your care and come up with a treatment plan. The role of a pathologist is central to ensuring the correct treatment and prognosis for each patient.

Having our in-house pathology division at Luma with a specialized breast pathologist adds to our multidisciplinary care team and demonstrates our commitment to providing bespoke breast care.

Read the latest article written by Prof. Tan Puay Hoon :

Refining the classification of breast phyllodes tumours

Predictive Model for Breast Phyllodes Tumour (Nomogram)

Phyllodes tumours are uncommon, biphasic, fibroepithelial lesions of the breast, characterised by leafy stromal fronds capped by benign bilayered epithelium.

The Nomogram model is designed for healthcare professionals in individual prediction of clinical behaviour of breast phyllodes tumours. It predicts the recurrence free survival at 1, 3, 5, and 10 years, based on atypia, mitoses, overgrowth and surgical margins (AMOS criteria)

Click here to access the nomogram tool.

Definitions for nomogram:

 

Figure 1. Assessment of stromal atypia in phyllodes tumours. (A) Mild (B) Moderate (C) Marked

  • Atypia: "Mild stromal atypia shows nuclei with little variation in size, with smooth nuclear contours. Moderate atypia shows some variation in nuclear size, with wrinkled nuclear membranes, to an extent exceeding that in mild atypia but less than that in marked atypia. Marked atypia shows marked variation in nuclear size, coarse chromatin, and irregular nuclear membranes with discernible nucleoli.“

  • Stromal overgrowth: The presence of stroma without epithelium in at least one low-power field as observed with a x4 microscope objective.

Acknowledgement:

This tool is based on the following study: Tan PH, Thike AA, Tan WJ, Thu MM, Busmanis I, Li H, Chay WY, Tan MH; Phyllodes Tumour Network Singapore. Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol. 2012 Jan;65(1):69-76. Erratum in: J Clin Pathol. 2013 May;66(5):455-6. PMID: 22049216 https://pubmed.ncbi.nlm.nih.gov/22049216/

Validation studies:

1) Nishimura R, Tan PH, Thike AA, Tan MH, Taira N, Li HH, Ohsumi S. Utility of the Singapore nomogram for predicting recurrence-free survival in Japanese women with breast phyllodes tumours. J Clin Pathol. 2014 Aug;67(8):748-50. https://pubmed.ncbi.nlm.nih.gov/24811489/

2) Chng TW, Lee JY, Lee CS, Li H, Tan MH, Tan PH. Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours: an Australian cohort. J Clin Pathol. 2016 Dec;69(12):1124-1126.                                                                                https://pubmed.ncbi.nlm.nih.gov/27466383/

3) Chng TW, Gudi M, Lim SH, Li H, Tan PH. Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours in a large patient cohort. J Clin Pathol. 2018 Feb;71(2):125-128. https://pubmed.ncbi.nlm.nih.gov/28751520/

4) Choi JE, Kang SH, Tan PH, Bae YK. Recurrence prediction for breast phyllodes tumours: validation of the Singapore nomogram in Korean women. J Clin Pathol. 2022 Mar;75(3):159-163. https://pubmed.ncbi.nlm.nih.gov/33376198/

5) Cristando C, Li HH, Almekinders M, Tan PH, Brogi E, Murray M. Validation of the Singapore Nomogram for Outcome Prediction in a US-Based Population of Women with Breast Phyllodes Tumors (PT). Breast Pathology. Mod Pathol. 2017;30(Suppl 2):27–81. https://doi.org/10.1038/modpathol.2016.241

Definitions and images reproduced from our publication (with permission):

1) Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, Calvo JP, Dabbs DJ, Ellis IO, Eusebi V, Farshid G, Fox SB, Ichihara S, Lakhani SR, Rakha EA, Reis-Filho JS, Richardson AL, Sahin A, Schmitt FC, Schnitt SJ, Siziopikou KP, Soares FA, Tse GM, Vincent-Salomon A, Tan PH. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016 Jan;68(1):5-21. https://pubmed.ncbi.nlm.nih.gov/26768026/

2) Tan PH. Refining the classification of breast phyllodes tumours. Pathology. 2023 Jun;55(4):437-448. https://pubmed.ncbi.nlm.nih.gov/37085395/