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Protocol appl ...

Posted Aug 25 2011 5:27pm

Protocol applies to DCIS without invasive carcinoma or microinvasion.
The complete pathology report should include following parameters.

Specimen type.


Lymph Node Sampling (select all that apply) 

Specimen Integrity

Specimen Size (for excisions less than total mastectomy)

Greatest dimension: ___ cm
*Additional dimensions: ___ x ___ cm
___ Cannot be determined

Specimen Laterality

*Tumor Site (select all that apply)

Size (Extent) of DCIS    ( Click here for more info about measuring size of DCIS)

Histologic Type 

*Architectural Patterns (select all that apply) 

Nuclear Grade 


Margins (select all that apply) 

___ Margins cannot be assessed ___ Margin(s) uninvolved by DCIS             Distance from closest margin: ___ mm             *Specify margins:                   *Distance from superior margin: ___ mm                   *Distance from inferior margin:    ___ mm                   *Distance from medial margin:     ___ mm                   *Distance from lateral margin:      ___ mm                   *Distance from anterior margin:   ___ mm                   *Distance from posterior margin: ___ mm                   *Distance from other specified margin: ___ mm                        *Designation of margin:  ______________________
___ Margin(s) positive for DCIS
            *Specify which margin(s) and extent of involvement:
                  *___ Superior margin
                        *___ Focal
                        *___ Minimal/moderate
                        *___ Extensive
                  *___ Inferior margin
                        *___ Focal
                        *___ Minimal/moderate
                        *___ Extensive
                  *___ Medial margin
                        *___ Focal
                        *___ Minimal/moderate
                        *___ Extensive
                  *___ Lateral margin
                        *___ Focal
                        *___ Minimal/moderate
                        *___ Extensive
                  *___ Anterior margin
                        *___ Focal
                        *___ Minimal/moderate
                        *___ Extensive
                  *___ Posterior margin
                        *___ Focal
                        *___ Minimal/moderate
                        *___ Extensive

*Treatment Effect: Response to Presurgical (Neoadjuvant) Therapy

Lymph Nodes (required only if lymph nodes are present in the specimen) 

Note:  The sentinel node is usually the first involved lymph node.  In the unusual situation in which a sentinel node is not involved by metastatic carcinoma, but a nonsentinel node is involved, this information should be included in a note.


*Extranodal extension:

*Method of Evaluation of Sentinel Lymph Nodes (select all that apply)

Pathologic Staging (pTNM) 

TNM Descriptors (required only if applicable) (select all that apply)

Note: If there has been a prior core needle biopsy, the pathologic findings from the core, if available, should be incorporated in the T classification.  If invasive carcinoma or microinvasion were present on the core, the protocol for invasive carcinomas of the breast1 should be used and should incorporate this information.

Note: If internal mammary lymph nodes, infraclavicular nodes, or supraclavicular lymph nodes are included in the specimen, consult the AJCC Staging Manual for additional lymph node categories.

___ (sn)              Only sentinel node(s) evaluated.  If 6 or more sentinel nodes and/or nonsentinel nodes are removed, this modifier should not be used.

Category (pN)
___ pNX:            Regional lymph nodes cannot be assessed (eg, previously removed, or not removed for pathologic study) ___ pN0:            No regional lymph node metastasis identified histologically Note: Isolated tumor cell clusters (ITC) are defined as small clusters of cells not greater than 0.2 mm or single tumor cells, or a cluster of fewer than 200 cells in a single histologic cross-section.#   ITCs may be detected by routine histology or by immunohistochemical (IHC) methods.  Nodes containing only ITCs are excluded from the total positive node count for purposes of N classification but should be included in the total number of nodes evaluated. ___ pN0 (i-):       No regional lymph node metastases histologically, negative IHC ___ pN0 (i+):      Malignant cells in regional lymph node(s) no greater than 0.2 mm and no more than 200 cells (detected by H&E or IHC including ITC) ___ pN0 (mol-):  No regional lymph node metastases histologically, negative molecular findings (reverse transcriptase polymerase chain reaction [RT-PCR]) ___ pN0 (mol+): Positive molecular findings (RT-PCR), but no regional lymph node metastases detected by histology or IHC ___ pN1mi:        Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm). ___ pN1a:          Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis greater than 2.0 mm ___ pN2a:          Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm) ___ pN3a:          Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm) # Approximately 1000 tumor cells are contained in a 3-dimensional 0.2-mm cluster.  Thus, if more than 200 individual tumor cells are identified as single dispersed tumor cells or as a nearly confluent elliptical or spherical focus in a single histologic section of a lymph node, there is a high probability that more than 1000 cells are present in the lymph node.  In these situations, the node should be classified as containing a micrometastasis (pN1mi).  Cells in different lymph node cross-sections or longitudinal sections or levels of the block are not added together; the 200 cells must be in a single node profile even if the node has been thinly sectioned into multiple slices.  It is recognized that there is substantial overlap between the upper limit of the ITC and the lower limit of the micrometastasis categories due to inherent limitations in pathologic nodal evaluation and detection of minimal tumor burden in lymph nodes.  Thus, the threshold of 200 cells in a single cross-section is a guideline to help pathologists distinguish between these 2 categories.  The pathologist should use judgment regarding whether it is likely that the cluster of cells represents a true micrometastasis or is simply a small group of isolated tumor cells.
___ Not applicable ___ cM0(i+):   No clinical or radiographic evidence of distant metastasis, but deposits of molecularly or microscopically detected tumor cells in circulating blood, bone marrow, or other nonregional nodal tissue that are no larger than 0.2 mm in a patient without symptoms or signs of metastasis ___ pM1:      Distant detectable metastasis as determined by classic clinical and radiographic means and/or histologically proven larger than 0.2 mm Note: The presence of distant metastases in a case of DCIS would be very unusual.  Additional sampling to identify invasive carcinoma in the breast or additional history to document a prior or synchronous invasive carcinoma is advised in the evaluation of such cases.

*Additional Pathologic Findings 

*Specify: ____________________________

*Ancillary Studies

*Estrogen Receptor (results of special studies performed on this specimen or a prior core needle biopsy) 
*___ Immunoreactive tumor cells present
*___ No immunoreactive tumor cells present
*___ Pending
*___ Not performed
*___ Other (specify):  _____________________

*Name of antibody: ___________________
*Name of vendor: ___________________
*Type of fixative: ________________

*Progesterone Receptor (results of special studies performed on this specimen or a prior core needle biopsy)  *___ Immunoreactive tumor cells present *___ No immunoreactive tumor cells present *___ Pending *___ Not performed
*___ Other (specify):  _____________________

*Name of antibody: ___________________
*Name of vendor: ___________________
*Type of fixative: ________________

*Microcalcifications (select all that apply) 

*Clinical History (select all that apply) 

The current clinical/radiologic breast findings for which this surgery is performed include: *___ Palpable mass *___ Radiologic finding             *___ Mass or architectural distortion             *___ Calcifications             *___ Other (specify):  _________________________ *___ Nipple discharge *___ Other (specify):  ____________________
*___ Prior history of breast cancer *Specify site, diagnosis, and prior treatment:  ______________________ *___ Prior neoadjuvant treatment for this diagnosis of DCIS *Specify type:  ______________________


For specimens with a known diagnosis of DCIS (eg, by prior core needle biopsy) it is highly recommended that the entire specimen is examined using serial sequential sampling to exclude the possibility of invasion, to completely evaluate the margins, and to aid in determining extent.  If an entire excisional specimen or grossly evident lesion is not examined microscopically, it is helpful to note the approximate percentage of the specimen or lesion that has been examined.

Ref. College of American pathologist.

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