INVASIVE CARCINOMA OF THE BREAST: Complete Excision (Less Than Total Mastectomy, Including Specimens Designated Biopsy, Lumpectomy, Quadrantectomy, and Partial Mastectomy With or Without Axillary Contents) and Mastectomy (Total, Modified Radical, Radical With or Without Axillary Contents)


Procedure Type:

Lymph Node Sampling:

Specimen Integrity:

Specimen Laterality:

Tumor Site: Invasive Carcinoma:


Tumor Size: Size of Largest Invasive Carcinoma

Note: The size of the invasive carcinoma should take into consideration the gross findings correlated with the microscopic examination. In some cases, it may be helpful to use information about tumor size from imaging studies. If multiple foci of invasion are present, the size listed is the size of the largest contiguous area of invasion. The size of multiple invasive carcinomas should not be added together. The size does not include adjacent DCIS.
If there has been a prior core needle biopsy or incisional biopsy showing a larger area of invasion than in the excisional specimen, the largest dimension of the invasive carcinoma in the prior specimen should be used for T classification, if known.
If there has been prior treatment and no invasive carcinoma is present, the cancer is classified as Tis if there is residual DCIS and T0 if there is no remaining carcinoma.

Tumor Focality:

Note: If there are multiple invasive carcinomas, size, grade, histologic type, and the results of studies for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu should pertain to the largest invasive carcinoma. If smaller invasive carcinomas differ in any of these features, this information may be included in the “Comments” section.

Macroscopic and Microscopic Extent of Tumor:



Skeletal Muscle:

Note: Invasion into pectoralis muscle is not considered chest wall invasion, and cancers are not classified as T4a unless there is invasion deeper than this muscle.

Ductal Carcinoma In Situ (DCIS):

Note: The size (extent) of DCIS is an estimation of the volume of breast tissue occupied by DCIS. This information may be helpful for cases with a predominant component of DCIS (eg, DCIS with microinvasion) but may not be necessary for cases of EIC negative invasive carcinomas.

Architectural Patterns:

Nuclear Grade:


Lobular Carcinoma In Situ (LCIS):

Histologic Type of Invasive Carcinoma:

Note: The histologic type corresponds to the largest area of invasion. If there are smaller foci of invasion of a different type, this information should be included under “Additional Pathologic Findings.”

Histologic Grade: Nottingham Histologic Score

Glandular (Acinar)/Tubular Differentiation:

Nuclear Pleomorphism:

Mitotic Count:

Number of mitoses per 10 high-power fields:
Diameter of microscope field (mm):

Overall Grade:

Note: The grade corresponds to the largest area of invasion. If there are smaller foci of invasion of a different grade, this information should be included under “Additional Pathologic Findings.”


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.

Pathologic Staging (based on information available to the pathologist) (pTNM)

TNM Descriptors (required only if applicable)

Primary Tumor (Invasive Carcinoma) (pT) :

For the purposes of this checklist, pT0 and pTis should only be used in the setting of preoperative (neoadjuvant) therapy for which a previously diagnosed invasive carcinoma is no longer present after treatment.
Inflammatory carcinoma is a clinical-pathologic entity characterized by diffuse erythema and edema (peau d’orange) involving one-third or more of the skin of the breast. The skin changes are due to lymphedema caused by tumor emboli within dermal lymphatics, which may or may not be obvious in a small skin biopsy. However, a tissue diagnosis is still necessary to demonstrate an invasive carcinoma in the underlying breast parenchyma or at least in the dermal lymphatics, as well as to determine biological markers, such as ER, PR, and HER2 status. Tumor emboli in dermal lymphatics without the clinical skin changes described above do not qualify as inflammatory carcinoma. Locally advanced breast cancers directly invading the dermis or ulcerating the skin without the clinical skin changes and tumor emboli in dermal lymphatics also do not qualify as inflammatory carcinoma. Thus the term inflammatory carcinoma should not be applied to neglected locally advanced cancer of the breast presenting late in the course of a patient’s disease. The rare case that exhibits all the features of inflammatory carcinoma, but in which skin changes involve less than one-third of the skin, should be classified by the size and extent of the underlying carcinoma.

Regional Lymph Nodes (pN) (choose a category based on lymph nodes received with the specimen; immunohistochemistry and/or molecular studies are not required)

If internal mammary lymph nodes, infraclavicular nodes, or supraclavicular lymph nodes are included in the specimen, consult the AJCC Cancer Staging Manual1 for additional lymph node categories.

Modifier (required only if applicable)

Category (pN):

Note: Isolated tumor cell (ITC) clusters 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.
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 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 because of 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):

Ancillary Studies

Estrogen Receptor (immunohistochemical results on invasive carcinoma performed on this specimen or a prior core needle biopsy or incisional biopsy):

Progesterone Receptor (immunohistochemical results for invasive carcinoma performed on this specimen or a prior core needle biopsy or incisional biopsy):

HER2/neu (results for invasive carcinoma performed on this specimen or a prior core needle biopsy or incisional biopsy)

Immunoperoxidase Studies:

Fluorescence In Situ Hybridization (FISH) for HER2/neu: