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.
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.