• Examine and dissect the axillary contents in the unfixed state.
• The same procedure should be followed whether the axillary contents are received attached to the breast or as a separate specimen.  If the former, separate the axillary contents from the breast and retain their orientation.
• Measure and divide the contents into levels I-III if these levels are identified by the surgeon or the specimen is a true radical mastectomy.  Otherwise, divide the contents into upper and lower halves (unless received as an unoriented, separate specimen).
• Dissect out all of the lymph nodes without crushing them.
• Measure the smallest and the largest lymph nodes.  Note whether any appear obviously involved by tumor.
• Lymph nodes < 4 mm (after fat is removed) are submitted as a single piece (i.e. intact).  Carefully nick the capsule with a blade to assist in formalin penetration.
• Lymph nodes > 5 mm are bisected across the long axis and, if necessary, further sectioned into 2-3 mm slices.
• If a lymph node is grossly uninvolved by tumor, the majority of the perinodal fat should be removed without destroying the capsule.
• If a lymph node is grossly involved by tumor, a portion of the surrounding soft tissue should be left attached to it.  This will help in the identification of extranodal extension of tumor.

• All lymph nodes should be submitted, labeled according to their location.
• If a lymph node is extremely large and obviously replaced by tumor, submit representative sections from areas with the greatest degree of extranodal extension.
• Unsectioned (i.e. intact or uncut) lymph nodes:
• Do not submit more than four lymph nodes in a single cassette.
• Lymph nodes submitted in the same cassette should be of the same approximate size.
• Specify in the section code the number of lymph nodes in the cassette.
• Sectioned (i.e. bisected or serially sectioned) lymph nodes:
• Never put more than one sectioned lymph node in a cassette!  However, it is acceptable to put more than one slice from the same lymph node in a cassette.
• Specify in the section code whenever a single lymph node has been placed in one or more than one cassette.
• Store the remainder of the large lymph nodes in formalin, properly identified by location.

Internal use only

Received in formalin/fresh, labeled _____ and “___” is a ___ x ___ x ___ cm unoriented fragment of fatty tissue with no skin attached.  A surgical suture marks the proximal/distal end.  A total of ___ lymph nodes are identified, ranging from ___ to ___ cm in maximum dimensions. The largest node measures ___ x ___ x ___ cm and has a predominately fatty/fleshy cut surface. The lymph nodes are entirely submitted as follows:

       #__ - #__ = __ lymph nodes per cassette (#__ = proximal 1/3 of specimen, #__ = middle 1/3, #__ & #__ = distal 1/3); ___ pieces in each.

       #__ - #__ = __ lymph nodes per cassette, all from middle 1/3 of specimen; ___ pieces in each.

#__ - #__ = __ lymph nodes per cassette, all from distal 1/3 of specimen; ___ pieces in each.

__blocks, __H&E