Determine the indication for the mastectomy (i.e. resection for cancer vs. prophylaxis due to high risk of cancer development).
Identify (right or left breast) and orient the specimen.
Measure: breast, axillary tail, attached skin, nipple and areola, scar and incision.
Ink the deep margin (and anterior superior and anterior inferior margins if the tumor is at or very close to these margins).
Evaluate features of the external surface (e.g. scars, incisions, erythema, induration, retraction).
With skin-side down, make longitudinal parallel sections no thicker than 1 cm intervals, from the posterior surface toward the skin (keep the skin intact so that the specimen can be re-oriented at a later time if necessary). Number each slice consecutively, from lateral toward medial, not including the axillary tail.
Palpate each slice with your thumb and first index finger for masses and nodularity.
Identify previous biopsy site and residual tumor (e.g. location, size, shape, border, consistency, cavitation, hemorrhage).
Submit a portion of the tumor for tumor bank if a large residual tumor is present.
Tumor: 3-5 sections. Include adjacent breast tissue and, if possible, adjacent margin(s).
Previous biopsy site: three to six sections.
Skin overlying the tumor including any scar or incision: one section.
Deep margin: one section. Submit more sections if the tumor is close to or is at the margin.
Sample any grossly apparent lesion.
Nipple: entirely submit.
Two sections of fibrous tissue without gross tumor per quadrant. More extensive sampling is required in cases of in situ lobular or intraductal carcinoma, Paget’s disease of the nipple without a detectable underlying breast mass, metastatic carcinoma in an axillary lymph node without a known primary tumor, and pre-treated cancer which has shrunk and is no longer grossly apparent.
Received without fixative/in formalin labeled ____ and "____" is a left/right simple/modified radical mastectomy specimen measuring __ x __ x __ cm overall and weighing __g. It has an overlying _____ (color, indurated, erythematous) elliptical/irregular portion of skin measuring __ x __ cm containing a __ x __ cm areola with __ cm diameter everted/inverted nipple. There is a __ cm linear scar located __ cm _____ (e.g. inferior) to the nipple and __ cm from the nearest (_____) skin margin. The attached axillary tail measures __ x __ x __ cm. The posterior surface is covered by fascia and is inked black. Serial coronal sections of the specimen are consecutively numbered #1 to #___, from lateral to medial. A __ x __ x __ cm _____ (color, shape, consistency, border) mass is identified in _____ (location by quadrant), __ cm from the deep margin, __ cm from the _____ margin, and __ cm from the skin, within slices # __ through __. The mass is ___ cm or more from all other margins. The uninvolved breast parenchyma has a fat to fibrous tissue ratio of approximately __:__. No additional lesions/multiple blue cysts ranging from __ to __ cm in diameter are identified. Multiple _____ (color) lymph nodes are identified in the axillary tail, ranging from __ cm in diameter to __ x __ x __ cm. Some of the larger lymph nodes are firm and have ill-defined edges. (Alternatively, see Axillary Lymph Node Dissection dictation template.). Representative sections of the specimen are submitted as follows:
#__ - #__ = mass and _____ margin (#__ & #__ = slice #__; #__ & #__ = slice #__)
#__ - #__ = firm tissue adjacent to mass with _____ margin (#__ & #__ = slice #__; #__ = slice #__)
#__ = skin and scar; ___ pieces.
#__ = nipple
#__ & #__ = upper inner quadrant (margin) (slices # __ and __); ___ pieces in each.
#__ & #__ = upper outer quadrant (margin) (slices # __ and __); ___ pieces in each.
#__ & #__ = lower inner quadrant (margin) (slices # __ and __); 1 piece in each.
#__ & #__ = lower outer quadrant (margin (slices # __ and __); 1 piece in each.
#__ - #__ = 1 bisected lymph node in each cassette; 2 pieces in each.
# __& # __= lower half of axillary tail; ___ pieces in each.
# __& # __= upper half of axillary tail; ___ pieces in each.
#__ - #__ = 3 intact lymph nodes in each cassette, all from upper half of axillary tail; 3 pieces in each.