J Pathol Transl Med.  2021 Jan;55(1):1-15. 10.4132/jptm.2020.11.20.

Standardized pathology report for breast cancer

• Cho SY
• Park SY
• Bae YK
• Kim JY
• Kim EK
• Kim WG
• Kwon Y
• Lee A
• Lee HJ
• Lee JS
• Park JY
• Gong G
• Yoon HK

• KMID: 2511508
• DOI: http://doi.org/10.4132/jptm.2020.11.20

Abstract

Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of ‘standard data elements,’ ‘conditional data elements,’ and a biomarker report form. The ‘standard data elements’ consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the ‘conditional data elements.’ In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.

Keyword

Breast neoplasms; Diagnosis; Pathology report

Figure

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  Fig. 1. Measurement of invasive tumor size. (A) Pathologic tumor (pT) category is based on the largest diameter of invasive carcinoma. Ductal carcinoma in situ, which is present on the upper right side of the invasive carcinoma, is not included in this measurement. (B) In posttreatment samples, the pT category (ypT) is based on the diameter of the largest contiguous focus (bar) of residual invasive carcinoma.

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  Fig. 2. Histological grades of invasive breast carcinoma of no special type: (A) grade 1, (B) grade 2, and (C) grade 3.

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  Fig. 3. Extensive intraductal component-positive invasive carcinoma. (A) Ductal carcinoma in situ (DCIS) constitutes ≥25% of the area of invasive carcinoma and also is present outside the area of invasive carcinoma. (B) A small invasive carcinoma is present in background of extensive DCIS.

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  Fig. 4. Skin involvement in invasive breast carcinoma. (A) Tumor cells infiltrate into the upper dermis in the absence of ulceration. These cases should not be classified as pT4b category. (B) There is an ulceration of overlying epidermis accompanied by tumor extension, corresponding to the pT4b category.

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  Fig. 5. Classification of lymph node metastases. (A) Multiple clusters of tumor cells. N category is based on the size of the largest contiguous cluster of tumor cells. (B) Dispersed pattern of metastasis. Some lobular carcinomas may metastasize as single cells and may not form cohesive clusters. If more than 200 tumor cells are present in a node cross section, then the category of micrometastasis is recommended. (C) Isolated tumor cells. A dispersed pattern of lobular carcinoma with fewer than 200 cells is detected by cytokeratin immunohistochemistry. (D) Macrometastasis with extranodal extension. This metastasis is classified as a macrometastasis based on the size of cluster (>2 mm). Extranodal extension, an area of invasion outside the lymph node capsule (arrow), is noted.

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  Fig. 6. Different levels of tumor-infiltrating lymphocyte (TIL) infiltration in invasive breast carcinoma: (A) TIL <10%, (B) TIL 10%–50%, and (C) TIL > 50%.

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  Fig. 7. Representative examples of estrogen receptor (ER) expression assessed by immunohistochemistry in invasive breast carcinoma: (A) ER negative, (B) ER positive, and (C) ER low positive.

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  Fig. 8. Representative examples of human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) scores in invasive breast carcinoma: (A) HER2 IHC score 0, (B) HER2 IHC score 1+, (C) HER2 IHC score 2+, and (D) HER2 IHC score 3+.

Reference

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