Changing role of the pathologist

The pathologist's role in diagnosing and managing patients with breast disorders is changing. The introduction of mammographic screening has altered the spectrum of histological changes presenting to histopathologists for diagnosis, with a greater emphasis on 'borderline' lesions, and has increased the need for specimen radiography as part of the gross examination of biopsy specimens. Reporting prognostic features of carcinomas is required as they may give an early indication of the impact of screening and increased cytological services are needed to reduce the need for open biopsy. Together with a recent Government White Paper, screening has also stimulated various quality assurance initiatives in breast pathology. Increased therapeutic options with the associated need to counsel patients demand more comprehensive pathological services--particularly pre-operative cytological diagnosis, reporting of prognostic features and determining the adequacy of excision of carcinomas. Finally, the management of patients with primarily benign biopsies may be influenced by the detection of various neoplastic or pre-neoplastic lesions of microscopic size by the pathologist.