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Invasive Carcinoma of the Breast

Histopathology Reporting Guide

Family/Last name Date of birth

DD – MM – YYYY
Given name(s)

Patient identifiers Date of request Accession/Laboratory number

DD – MM – YYYY
Elements in black text are CORE. Elements in grey text are NON-CORE.
SCOPE OF THIS DATASET
indicates multi-select values indicates single select values

CLINICAL INFORMATION Known genetic predisposition

Information not provided Information not provided None

Presentation mode Gene predisposition, specify

Information not provided

Screening
Symptomatic Other clinical information, specify
Current clinical findings for which this surgery is
performed (select all that apply)
Information not provided Paget disease of the nipple
Nipple discharge Palpable mass
Other, specify
a
OPERATIVE PROCEDURE

Not specified
Prior presurgical therapy for this diagnosis of invasive Excision (less than total mastectomy)
breast carcinoma
Diagnostic excision/excision biopsy/localisation biopsy
Information not provided No
Therapeutic wide local excision
Yes (a separate dataset is to be used in the setting of
neoadjuvant therapy) Duct excision/microdochectomy
Re-excision
Prior history of breast cancer
Total mastectomy
Information not provided No
Simple mastectomy
Yes, specify laterality, site(s), diagnosis, and prior
treatment(s) Nipple-sparing mastectomy
Skin-sparing mastectomy
Modified radical mastectomy
Radical mastectomy
Additional specimens, specify

Imaging modality (select all that apply)

Information not provided None
Mammography Ultrasound
Magnetic resonance imaging (MRI)
a
If a lymph node staging specimen is submitted, then a separate dataset
Other, specify is used to record the information.

SPECIMEN LATERALITY
Radiological findings (select all that apply)
Left Right Not specified
Information not provided None
Single lesion Multiple lesions
Calcifications Architectural distortion SPECIMEN DIMENSIONS
Mass
Other, specify mm x mm x mm

SPECIMEN WEIGHT
Extent by imaging, if available mm
g
Clip inserted Yes No Not known

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Version 2.1 Published June 2022 ISBN: 978-1-922324-35-1 Page 1 of 6
© 2022 International Collaboration on Cancer Reporting Limited (ICCR).
 Invasive Carcinoma of the Breast

c
SPECIMEN DETAILS HISTOLOGICAL TUMOUR TYPE
(Value list based on the World Health Organization
Depth of tissue excised Classification of Breast Tumours (2019))
Skin to deep fascia Yes No
No residual invasive carcinoma
Specimen includes (select all that apply) Invasive breast carcinoma of no special type (invasive
e
Skin ductal carcinoma, not otherwise specified)
Nipple Invasive lobular carcinoma
Skeletal muscle Tubular carcinoma
Cribriform carcinoma
TUMOUR SITE (select all that apply) Mucinous carcinoma
Invasive micropapillary carcinoma
Not specified
Carcinoma with apocrine differentiation
Distance from nipple mm Metaplastic carcinoma
f
AND Mixed, specify subtypes present
Position, specify o’clock
OR
Other, specify
Upper outer quadrant
Lower outer quadrant
Upper inner quadrant
e
Lower inner quadrant Refer to Note for details of variants including medullary carcinoma.
f
Central Tumour exhibiting more than one tumour type should be designated
mixed and the types present stated.
Nipple
Other, specify
HISTOLOGICAL TUMOUR GRADE

No residual invasive carcinoma

Grade 1 (scores of 3, 4, or 5)
TUMOUR FOCALITY Grade 2 (scores of 6 or 7)
Grade 3 (scores of 8 or 9)
Cannot be assessed
Single focus of invasive carcinoma
Multiple foci of invasive carcinoma Tubule score 1,2,3
Number of foci
Cannot be assessed Nuclear pleomorphism 1,2,3

Mitotic count

per mm2
is at least
OR
b
Sizes of individual foci
per 10 HPF (field diameter ____ mm)

b
Score 1,2,3
Record the largest measurement of individual foci in millimetres. If there
are many foci a range may be included.

Total score
TUMOUR DIMENSIONS
c
Only microinvasion present (not graded)
No residual invasive carcinoma
c Score cannot be determined, specify
Only microinvasion present (≤1 mm)
Maximum dimension of largest invasive
focus >1 mm (specify exact measurement mm
d
rounded to nearest mm)
CARCINOMA IN SITU
Additional dimensions
of largest invasive mm x mm Not identified
focus
Present (select all that apply)
Maximum dimension of whole tumour field Ductal carcinoma in situ (DCIS)
(invasive + DCIS)/total extent of disease mm
Negative for extensive intraductal component (EIC)
Cannot be assessed, specify Positive for EIC
Paget disease of the nipple
Encapsulated papillary carcinoma
c Solid papillary carcinoma in situ
For microinvasive disease refer to the DCIS, variants of LCIS and low
grade lesions dataset. Lobular carcinoma in situ (LCIS)
d
Based on a combination of macroscopic and microscopic assessment.

