Skip to main content

Table 4 Summary of actions and recommendations for the post-analytical phase

From: Optimizing pathological assessment of breast cancer in Brazil: recommendations from a multidisciplinary working group on the tumor-tissue journey

 

Recommendations 

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

  1. (Cardoso et al. 2020), (D'Angelo and Mejabi 2016), (Hortobagyi 2017)