Yale Breast Pathology

Breast Pathology

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The Breast Pathology Service at Yale School of Medicine is highly focused on precise diagnosis and providing reliable results. Board certified pathologists with expertise in breast subspecialty interpret challenging breast cases on a daily basis.  We provide standardized high-quality assays that reduce the likelihood of false positive or negative results. In addition to performing comprehensive studies and our attention to detail to ensure accuracy, we review difficult diagnoses at a daily consensus conference where challenging cases, which include “borderline cases of atypical ductal hyperplasia versus carcinoma and rare or unusual types of breast cancer," are presented and discussed. These meetings serve as a sort of “second opinion” that is built into the system. The goal is to provide accurate results for each individual patient. Breast cases that need multidisciplinary management are discussed at the multidisciplinary breast tumor board, where experts from various specialties from Smilow Cancer Hospital, surgeons, radiologists, and oncologists meet to review treatment options.  

Breast Service

The Breast Pathology Service supports a large volume of cases that include 2000 breast biopsies and 1000 mastectomy specimens annually. Our average turnaround time for rush biopsies is two days, including ancillary receptor studies. We are heavily invested in patient care and are committed to communicating pathology findings to our clinical team, especially when cases are encountered with unexpected diagnoses. Similarly, any anticipated delay in patients' diagnosis due to additional ancillary testing is also discussed with the clinician.
The breast team receives pathology slides submitted from outside institutions across the nation and internationally for our expert opinion.

Services and Expertise

In addition to a more complete detailed pathology report than is typically provided, which includes information about traditional pathologic factors such as tumor stage and ER, PR, and HER2 status in breast cancers, additional sophisticated molecular tests are available if required. Breast cancers continue to be classified based on traditional histologic features, and therefore a thorough work up of problematic cases with ancillary studies using immunohistochemical stains is done to avoid potential diagnostic pitfalls. As we move closer to the era of targeted therapy, each individual patient’s tumor, with its own unique signature, can be investigated by gene expression profiling here at Yale. The breast faculty serves as expert consultants for cross-specialty consultations within the department for complex cases.
We also provide consultative diagnostic services within the state of Connecticut and outside, including internationally. 

Director

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Malini Harigopal, MD

Director

Associate Professor of Pathology

Director, Breast Pathology

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Pathologists

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Natalia Buza, MD

Associate Professor of Pathology

Associate Director of Gynecologic Pathology

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Marguerite Pinto, MBBS

Assistant Professor of Pathology

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Emily Reisenbichler, MD

Assistant Professor

Director, Breast Pathology Fellowship

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Serena Wong, MD

Assistant Professor of Pathology

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Research

The Breast Pathology Service has a varied and diverse interest in both clinical and research fields. At the translational level, several of our members are actively involved in the Rimm Lab- David Rimm, MD, PhD, which focuses on quantitative pathology using AQUA technology using breast tissue microarrays and whole sections.
Opportunities to participate in basic research are provided by the Stern Lab- David Stern, PhD and the Wajapeyee Lab- Narendra Wajapeyee, PhD. 

Publications:

Chagpar AB, Cicek AF, Harigopal M. Can Tumor Biology Predict Occult Multifocal Disease in Breast Cancer Patients? Am Surg. 2017 Jul 1;83(7):704-708. PubMed PMID: 28738939.

Bossuyt V, Symmans WF. Standardizing of Pathology in Patients Receiving Neoadjuvant Chemotherapy. Ann Surg Oncol. 2016 Oct;23(10):3153-61. doi: 10.1245/s10434-016-5317-x. Epub 2016 Jul 5. PubMed PMID: 27380637.

Chagpar AB, Horowitz NR, Killelea BK, Tsangaris T, Longley P, Grizzle S, Loftus M, Li F, Butler M, Stavris K, Yao X, Harigopal M, Bossuyt V, Lannin DR, Pusztai L, Davidoff AJ, Gross CP: Economic Impact of Routine Cavity Margins Versus Standard Partial Mastectomy in Breast Cancer Patients: Results of a Randomized Controlled Trial. Ann Surg. 2017 Jan. PMID: 27192352 

Zarrella ER, Coulter M, Welsh AW, Carvajal DE, Schalper KA, Harigopal M, Rimm DL, Neumeister VM: Automated measurement of estrogen receptor in breast cancer: a comparison of fluorescent and chromogenic methods of measurement. Lab Invest. 2016 Sep; 2016 Jun 27. PMID: 27348626 

Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, Yao X, Bossuyt V, Harigopal M, Lannin DR, Pusztai L, Horowitz NR: A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer. N Engl J Med. 2015 Aug 6; 2015 May 30. PMID: 26028131 

Harigopal M, Barlow WE, Tedeschi G, Porter PL, Yeh IT, Haskell C, Livingston R, Hortobagyi GN, Sledge G, Shapiro C, Ingle JN, Rimm DL, Hayes DF: Multiplexed assessment of the Southwest Oncology Group-directed Intergroup Breast Cancer Trial S9313 by AQUA shows that both high and low levels of HER2 are associated with poor outcome. Am J Pathol. 2010 Apr; 2010 Feb 11. PMID: 20150438

Harigopal M, Heymann J, Ghosh S, Anagnostou V, Camp RL, Rimm DL: Estrogen receptor co-activator (AIB1) protein expression by automated quantitative analysis (AQUA) in a breast cancer tissue microarray and association with patient outcome. Breast Cancer Res Treat. 2009 May; 2008 Jun 3. PMID: 18521745 

Moeder CB, Giltnane JM, Harigopal M, Molinaro A, Robinson A, Gelmon K, Huntsman D, Camp RL, Rimm DL, American Society of Clinical Oncology., College of American Pathologists.: Quantitative justification of the change from 10% to 30% for human epidermal growth factor receptor 2 scoring in the American Society of Clinical Oncology/College of American Pathologists guidelines: tumor heterogeneity in breast cancer and its implications for tissue microarray based assessment of outcome. J Clin Oncol. 2007 Dec 1. PMID: 18048824 

Education and Training

The faculty in Breast Pathology are committed to subspecialty training of pathology residents and fellows. The Department of Pathology offers a highly competitive Breast one-year fellowship that is comprehensive and focused on a multidisciplinary approach in patient care. The faculty is actively engaged in breast pathology didactics, "unknown" conferences, and breast journal clubs that are attended by residents, fellows and attendings across specialties. Two multidisciplinary conferences (Breast Radiology Conference and Breast Tumor Board) are held every week and are attended by specialists involved in patient care.
Some of the faculty are course developers at the Yale School of Medicine and are actively involved in recruitment of lecturers for medical student teaching. We welcome visiting pathologists, both national and international, to participate in educational activities for periods ranging from a month to a year. Several opportunities exist for scholarly research projects with our clinical collaborators and also within the department for translational or basic research.