DCIS OF THE BREAST

Specimen:
Partial breast
Total breast (including nipple and skin)
Other (specify):
Not specified

Procedure Type:
Excision without wire-guided localization
Excision with wire-guided localization
Total mastectomy (including nipple and skin)
Other (specify):
Not specified

Lymph Node Sampling:
   No lymph nodes present
   Sentinel lymph node(s)
   Axillary dissection (partial or complete dissection)
   Lymph nodes present within the breast specimen (ie, intramammary lymph nodes)
   Other lymph nodes (eg, supraclavicular or location not identified):

Specimen Integrity:
Single intact specimen (margins can be evaluated)
Multiple designated specimens (eg, main excisions and identified margins)
Fragmented (margins cannot be evaluated with certainty)
Other (specify):

Specimen Size (for excisions less than total mastectomy)
   Greatest dimension (cm):
   Additional dimensions: x cm
   Cannot be determined

Specimen Laterality:
Right
Left
Not specified

Tumor Site:
   Upper outer quadrant
   Lower outer quadrant
   Upper inner quadrant
   Lower inner quadrant
   Central
   Nipple

Position:
o’clock
Other (specify):
Not specified

Size (Extent) of DCIS:
   Estimated size (extent) of DCIS (greatest dimension using gross and microscopic evaluation): at least cm
   Additional dimensions: x cm
   Number of blocks with DCIS:
   Number of blocks examined:
   Note: The size (extent) of DCIS is an estimation of the volume of breast tissue occupied by DCIS.

Histologic Type: Ductal carcinoma in situ,
Tis (DCIS)
Tis (Paget)

Architectural Patterns:
   Comedo
   Paget disease (DCIS involving nipple skin)
   Cribriform
   Micropapillary
   Papillary
   Solid
   Other (specify:)

Nuclear Grade:
Grade I (low)
Grade II (intermediate)
Grade III (high)

Necrosis:
Not identified
Present, focal (small foci or single cell necrosis)
Present, central (expansive “comedo” necrosis)

Margins:
   Margins cannot be assessed
   Margin(s) uninvolved by DCIS:
       Distance from closest margin: mm
       Distance from superior margin: mm
       Distance from inferior margin: mm
       Distance from medial margin: mm
       Distance from lateral margin: mm
       Distance from anterior margin: mm
       Distance from posterior margin: mm
       Distance from : mm
   Margin(s) positive for DCIS:
       Superior margin:
        Focal
        Minimal/moderate
        Extensive
       Inferior margin:
        Focal
        Minimal/moderate
        Extensive
       Medial margin:
        Focal
        Minimal/moderate
        Extensive
       Lateral margin:
        Focal
        Minimal/moderate
        Extensive
       Anterior margin:
        Focal
        Minimal/moderate
        Extensive
       Posterior margin:
        Focal
        Minimal/moderate
        Extensive

Treatment Effect: Response to Presurgical (Neoadjuvant) Therapy:
No known presurgical therapy
No definite response to presurgical therapy
Probable or definite response to presurgical therapy

Lymph Nodes:
       Number of sentinel nodes examined:
       Total number of nodes examined (sentinel and nonsentinel):
       Number of lymph nodes with macrometastases (>0.2 cm):
       Number of lymph nodes with micrometastases (>0.2 mm to 0.2 cm and/or >200 cells):
       Number of lymph nodes with isolated tumor cells (<0.2 mm and =200 cells):
       Size of largest metastatic deposit (if present) (cm):
       Note: The sentinel node is usually the first involved lymph node. In the unusual situation in which a sentinel node is not involved by metastatic carcinoma, but a nonsentinel node is involved, this information should be included in a note.

Extranodal extension:
    Present
    Not identified
    Indeterminate

Method of Evaluation of Sentinel Lymph Nodes:
       Hematoxylin and eosin (H&E), 1 level
       H&E, multiple levels
       Immunohistochemistry
       Sentinel lymph node biopsy not performed
       Other (specify):

Pathologic Staging (pTNM)

TNM Descriptors (required only if applicable) (select all that apply)
r (recurrent)
y (post-treatment)

Primary Tumor (pT):
pTis (DCIS): Ductal 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.
Note: If there has been a prior core needle biopsy, the pathologic findings from the core, if available, should be incorporated in the T classification. If invasive carcinoma or microinvasion were present on the core, the protocol for invasive carcinomas of the breast1 should be used and should incorporate this information.

Regional Lymph Nodes (pN) (choose a category based on lymph nodes received with the specimen; immunohistochemistry and/or molecular studies are not required)
Note: If internal mammary lymph nodes, infraclavicular nodes, or supraclavicular lymph nodes are included in the specimen, consult the AJCC Staging Manual for additional lymph node categories.

Modifier (required only if applicable)
(sn) Only sentinel node(s) evaluated. If 6 or more sentinel nodes and/or nonsentinel nodes are removed, this modifier should not be used.

Category (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 Note: Isolated tumor cell clusters (ITC) are defined as small clusters of cells not greater than 0.2 mm or single tumor cells, or a cluster of fewer than 200 cells in a single histologic cross-section.# ITCs may be detected by routine histology or by immunohistochemical (IHC) methods. Nodes containing only ITCs are excluded from the total positive node count for purposes of N classification but should be included in the total number of nodes evaluated.
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 (RT-PCR), 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)

# 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 (M):
Not applicable
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 no larger than 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 larger than 0.2 mm

Note: The presence of distant metastases in a case of DCIS would be very unusual. Additional sampling to identify invasive carcinoma in the breast or additional history to document a prior or synchronous invasive carcinoma is advised in the evaluation of such cases.

Additional Pathologic Findings:

Ancillary Studies

Estrogen Receptor (results of special studies performed on this specimen or a prior core needle biopsy):
Immunoreactive tumor cells present
No immunoreactive tumor cells present
Pending
Not performed
Other (specify):

   Name of antibody:
   Name of vendor:
   Type of fixative:

Progesterone Receptor (results of special studies performed on this specimen or a prior core needle biopsy):
Immunoreactive tumor cells present
No immunoreactive tumor cells present
Pending
Not performed
Other (specify):

   Name of antibody:
   Name of vendor:
   Type of fixative:

Microcalcifications:
   Not identified
   Present in DCIS
   Present in non-neoplastic tissue
   Present in both DCIS and non-neoplastic tissue

Clinical History:
The current clinical/radiologic breast findings for which this surgery is performed include:
   Palpable mass
   Radiologic finding:
       Mass or architectural distortion
       Calcifications
       Other (specify):
   Nipple discharge
   Other (specify):
   Prior history of breast cancer: Specify site, diagnosis, and prior treatment
   Prior neoadjuvant treatment for this diagnosis of DCIS:

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