Breast cancinoma

Invasive carcinoma of the breast click to access explanations in the original CAP template

There is different protocol for biopsy specimen

Microscopic descriptions:

- Tumor histology and immunohistochemical studies:

- Histologic type (2019):
+ Tumor focality:
- Histologic grade (Nottingham) :
	- Glandular (acinar)/tubular differentiation :
	- Nuclear pleomorphism :
	- Mitotic rate (22 mm eyepiece, 40x) :
- Tumor extension:
	- Skin :
	- Nipple :
	- Skeletal muscle :
- Lymphatic and/or vascular invasion:
+ Dermal lymphatic and/or vascular invasion:
+ Perineural invasion:
- Treatment effect in the breast:
- Treatment effect in LN:
+ Residual Cancer Burden: MD Anderson Calculator 1. Primary tumor bed area 2. Lymph node Protocol Symmans et al. 2007
	RCB:
	Class:
	Primary tumor bed area (mm x mm) :
	Overall cancer cellularity (area%) :
	in situ (area%) :
	No. of positive LN :
	Largest LN metastasis (mm) :
- Ductal carcinoma in situ:
	+ Size of DCIS (mm x mm x mm) :
	+ Number of blocks with DCIS :
	+ Number of blocks examined :
	+ Nuclear grade:
	+ Necrosis:
	+ Architectural patterns of ductal carcinoma in situ: Comedo Paget disease Cribriform Micropapillary Papillary Solid Other, specify:
	+ Lobular carcinoma in situ:
+ Microcalcifications:	Not identified Present in DCIS Present in invasive carcinoma Present in non-neoplastic tissue Other (specify):

+ Anxillary tests for reporting of ER, PR, Ki-67, HER2 IHC, HER2 DISH and PD-L1.

Surgical margins for invasive tumor (at least one closest margin):

- Anterior margin:
- Posterior margin:
- Superior margin:
- Inferior margin:
- Medial margin:
- Lateral margin:
- Other margins (specify):

Surgical margins for DCIS (at least one closest margin):

- Anterior margin:
- Posterior margin:
- Superior margin:
- Inferior margin:
- Medial margin:
- Lateral margin:
- Other margins (specify):

Regional lymph nodes:

- Number of regional lymph nodes examined:
- Number of sentinel lymph nodes examined:
- Number of lymph nodes with macrometastasis (>2 mm):
- Number of lymph nodes with micrometastasis (> 0.2 to 2 mm and/or > 200 cells):
- Number of lymph nodes with isolated tumor cells (0.2 mm or less and < or = 200 cells):
- Size of largest metastatic deposit (mm), specify site:
- Size of largest lymph node involved (mm), specify site:
- Extranodal extension:

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.

Distant Metastasis: Not applicable Not identified Non-regional lymph node(s) (specify): Lung (specify): Liver (specify): Bone (specify): Brain (specify): Other (specify): Cannot be determined:

Pathologic Stage Classification (AJCC 8e):

- TNM Descriptors:	m (multiple foci of invasive carcinoma) r (recurrent) y (post treatment)
- Primary tumor (pT):
- Regional lymph nodes modifier:	sn Sentinel node(s) evaluated (< 6 lymph nodes) f Nodal metastasis confirmed by FNA or biopsy
- Regional lymph nodes (pN):
- Distant metastasis (pM):

- Additional notes: