Recommendations | |
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Slide reception by the pathologist | • Verify the clinical data provided in the pathological exam request form (age, clinical diagnosis, clinical information, imaging findings, neoadjuvant treatment, procedures performed) • Check the identification of the slides (name, number) • Review data from the macroscopic examination (type of specimen received, sampling, lesion features of the lesion(s), specimen dimension and localization) |
Slide interpretation | • Follow the recommendations of standardized manuals and guidelines: ○ Manual for Standardization of Histopathological Reports of the Brazilian Society of Pathology: http://www.sbp.org.br/manual-de-laudos-histopatologicos/ ○ Protocols for Cancer and Biomarker reporting released by the College of American Pathologists (CAP): https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templateshttps://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates ○ Guidelines on TIL-assessment developed by the International Immuno-Oncology Biomarker Working Group on Breast Cancer: https://www.tilsinbreastcancer.org/ ○ Residual Cancer Burden Calculator after neoadjuvant treatment http://www3.mdanderson.org/app/medcalc/index.cfm?pagename=jsconvert3 ○ AJCC/TNM for anatomopathological staging and prognosis: https://cancerstaging.org/references-tools/deskreferences/Documents/AJCC%20Breast%20Cancer%20Staging%20System.pdf • Use standardized synoptic reports specifically designed for each type of specimen • Include in the report information regarding the sample quality (see description below) ○ adequate: no impact on histological, immuno-histochemical and molecular assessments ○ limited: can possibly impact on histological, immuno-histochemical and molecular assessments ○ inadequate: impairment of the histological, immuno-histochemical and molecular assessments |
Sample quality | • Sample quality must be assessed • If sample quality is limited or inadequate, specify the causes: () Cold ischemia time: □ 1 h-8 h □ 8 h-12 h □ 12 h-24 h □ > 24 h () Fixative: □ Non-buffered formalin □ alcohol □ no fixative □ other: ____________ () Fixative volume is inadequate () Fixation time: □ < 6 h □ 6-72 h □ 72-96 h □ > 96 h () Histological sections with technical artifacts □ thick sections □ signs of excessive heat in paraffin □ signs of excessive heat in water bath □ excess of folding □ clamping artifacts □ thermal artifacts □ loss of material during microtomy □ inadequate staining (weak or strong) () Immuno-histochemistry reaction □ no internal control □ no external control □ presence of artifacts in the histological sections □ abnormal staining |
Suspected inconsistencies | • Notify if clinical, imaging, histological and immunohistochemical findings are consistent • Examples of inconsistencies: • Radiologic image with extensive microcalcifications, invasive neoplasm with apocrine pattern, but HER2-negative • Low grade carcinoma, with low proliferative activity, but hormone receptor-negative or hormone receptor-low • HER2-positive carcinoma, but with low grade, low proliferative activity • High-grade carcinoma, high proliferative activity, but hormone receptor-positive/HER2-negative |