Use of this dataset is only permitted subject to the details described at: Disclaimer - International Collaboration on Cancer Reporting (iccr-cancer.org)
Version 2.1 Published June 2022 ISBN: 978-1-922324-35-1 Page 2 of 6
© 2022 International Collaboration on Cancer Reporting Limited (ICCR).
 i
CLASSIFICATION OF CARCINOMA IN SITU (if present) MARGIN STATUS
(For wide local excision specimens and similar non-complete
Histological nuclear grade mastectomy specimens)
(Applicable to DCIS, encapsulated papillary carcinoma and Cannot be assessed, specify
solid papillary carcinoma in situ)
Grade 1 (Low)
Grade 2 (Intermediate)
Grade 3 (High) Invasive carcinoma
Involved (select all that apply)
Histological architectural pattern (select all that apply)
Anterior (superficial)
(Applicable to DCIS only)
Specify extent
Cribriform
Micropapillary Posterior (deep)
Papillary Specify extent
Solid
Other (e.g., clinging/flatg), specify Superior
Specify extent

Inferior
g
Applies to high nuclear grade DCIS only. Specify extent

Medial
Necrosis
Specify extent
Not identified
Present Lateral

Central (Comedo) necrosis Specify extent

Focal (Punctate) necrosis (<10% duct diameter)
Other margin,
specify
Classification of LCIS (select all that apply)
(Applicable if LCIS is present in specimen)
Specify extent
Classical LCIS
Pleomorphic LCIS
Not involved
Florid LCIS
Other, specify Specify closest
margin, if possible

Distance of invasive carcinoma to closest margin

TUMOUR EXTENSION
h mm (< or > may be used)

Skin Cannot be determined, specify

Skin is not present
Skin is present and uninvolved
Invasive carcinoma directly invades into the dermis or
epidermis without skin ulceration Distance of invasive carcinoma to other margins
(< or > may be used)
Invasive carcinoma directly invades into the dermis or
epidermis with skin ulceration (classified as pT4b) Anterior (superficial) mm
Satellite skin foci of invasive carcinoma are present
(i.e., not contiguous with the invasive carcinoma in the
breast) (classified as pT4b) Posterior (deep) mm

Nipple (including areola complex)

Superior mm
Nipple tissue is not present
DCIS does not involve the nipple epidermis
Inferior mm
DCIS involves nipple epidermis (Paget disease of the
nipple)
Medial mm
Skeletal muscle

Skeletal muscle is not present

Lateral mm
Skeletal muscle is free of carcinoma
Tumour involves skeletal muscle
Other margin,
Tumour involves both skeletal muscle and chest wall mm
specify
(classified as pT4a)
h i
Where there is disease extension to involve skin, nipple or skeletal Core for all wide local excision specimens, similar non-complete
muscle, disease extent classification is a core element; in all other mastectomy and some (refer to Note) complete mastectomy specimens.
cases it is non-core.

Use of this dataset is only permitted subject to the details described at: Disclaimer - International Collaboration on Cancer Reporting (iccr-cancer.org)
Version 2.1 Published June 2022 ISBN: 978-1-922324-35-1 Page 3 of 6
© 2022 International Collaboration on Cancer Reporting Limited (ICCR).
 Invasive Carcinoma of the Breast

j i
DCIS MARGIN STATUS
(For complete mastectomy specimens)
Involved (select all that apply)
Anterior (superficial) Cannot be assesessd, specify

Specify extent
Involved by invasive carcinoma, specify margin/sites of
Posterior (deep) Invasive carcinoma
involvement
Specify extent Involved, specify margin/sites of involvement
Superior
Specify extent

Inferior
Specify extent
Not involved
Medial
Specify closest
Specify extent
margin, if possible
Lateral
Distance of invasive carcinoma to closest margin
Specify extent
mm (< or > may be used)
Other margin,
specify
Cannot be determined, specify

Specify extent

Not involved
j
DCIS
Specify closest
margin, if possible Involved, specify margin/sites of involvement

Distance of DCIS to closest margin

mm

Cannot be determined, specify Not involved

Specify closest
margin, if possible

Distance of DCIS to other margins (< or > may be used) Distance of DCIS to closest margin

Anterior (superficial) mm (< or > may be used)

mm

Posterior (deep) mm Cannot be determined, specify

Superior mm

i
Core for all wide local excision specimens, similar non-complete
Inferior mm mastectomy and some (refer to Note) complete mastectomy specimens.

Medial mm LYMPHOVASCULAR INVASION IN PRIMARY BREAST

CARCINOMA
Lateral mm Not identified
Present
Other margin, Specify extent
mm
specify

j
Required only if DCIS or florid LCIS or pleomorphic LCIS is also present in
specimen. Indeterminate

Lymphovascular invasion identified elsewhere, specify

Use of this dataset is only permitted subject to the details described at: Disclaimer - International Collaboration on Cancer Reporting (iccr-cancer.org)
Version 2.1 Published June 2022 ISBN: 978-1-922324-35-1 Page 4 of 6
© 2022 International Collaboration on Cancer Reporting Limited (ICCR).
 Invasive Carcinoma of the Breast

COEXISTENT PATHOLOGY PROGESTERONE RECEPTOR (PR)

