* Repeat testing for ER, PR:

1. Repeat if the results were negative in needle biopsy and the tumor is poorly differentiated

2. Order ER, PR on any new/ second primary tumor identified in excision

3. When multiple foci of invasive carcinoma are seen, ensure that the largest two tumor foci are repeated (either on core or excision). Testing smaller invasive carcinomas is recommended if they are of different histologic type or higher grade

4. Repeat testing if the same tumor shows different histologic features or higher grade from the core biopsy

Repeat testing for HER-2/neu:

1. Her2 is negative in core biopsy and the tumor is grade 3 or there was a small amount

     of invasive tumor in the core biopsy

2. Her2 is positive in grade 1 carcinoma including these subtypes (invasive ductal or

     lobular carcinoma that is ER, PR positive and grade 1, tubular carcinoma (>90%),

     mucinous (>90%), cribriform (>90%), adenoid cystic carcinoma (>90%) and

     often is triple negative

3.  Repeat if IHC and FISH were equivocal in the needle biopsy.

4.  New or second tumor discovered in excision specimen.

5.  When multiple foci of invasive carcinoma are seen, ensure that the largest two tumor

     are tested (either on core or excision).  Testing smaller invasive carcinomas

     is recommended if they are of different histologic type or higher grade.

6.  Repeat testing if the same tumor shows different histologic features or higher grade from the core biopsy.

Response Options to "If present, specify type(s) of lymph nodes"

(list all that apply)

___ Sentinel lymph node(s)

___ Axillary dissection (partial or complete dissection)

___ Lymph nodes present within the breast specimen (ie, intramammary lymph nodes)

___ Other lymph nodes (eg, supraclavicular or location not identified)

Specify location, if provided: _________________________

Response Options to "Tumor Extension" (required ONLY if the structures are present AND involved) (select all that apply)

Skin

- Invasive carcinoma invades dermis or epidermis WITHOUT skin ulceration

- Invasive carcinoma invades dermis or epidermis WITH skin ulceration

- Satellite skin foci of invasive carcinoma (ie, not contiguous with the invasive carcinoma in the breast)

Nipple

- DCIS involving nipple epidermis (Paget disease of nipple)

Skeletal Muscle

- Carcinoma invades skeletal muscle (does not change T stage)

- Carcinoma invades through skeletal muscle and into chest wall

Definition of EIC-positive carcinoma

1. Ductal carcinoma in situ is a major component within the area of invasive carcinoma (≥ 25%) and DCIS is also present in the surrounding breast parenchyma.
2. There is extensive DCIS associated with a small (~10 mm or less) invasive carcinoma (ie, the invasive carcinoma is too small for DCIS to comprise 25% of the area).

Breast

Staging

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