Breast Ductal Carcinoma In Situ Worksheet 4.1.0.0

Please note: this page should work, but has not been extensively tested.

In Situ Carcinoma:

Architectural patterns Solid
Cribriform
Comedo
Clinging
Papillary
Micropapillary
Paget disease

Nuclear grade Grade I (low)
Grade II (intermediate)
Grade III (high)

Without necrosis
With spotty necrosis
With comedo necrosis

Extent of DCIS: The largest focus of DCIS measures mm
Check if ONLY LCIS is present
Check if multifocal
(Optional) DCIS is seen in: out of blocks.

Nipple involvement No nipple is present
No nipple involvement is identified
Paget disease is present

Lymphovascular Invasion Do not mention
Lympatic invasion not identified
Lymphatic invasion is present

Margins:

Margin	In Situ Tumor
Superior:	Margin Negative ( ≥ 0.1 cm ) Margin Positive ( < 0.1 cm )
Inferior:	Margin Negative ( ≥ 0.1 cm ) Margin Positive ( < 0.1 cm )
Superficial:	Margin Negative ( ≥ 0.1 cm ) Margin Positive ( < 0.1 cm )
Deep:	Margin Negative ( ≥ 0.1 cm ) Margin Positive ( < 0.1 cm )
Lateral:	Margin Negative ( ≥ 0.1 cm ) Margin Positive (< 0.1 cm)
Medial:	Margin Negative ( ≥ 0.1 cm ) Margin Positive (< 0.1 cm)
Overall margin status: Margins negative Focal positive margins (DCIS at margin in <1 mm area in one block) Minimal/moderate positive margins (between Focal and Extensive) Extensive positive margins (DCIS present ≥15 mm or in 5 or more low-power fields and/or in 8 or more blocks) Check if positive margin was identified grossly.
Optional: Closest margin to in situ tumor: DCIS is mm from the margin.

Staging

NOTE: If nodes were positive before neoadjuvent therapy, or there was a metastatic site prior to neoadjucant therapy,
N and M stagings persist, and do not go to 0, even if metastatic tumor is not found in post-therapy histologic examination.

Enter prior N value:

Enter prior M value:

Note: If the select boxes above are used, don't enter information below.

Lymph Node Status No lymph nodes sampled
Lymph nodes sampled:

Site	Sampled	Positive (>2.0mm)	MicMets (≤2.0mm, >0.2mm)	ITCs (≤0.2mm)
Sentinel lymph nodes
Axillary/intramammary nodes

Positive ipsilateral internal mammary node by imaging
Positive ipsilateral internal mammary node by pathology (at least 2 mm).
Positive infraclavicular (Level III axillary) node

Metastasis Status No tissue submitted for metastatic examination
Tissue submitted and NEGATIVE for metastatic disease
Tissue submitted and POSITIVE for metastatic disease

Metastasis to non-regional lymph node(s)

Site:

Metastatic to other site(s)

Site:

Check if metastatic focus measures ≤ 2.0mm.

Final Report

Breast Ductal Carcinoma In Situ Worksheet 4.1.0.0

Please note: this page should work, but has not been extensively tested.

NOTE: If nodes were positive before neoadjuvent therapy, or there was a metastatic site prior to neoadjucant therapy, N and M stagings persist, and do not go to 0, even if metastatic tumor is not found in post-therapy histologic examination.

Enter prior N value: None 0 N1mi N1 N2 N3

Enter prior M value: None No known mets M1

Note: If the select boxes above are used, don't enter information below.

NOTE: If nodes were positive before neoadjuvent therapy, or there was a metastatic site prior to neoadjucant therapy,
N and M stagings persist, and do not go to 0, even if metastatic tumor is not found in post-therapy histologic examination.

Enter prior N value:

Enter prior M value: