Breast
General
Features to report
Author: Monika Roychowdhury, M.D.
Topic Completed: 1 August 2012
Minor changes: 21 June 2020
Revised: 30 January 2019
Copyright: (c) 2001-2019, PathologyOutlines.com, Inc.
Editor's note
Cite this page: Roychowdhury M Features to report. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantreport.html. Accessed August 7th, 2020.
Definition / general
Required features to report
- Specimen type / procedure
- Lymph node sampling (specify)
- Specimen size (third dimension is not required)
- Laterality (if known)
- Tumor site (if known)
- Invasive tumor size (at least one dimension is required)
- Invasive tumor histologic type
- Invasive tumor grade (Nottingham modification of Bloom-Richardson), including tubule formation, nuclear pleomorphism and mitotic activity (should grade lobular carcinoma and colloid carcinoma, do not need to grade medullary carcinoma)
- Note: if another grading system is used, must still specify mitotic count
- TNM staging
- Number of lymph nodes examined, number involved by tumor, maximal metastasis size and presence of extracapsular spread
- Margins (distance of invasive and in situ tumor from closest margin, specify margin)
Optional features to report, but recommended
- Angiolymphatic invasion (note: tumor in dermal lymphatics may be due to benign mechanical transport, Hum Pathol 2005;36:310)
- Perineural invasion
- Involvement of nipple, skin (epidermis or dermis) and chest wall
- Multifocality
- Presence of microcalcifications and correlation with mammography
- Correlation of other findings with mammography
- Extent of margin involvement (if positive)
- DCIS (particularly if no invasive carcinoma present): size, morphologic type (architectural pattern), nuclear grade (high, intermediate, low), presence of comedocarcinoma (necrosis) and % of carcinoma represented by DCIS (25% or more is "extensive"); also margin involvement (focal or diffuse and distance to margin), presence of microcalcifications (within DCIS or elsewhere) and correlate with mammographic findings
- For invasive carcinoma: % of cells staining for ER and PR and intensity of staining (weak, moderate, strong)
- For invasive carcinoma: HER2 staining (0 / negative, 1+ / weak, 2+ / partial circumferential staining and 3+ / strong circumferential staining visible at low power)
- Fibrocystic disease
- Presence of ADH, ALH or LCIS
Optional features to report
- Fibrotic focus
- Presence of extensive tumor necrosis
- Host lymphocytic response (Am J Surg Pathol 2003;27:194)
Quality of reporting
- Improved in Australia after guidelines were issued; synoptic reports are more complete (Pathology 2009;41:361)
Templates
Microscopic (histologic) images
AFIP images
DCIS close to inked margin
DCIS with a positive margin
DCIS at (or a basement
membrane away from)
the inked margin
Additional references