None identified Antibody clone,

Present, specify specify

Testing performed on Core biopsy Current specimen

Positive
k
Percentage of cells with nuclear positivity

% OR Range
MICROCALCIFICATIONS (select all that apply) (Note 14)
1-10%
Not identified
11-20%
Present in DCIS
21-30%
Present in invasive carcinoma
31-40%
Present in non-neoplastic tissue
41-50%
Other, specify
51-60%
61-70%
71-80%
81-90%
91-100%

ESTROGEN RECEPTOR (ER) AND

Antibody clone, Average intensity of staining

specify Weak
Testing performed on Core biopsy Current specimen Moderate
Strong
Positive
Low positive Negative (less than 1% nuclear positivity)
For both options above specify percentage of cells with Internal control cells present and stain as expected
k
nuclear positivity Internal control cells absent
Other, specify
% OR Range
l
1-10%
11-20%
21-30% Cannot be determined
31-40%
Internal control cells present; no immunoreactivity
41-50% of either tumour cells or internal controls
51-60% Other, specify
61-70%
71-80%
81-90%
91-100%
HER2
AND
Average intensity of staining Antibody clone,
specify
Weak
Moderate Testing performed on Core biopsy Current specimen
Strong By immunohistochemistry
Negative (less than 1% nuclear positivity) Not performed
Internal control cells present and stain as expected Negative (Score 0)
Internal control cells absent Negative (Score 1+)
Other, specify Equivocal (Score 2+)
Positive (Score 3+)
Percentage of cells with uniform,
%
Cannot be determined intense, complete membrane staining

Internal control cells present but no immunoreactivity Cannot be determined, specify

of either tumour cells or internal controls
Other, specify

k
Percentage of cells with nuclear positivity may be reported as a specific
number or a range if more than 10%.
l
Classified as low ER positive.

Use of this dataset is only permitted subject to the details described at: Disclaimer - International Collaboration on Cancer Reporting (iccr-cancer.org)
Version 2.1 Published June 2022 ISBN: 978-1-922324-35-1 Page 5 of 6
© 2022 International Collaboration on Cancer Reporting Limited (ICCR).
 m
HER2 continued PATHOLOGICAL STAGING (UICC TNM 8th edition)

By in situ hybridization TNM Descriptors (only if applicable) (select all that apply)
Not performed m - multiple foci of invasive carcinoma
Negative (not amplified) r - recurrent
Positive (amplified)
n
Pending Primary tumour (pT)
Cannot be determined, specify TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 Tumour 2 cm or less in greatest dimension
T1a More than 0.1 cm but not more than 0.5 cm in
greatest dimension
T1b More than 0.5 cm but not more than 1 cm in greatest
dimension
Number of observers
T1c More than 1 cm but not more than 2 cm in greatest
dimension
Number of invasive tumour cells counted T2 Tumour more than 2 cm but not more than 5 cm in
greatest dimension
Dual probe assay T3 Tumour more than 5 cm in greatest dimension
T4 Tumour of any size with direct extension to
Average number of HER2 o
chest wall and/or to skin (ulceration or skin nodules)
signals per cell
T4a Extension to chest wall (does not include pectoralis
muscle invasion only)
Average number of CEP17
signals per cell T4b Ulceration, ipsilateral satellite skin nodules, or skin
oedema (including peau d’orange)
T4c Both 4a and 4b
HER2/CEP17 ratio / p
T4d Inflammatory carcinoma
Single probe assay
m
Reproduced with permission. Source: UICC TNM Classification of
Average number of HER2 Malignant Tumours, 8th Edition, eds by James D. Brierley, Mary K.
signals per cell Gospodarowicz, Christian Wittekind. 2016, Publisher Wiley
(incorporating any errata published up until 6th October 2020).
Aneusomy n
Note that the results of surgically removed lymph nodes are derived
from a separate dataset.
Not identified
o
Present Invasion of the dermis alone does not qualify as T4. Chest wall includes
ribs, intercostal muscles, and serratus anterior muscle but not pectoral
muscle.
Heterogeneous signals p
Inflammatory carcinoma of the breast is characterised by diffuse,
Not identified brawny induration of the skin with an erysipeloid edge, usually with no
underlying mass. If the skin biopsy is negative and there is no localised
Present measurable primary cancer, the T category is pTX when pathologically
staging a clinical inflammatory carcinoma (T4d). Dimpling of the skin,
Percentage of cells with
% nipple retraction, or other skin changes, except those in T4b and T4d,
amplified HER2 signals may occur in T1, T2, or T3 without affecting the classification.

ANCILLARY STUDIES

Not performed
Performed

Ki-67 proliferation index %

Other, specify test(s) and result(s)

Representative blocks for ancillary studies, specify those

blocks best representing tumour and/or normal tissue for
further study

Use of this dataset is only permitted subject to the details described at: Disclaimer - International Collaboration on Cancer Reporting (iccr-cancer.org)
Version 2.1 Published June 2022 ISBN: 978-1-922324-35-1 Page 6 of 6
© 2022 International Collaboration on Cancer Reporting Limited (ICCR).