I am sending here generally how we sign out the invasive carcinoma for excision or mastectomy specimens. Below you can see what we describe in our final report. It is not neccesary for you to do the same also. Just for your referecne. I once studied and work in several hospitals in the US. Every one is different in term of the report. However, the priniciples are same.

Breast (Re-)excision/mastectomy for invasive and in situ carcinoma

SECTION A (INVASIVE CA)

-Invasive ductal carcinoma, _________,(no special type, pure mucinous type, pure tubular type etc.) type.

-Invasive ductal carcinoma, mixed __________(__%) and _________(___%) types.

-Invasive lobular carcinoma, classical type, with a solid / alveolar / trabecular growth pattern(s).

-Invasive lobular carcinoma, pleomorphic type.

-Invasive lobular carcinoma, mixed pleomorphic (___%) and classical (_____%) types.

-Invasive mixed ductal and lobular carcinoma.

SECTION B (Grade)

Nottingham Grade I / II / III (tubule formation: _____, nuclear pleomorphism: ________, mitotic activity: _______; total score: ___/9).

SECTION C (Size)

The invasive tumor measures __________cm in largest dimension (give microscopic size if it is a small tumor;  use the gross dimension for large tumor).

SECTION D (In-situ CA)

Ductal carcinoma in situ (DCIS), nuclear grade 1 / 2 / 3, solid / cribriform / papillary / micropapillary / apocrine type(s)

with minimal / moderate / comedo necrosis.

Lobular involvement by DCIS is present.

The DCIS constitutes  ____% of the total tumor mass, and is present admixed with and away from the invasive component / and is present admixed with the invasive component / and is present away from the invasive component.

The DCIS is present in _____ of ______ slides (Give this information in cases of extensive intraductal component).

Lobular carcinoma in situ (LCIS) is also identified, with pagetoid extension into ducts.

SECTION E (Lympho-vascular space Invasion)

Lympho-vascular space invasion is identified.

No lympho-vascular space invasion is noted.

SECTION F (Surgical Margins)

Negative:

Resection margins are negative for carcinoma.

Resection margins are negative for invasive carcinoma.

Resection margins are negative for ductal carcinoma in situ.

Invasive carcinoma is _____cm from the nearest ____________________marigin.

Ductal carcinoma in situ is ______cm from the nearest ____________________marigin.

Pleomorphic lobular carcinoma in situ is _______ cm from the nearest ____________________marigin.

Positive:

Rare / A few / Multiple focus/foci of invasive carcinoma extends to the ____________________ margin(s).

Rare / A few / Multiple foci of ductal carcinoma in situ extends to the _____________________ margin(s).

Rare / A few / Multiple foci of pleomorphic lobular carcinoma in situ extends to the _________________ margin(s).

Do not report the margin for classic lobular carcinoma in situ.

Negative inked margins but tumor <1mm from margin:

Inked margins are negative for carcinoma. However, rare / a few / multiple focus/foci of invasive carcinoma is/are <1mm to the _________________ margin(s).

Inked margins are negative for carcinoma. However, rare / a few / multiple focus/foci of ductal carcinoma in situ is/are <1mm to the _________________ margin(s).

Good questions:

All these procedures are to take off fragments of breast tissue by similar methods.

excisional biopsy: It is for diagnosis if breast core biopsy is papillom, atypical ductal hyperplasia, ALH, radial scar et. Previous biopsy site with surrounding breast tissue was cut off to see if there are more serious lesions such as cancer, present.

Segmental mastectomy, segmental excision, lumpectomy, partial mastectomy. all share similar meaning. Generally we call segmental mastectomy for billing. These procedures are for treatment and for clear margins when the patients have DCIS or invasive carcinoma diagnosed by core biopsy already.

Re-excision/re-segmental mastectomy (or re-excision segmentectomy): Patients have second segmental mastectomy procedure when surgical margins are positive or close to DCIS or invasive carcinoma in first segmental mastectomy specimen.Physician assistants or residents will inked segmental mastectomy or excisional biopsy specimens in 6 colors for superior, inferior, medial, lateral, anterior and posterior margins. Pathologists have to report the margin negative or positive in which margins. The surgeons know how and where they will do the re-excision.

Hope it helps.

 Continue:

Inked margins are negative for carcinoma. However, rare / a few / multiple focus/foci of pleomorphic lobular carcinoma in situ is/are <1mm to the _________________ margin(s).

墨汁标记的切缘未见癌。但是，少许/一些/多灶/局灶的多形性小叶癌距离____切缘<1mm。

SECTION G (Tumor Location, for mastectomy only)

G 肿瘤位置（仅乳房切除标本）

The invasive carcinoma is located in the UOQ / UIQ / LOQ / LIQ / central area (or give clock position).

 浸润性癌位于外上象限 / 内上象限 /外下象限 /内下象限 / 中央部位 (或提供时钟位)。

SECTION H (Nipple, for mastectomy only)

H 乳头（仅乳房切除标本）

Nipple is negative for tumor

乳头无肿瘤

The nipple epidermis is involved by ductal carcinoma in situ (Paget disease).

乳头表皮被DCIS累犯（Paget病）。

The nipple is involved by invasive carcinoma.

乳头被浸润性癌累犯。

SECTION I (Skin)

I 皮肤

Skin is negative for tumor.

皮肤无肿瘤。

The skin is involved by invasive carcinoma by direct extension.

皮肤被浸润性癌累犯，直接扩散。

The skin shows tumor emboli in the dermal lymphatic channels.

皮肤的真皮淋巴管内见肿瘤栓子。

SECTION J (Skeletal muscle)

J 骨骼肌

The attached skeletal muscle is negative for tumor.

附属的骨骼肌无肿瘤。

The attached skeletal muscle is involved by invasive carcinoma by direct extension.

附属的骨骼肌被浸润性癌累犯，直接扩散。

SECTION K (Atypical proliferation)

K 不典型增生

Atypical ductal hyperplasia.

不典型导管增生。

Atypical lobular hyperplasia.

不典型小叶增生。

SECTION L (Benign lesions)

L 良性病变

Calcifications are associated with in situ carcinoma / invasive carcinoma / and/or in benign breast parenchyma.

钙化伴原位癌/浸润癌或良性乳房间质中。

The non-neoplastic breast shows ____________________________________________.

非肿瘤性乳房呈________病变。

Previous biopsy site changes.

以前活检部位引起的改变。

SECTION M (Lymph nodes for MRM specimens only)

M 淋巴结（仅MRM标本）

_____ axillary lymph nodes, negative for metastatic tumor (0/___).

共__枚腋窝淋巴结，无转移性肿瘤（0/__）。

Metastatic carcinoma involving ______ of _______ lymph nodes (___/___).

转移性癌累犯__枚淋巴结中的__枚（__/__）。

The largest metastatic focus measures______cm.

最大转移灶大小__cm。

No extracapsular extension identified.

未见包膜外扩散。

Extracapsular extension identified.

 见包膜外扩散。

SECTION N (Receptor studies)

N 受体研究

The invasive tumor cells are _________ for Estrogen and Progesterone Receptors and _________ for HER2, as per previous pathology report (case number______________).

浸润性肿瘤细胞对ER和PR及HER2分别为__，__和__，见以前的病理报告（病例号____）。

Please do stains if not performed previously.

如果以前未做过，请做这些免疫染色。

（abin译）