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In order to assist with optimal management of patients with breast cancer, the oncologists in British Columbia have requested the following information to be included in pathology reports. For the convenience of the reporting pathologist, the required information is presented in the form of a checklist. This information may be incorporated in the standard report format or may be listed in the form of a synoptic report.

Gross Assessment

SIDE : RIGHT/LEFT – (if bilateral please describe each side individually).

SPECIMEN TYPE: FNA, NEEDLE CORE BIOPSY, SURGICAL BIOPSY (incisional/excisional), WIDE EXCISION/PARTIAL MASTECTOMY, TOTAL MASTECTOMY +/- axillary dissection

MEASUREMENT OF SPECIMEN:

PRESENCE OR ABSENCE OF TUMOR:

NUMBER OF TUMORS: solitary/ multiple

SIZE OF TUMOR: please measure in 3 dimensions.

GROSS RELATIONSHIP OF TUMOR TO MARGINS: measurement to closest margin

GROSS INVOLVEMENT OF SKIN OR SKELETAL MUSCLE

Histological Assessment

HISTOLOGICAL DIAGNOSIS: state any specific type of carcinoma.

SIZE: check if greater than gross estimate; use a micrometer if possible.

GRADE: note - see below

LYMPHATIC INVASION OUTSIDE THE TUMOR: YES / NO

VENOUS INVASION: YES / NO

NEURAL INVASION: note - see below

MARGINS (Invasive ca.):
- STATE DISTANCE OF CLOSEST MARGIN

- STATE WHICH MARGIN, IF POSSIBLE SKELETAL MUSCLE:

STATE IF INVADED SKIN:
- ULCERATION
- DERMAL INVASION
- DERMAL LYMPHATIC INVASIONNIPPLE:
- PAGET’S DISEASE
- STROMAL INVASION

ESTROGEN RECEPTOR STATUS: (see below)

INTRADUCTAL COMPONENT: PRESENT/ABSENT
- PATTERN OF DCIS (Type)
- GRADE OF DCIS
- EIC PATTERN : YES/NO (see below)
- FOR DCIS ALONE, MEASUREMENT OF SIZE IS IMPORTANT
- MARGIN STATUS: measure distance of DCIS to closest margin

CALCIFICATION IN THE TUMOR (or DCIS): YES/NO

LYMPH NODES: TOTAL NUMBER

HANDLING OF SPECIMENS

All specimens should be measured and margins inked. All wire-guided biopsies and wide excisions short of complete mastectomy should be processed in entirety.

Label all blocks separately and designate each block as to site in the gross description.(e.g. Block A = Nipple; B-E = Tumour; F = deep margin etc.). Blocks from wire-guided biopsies and wide excisions should be taken sequentially so the size of the DCIS component can be assessed.

Margin status:- State how the block is taken in relation to the margin. Usually blocks are taken perpendicular to the margin but if taken "en face" this must be recorded in the dictation or on a specimen diagram.

Submit all lymph nodes and state the number included in each cassette. In general the entire node should be processed.

Frozen sections should be avoided if possible - especially on lesions, which measure <1cm. in diameter.