Table 2.

Example of pathologic report form in breast cancer after neoadjuvant therapy

Pathologic report form
Gross finding
Residual identified tumor: yes/no
Quadrant of tumor
Multifocality: yes/no
Size of residual tumor: xx mm
Identified clip of marker: yes/no
Microscopic finding
Histologic diagnosis: invasive carcinoma, NST
Histologic grade: I/II/III (tubule score–nuclear grade–mitosis score)
Size of residual tumor bed: x mm
Size of the largest residual invasive carcinoma: x mm
Residual tumor cellularity: %
Lymphovascular invasion: absent/present
DCIS component: yes/no
Total tumor size including DCIS: x mm
Extensive intraductal component: yes/no
Type: cribriform/micropapillary/solid/papillary
Nuclear grade: low/intermediate/high
Necrosis: absent/present (focal/commedo)
ER/PR/HER-2 status: optional
Resection margin
Invasive carcinoma: absent/present; distance to the closest margin
DCIS: absent/present; distance to the closest margin
Tumor bed: absent/present
Lymph node status
Number of sentinel lymph nodes
Number of total axillary lymph nodes
Number of lymph nodes with macrometastasis
Size of largest metastasis: mm
Number of lymph nodes with micrometastasis
Number of lymph nodes with isolated tumor cells
Number of lymph nodes with histologic evidence of treatment response but no tumor cells
Extracapsular extension: yes/no

NST, no specific type; DCIS, ductal carcinoma in situ; ER, estrogen receptor; PR, progesterone receptor; HER-2, human epidermal growth factor receptor-2.