Histopathology Report

type and side of specimen. specimen size: dimensions (cm), weight (g). tumour type.

tumour grade : I, II, III (see Table 11.1 for grading system). DCIS present: no, yes (within/around/away from tumour). DCIS type.

DCIS nuclear grade (low, intermediate, high). size of invasive component (cm). size of DCIS. size of invasive + DCIS.

nearest margin: medial, lateral, inferior, superior, deep, superficial (skin). distance from margin: invasive/DCIS.

lymphovascular invasion: not seen/present within or outside tumour.

axillary nodal status: Levels I, II and III number of nodes and number involved by metastases.

extranodal tumour deposits: yes/no. Paget's disease of nipple: yes/no. skin involvment by tumour: yes/no. TNM staging

- pTis carcinoma in situ, Paget's with no tumour.

- pT1 tumour < 20 mm. T1 mic < 1 mm. T1 a 1 mm < tumour < 5 mm. T1 b 5 mm < tumour < 10 mm. T1 c 10 mm < tumour < 20 mm.

- pT4 tumour of any size with direct extension to chest wall (ribs, intercostal muscles, serratus anterior but not pectoral muscle) or skin.

(b) oedema including peau d'orange, skin ulceration or satellite nodules in the same breast.

(d) inflammatory carcinoma - sore red breast due to tumour involvement of dermal lymphatics.

- pNx nodes cannot be assessed (not removed/previously removed).

- pN0 no regional lymph node metastasis.

- pN1 mi micrometastasis (> 0.2 mm but < 2 mm in greatest dimension).

- pN1a metastasis in 1-3 ipsilateral axillary lymph node(s) (movable).

- pN1b

internal mammary nodes with micrometastasis detected by sentinel node

dissection but not clinically apparent.

- pN1c

a + b.

- pN2a

metastasis in 4-9 ipsilateral axillary nodes (fixed).

- pN2b

metastasis in clinically apparent internal mammary nodes in the absence of axil

lary node involvement.

- pN3a

metastasis in 10 or more ipsilateral axillary nodes, or ipsilateral infraclavicular

nodes.

- pN3b

internal mammary nodes with axillary node involvement.

- pN3c

supraclavicular node metastasis.

• Prognosis

- Nottingham Prognostic Index (NPI)

- Nottingham Prognostic Index (NPI)

- < 3.4 good prognosis, 85% five-year survival.

- 3.4-5.4 intermediate prognosis, 68% five-year survival.

- >5.4 poor prognosis, 21% five-year survival.

- NPI = 0.2 x tumour size(cm) + tumour grade + nodal score.

- Nodal score - 1 node negative.

2 1-3 low axillary nodes involved.

3 4 or more nodes/apical node involved.

• Predictive factors.

- Hormone receptor status - Oestrogen (ER) and Progesterone (PR) receptors.

- Oncogene receptor status Her 2/Neu/C-erb B2.

• For scoring methods, see Tables 11.2 and 11.3.

Table 11.2. Quick score method for immunohistochemical detection of ER status

Score for proportion of cells staining

Score for staining intensity

0. no nuclear staining

2. 1-10% nuclei staining

3. 10-33% nuclei staining

4. 33-66% nuclei staining

5. 66-100% nuclei staining

0. no staining

1. weak staining

2. moderate staining

3. strong staining

Adding the two scores together gives a maximum score of 8. Data so far suggests that with this scoring system, response to hormonal therapy correlates with the following cut-off values: score 0 indicates hormonal therapy will definitely not work score 2-3 indicates a small (20%) chance of treatment response score 4-6 indicates an even (50%) chance of response score 7-8 indicates a good (75%) chance of response Where PR content has also been determined, hormonal therapy is thought worthwhile in patients with low ER but high PR .

Table 11.3. Scoring method for Her2/neu oncogene overexpression by immunohistochemistry

0: no cytoplasmic staining

Her2 negative

1+: weak cytoplasmic staining

Her2 negative

2+: moderate cytoplasmic staining

Her2 status equivocal, for *FISH testing

3+: strong cytoplasmic staining

Her2 positive

* Fluorescent in-situ hybridization.

Her2 positive cases for anti-HER2 therapy.

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