Protocol for the Examination of Specimens From Patients With Invasive Carcinoma of the Breast

Abstract

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.This protocol applies to all invasive carcinomas of the breast, including ductal carcinoma in situ (DCIS) with microinvasion. The 7th edition TNM staging system for carcinoma of the breast of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) is recommended.Select a Single Response Unless Otherwise Indicated.* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management.Specimen (note A)__ Partial breast__ Total breast (including nipple and skin)__ Other (specify): ______ Not specifiedProcedure (note A)__ Excision without wire-guided localization__ Excision with wire-guided localization__ Total mastectomy (including nipple and skin)__ Other (specify): ______ Not specifiedLymph Node Sampling (select all that apply) (note B)__ No lymph nodes present__ Sentinel lymph node(s)__ Axillary dissection (partial or complete dissection)__ Lymph nodes present within the breast specimen (ie, intramammary lymph nodes)__ Other lymph nodes (eg, supraclavicular or location not identified) Specify location, if provided: ____Specimen Integrity (note C)__ Single intact specimen (margins can be evaluated)__ Multiple designated specimens (eg, main excision and identified margins)__ Fragmented (margins cannot be evaluated with certainty)__ Other (specify): ____Specimen Size (for excisions less than total mastectomy) (note C)Greatest dimension: __ cm* Additional dimensions: __ × __ cm__ Cannot be determinedSpecimen Laterality__ Right__ Left__ Not specified*Tumor Site: Invasive Carcinoma (select all that apply) (note D)*__ Upper outer quadrant*__ Lower outer quadrant*__ Upper inner quadrant*__ Lower inner quadrant*__ Central*__ Nipple* Position: __ o'clock* Other (specify): ____*__ Not specifiedTumor Size: Size of Largest Invasive Carcinoma (note E)__ Microinvasion only (≤0.1 cm)Greatest dimension of largest focus of invasion greater than 0.1 cm: __ cm* Additional dimensions: __ × __ cm__ No residual invasive carcinoma after presurgical (neoadjuvant) therapy__ Cannot be determined (see Comment)Note: The size of the invasive carcinoma should take into consideration the gross findings correlated with the microscopic examination. In some cases, it may be helpful to use information about tumor size of invasion are the size is the size of the largest of The size of invasive carcinomas should not be The size not a or a of invasion than in the the largest dimension of the invasive carcinoma in the specimen should be used for if and invasive carcinoma is the is as if is residual and if is (note Single focus of invasive Multiple of invasive carcinoma of __ of individual ______ No residual invasive carcinoma after presurgical (neoadjuvant) therapy__ are invasive and the results of for and should to the largest invasive invasive carcinomas in of these this information may be in the and of (select all that apply) (note is not present__ Invasive carcinoma not into the or Invasive carcinoma into the or without Invasive carcinoma into the or with as of invasive carcinoma are present (ie, not with the invasive carcinoma in the as not involve the nipple nipple of the not the No present__ is present and is of Carcinoma Carcinoma into and into the as into is not and are not as is invasion than this Carcinoma In (note No is present__ is present __ __ __ is present after presurgical (neoadjuvant) of size of dimension by gross and microscopic is at __ cm* Additional dimensions: __ × __ cm* of with o