Invasive ductal carcinoma

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Author: Mikael Häggström [note 1]

Gross examination

Gross appearance of invasive ductal carcinoma.

As per:

or mastectomy.

Microscopic evaluation

Invasive ductal carcinoma, with occasional entrapped normal ducts (arrow).

Differential diagnosis

In invasive ductal carcinoma, malignant cells have penetrated the basement membrane, in contrast to ductal carcinoma in situ.

Staging

TNM staging is the most common system for invasive carcinomas.[1]

For lymph nodes (N):[1]

  • Clusters <0.2mm can be called "isolated tumor cell clusters"
  • Clusters 0.2 - 2.0 mm: "Micrometastasis"
  • At least one carcinoma focus over 2.0 mm: "Metastasis". If one node qualifies as metastasis, count all other nodes even with smaller foci as metastases.

Critical numbers of involved nodes: 1-3, 4-9, and 10 and over. Note any extranodal extension.[1]

Further information: Evaluation of tumors

Template:Grading of breast cancer

Further information: Evaluation of tumors

Report

Breast excision

  • Tumor size, if not already given from gross report.[1] Give 3 dimensions or greatest dimension.[1]
  • Histopathologic subtype if apparent, but "invasive carcinoma" is acceptable.
  • Stage[1]
  • Grade, preferably by overall BRE grade. Optionally, give scores for the components thereof.[1]
  • Extent of any angiolymphatic invasion.[1]
  • Margins of resection,[1] as closest distance from carcinoma to margin in mm or cm or "tumor on ink"/"carcinoma is present on margin". ((If applicable, also specify as "close margins" (no tumor on ink but <2 mm), or "negative margins" (≥2 mm).))[2]
  • Results of any immunohistochemistry and other tests[1]
  • HER2 as a score or status.
  • Ki-67, preferably as labeling index

Example:

Breast excision with 70 x 55 x 18 mm ductal invasive breast cancer. Nottingham grade II. Estrogen receptor positive, progesterone receptor negative, HER2 receptor score 0, Ki-67 index 17%, T1b. Radically removed.


[2]

Needle or core biopsy

  • Histopathologic subtype if apparent, but "invasive carcinoma" is acceptable.
  • Results of any immunohistochemistry and other tests, as per excision[1]
  • Presence of absence of lymphatic and/or vascular invasion[1]
  • Optionally: Provisional grading. Grading can alternatively be deferred to excision.[1]
  • State if studies are deferred for a later excision sample[1]

For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines.

synoptic report example
Tumor type:  invasive ductal carcinoma with micropapillary pattern
Tumor size:  greatest microscopic measurement of invasive carcinoma in positive core(s)):  0.7 cm
In-situ component: no
Microscopic grading (Nottingham modification of the Bloom-Richardson system):
  • Only applies to infiltrating ductal and lobular carcinoma:  
Tubule formation: Little or none (score =3)
Nuclear pleomorphism: Marked variation in size, nucleoli, chromatin clumping, etc. (score =3)
Mitotic count : Less than 6 mitoses per 10 hpf (score =1)
Composite score: 7 points  (applies to infiltrating ductal and lobular carcinoma only)
Histologic grade: Grade II: 6-7  points
Nuclear grade: grade 3
Microcalcifications: Present in non-neoplastic tissue
Lymphocytic host response: absent
Necrosis:  absent
Blood vessel invasion: absent
Histopathology of lymphatic invasion by carcinoma, H&E stain
Lymphatic and/or vascular invasion: absent
Skin involvement: not applicable
Results of immunohistochemical stains for prognostic markers (as per original report):
Estrogen Receptor (ER) Status:  Positive (greater than 10% of cells demonstrate nuclear positivity)
Percentage of Cells with Nuclear Positivity:  91-100%
Average Intensity of Staining:  Strong
Progesterone Receptor (PgR) Status:  Positive
Percentage of Cells with Nuclear Positivity:  51-60%
Average Intensity of Staining:  Strong, moderate and weak
HER-2 by IHC:  2+ / Equivocal
REFLEX HER-2 FISH TEST:  Nonamplificed (ratio 1.5;  3.5 Her-2 signals/cell)
Ki-67:
Percentage of Cells with Nuclear Positivity: 43%
Primary Antibody: MIB1
Cold Ischemia and Fixation Times: 3 minutes
Fixation Time (hours): 14 hours and 33 minutes
Fixative:  formalin

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 . Infiltrating Ductal Carcinoma of the Breast (Carcinoma of No Special Type). Stanford Medical School. Retrieved on 2019-10-02.
  2. 2.0 2.1 Bundred JR, Michael S, Stuart B, Cutress RI, Beckmann K, Holleczek B (2022). "Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis. ". BMJ 378: e070346. doi:10.1136/bmj-2022-070346. PMID 36130770. PMC: 9490551. Archived from the original. . 

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