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INVASIVE BREAST CANCER WORK AID Patient Name: Hospital #: Case/Accession #: Diagnosis: Specimen Laterality: Right Left Not specified Margins: Margins cannot be assessed Procedure: Excision w/o wire-guided loc Margins uninvolved by invasive carcinoma Total mastectomy Distance from closest margin: ______ mm *Specify margin_______________ Excision w/ wire-guided loc. Other: _____________________ Margins involved by invasive carcinoma (*Specify margins and extent) Lymph Node Sampling: (required only when lymph nodes are *Superior ________ *Medial ________ *Anterior ________ present) *Inferior ________ *Lateral ________ *Posterior ________ Margins uninvolved by DCIS No lymph nodes Axillary dissection Sentinel lymph node(s) Lymph node(s) present w/in breast Other: ____________________________________________________ Invasive Carcinoma Size: ________ mm Cannot be determined carcinoma is present) Indeterminate Multiple* # of foci _________ Skin invasion w/o ulceration Skin ulceration *Medial ________ *Anterior ________ *Inferior *Lateral ________ *Posterior ________ _______ _____ # SLNs Examined ______ # LNs w/ Micromets _____ # Total LNs examined ______ # LNs w/ ITCs ______ # LNs w/out tumor cells _____ # LNs w/ Macromets Chest wall beyond pectoralis invasion m r y pT ______ pM (if present) ______ completion) In Situ Component: Estrogen (ER) Receptor: None Present Not performed Pending Percentage of cells with nuclear immunoreactivity: ________________ % DCIS Ductal Lobular Only microinvasion present Intensity of staining: Positive Mixed ductal and lobular Negative Absent Other (specify): ____________________________ Score 1 Positive Score 2 Score 3 Only microinvasion present No residual invasive carcinoma after neoadjuvant therapy Score cannot be determined 1 (>75% tubules) 2 (10 to 75% tubules) 3 (<10 tubules) Only microinvasion present (not graded) 1 Pending Absent Weak Medium Strong Other: _____________________________ Not performed Pending Negative (Score 0) Negative (Score 1+) Equivocal (Score 2+) Positive (Score 3+) Other: ___________ Unknown Not Amplified Not performed Pending Equivocal Amplified *Average number of chromosome 17 per cell: ____________ Unknown 2 Not performed *Ratio: ____________________________________________ Mitotic Rate: 3 Strong *Average number of HER2 gene copies per cell: ___________ No residual invasive carcinoma after neoadjuvant therapy Score cannot be determined Nuclear Pleomorphism: Negative Her-2/Neu IHC: Her-2/Neu FISH: Glandular/Tubular Differentiation: Medium Percentage of cells with nuclear immunoreactivity: ________________ % Intensity of staining: Histologic Grade (SBR/Nottingham): Weak Other: _____________________________ Progesterone (PgR) Receptor: 2 pN ______ Ancillary Studies: (required only if available at time of report Nipple Paget disease 1 ______Size of largest metastatic deposit (if present) Pathologic Staging: (Descriptors: m-multiple, r-recurrent, y-post tx) Skin Satellite nodules Histologic Type: *Superior _______ *size of largest focus: _____________ Extent of Tumor: (required only if structures are present and involved) Pectoralis muscle invasion Margins involved by DCIS (*Specify margins and extent) Lymph nodes (if present): Tumor Focality: (required only if more than 1 focus of invasive Single Distance from closest margin: ______ mm *Specify margin_______________ 3 Other: _______________________________________ Comments: Only microinvasion present No residual cancer after neo tx Score cannot be determined If the patient has received neo-adjuvant therapy, or if only microinvasion is present, refer to the Invasive Breast Carcinoma protocol. * Data elements with asterisks are not required. Breast Work Aid 3.1.0.0 Synoptic Report Example BREAST CARCINOMA Specimen laterality: Specimen: Procedure: Lymph node sampling: Invasive carcinoma size: Tumor focality: Extent of tumor Skin Chest wall In situ component: Histologic type: Histologic grade: Nuclear score: Tubule score: Mitosis score: Margins Invasive carcinoma Right Partial breast Excision with wire guided localization Sentinel lymph node(s), Axillary dissection 1.5 mm Single No skin present No skeletal muscle present DCIS present, EIC positive Ductal 2 (6 -7 points) 2 2 2 Margins uninvolved by invasive carcinoma Distance from closest margin: 4 mm Margin(s) positive for DCIS DCIS Lymph nodes # of Sentinel LNs 4 # of Total LNs 9 # of LNs with macrometastases 3 # of LNs with micrometastases 1 # of LNs with ITCs 1 Size of largest metastasis 8 mm Pathologic TNM classification: pT1c pN2a Estrogen and Progesterone Receptors ER Percentage of cells with nuclear immunoreactivity: Intensity of staining: Interpretation: PgR Percentage of cells with nuclear immunoreactivity: Intensity of staining: Interpretation: HER2/neu Immunohistochemistry Result: Negative (score 0) HER2/neu FISH Result: Not amplified 30% Medium Positive 20% Medium Positive Pathologic Staging [AJCC 7th edition TNM Staging System] Key: Primary Tumor (Invasive Carcinoma) (pT) pTX: Primary tumor cannot be assessed pT0: No evidence of primary tumor pTis (DCIS): Ductal carcinoma in situ pTis (LCIS): Lobular carcinoma in situ pTis (Paget): Paget disease of the nipple not associated with invasive carcinoma and/or carcinoma in situ (DCIS and/or LCIS) in the underlying breast parenchyma pT1: Tumor ≤20 mm in greatest dimension pT1mi: Tumor ≤1 mm in greatest dimension (microinvasion) pT1a: Tumor >1 mm but ≤5 mm in greatest dimension pT1b: Tumor >5 mm but ≤10 mm in greatest dimension pT1c: Tumor >10 mm but ≤20 mm in greatest dimension pT2: Tumor >20 mm but ≤50 mm in greatest dimension pT3: Tumor >50 mm in greatest dimension pT4: Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules). Note: Invasion of the dermis alone does not qualify as pT4. pT4a: Extension to chest wall, not including only pectoralis muscle adherence/invasion pT4b: Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d’orange) of the skin which do not meet the criteria for inflammatory carcinoma pT4c: Both T4a and T4b pT4d: Inflammatory carcinoma Regional Lymph Nodes (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 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 (RTPCR), 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) Distant Metastasis (M) 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 ≤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 >0.2 mm Breast Work Aid 3.1.0.0