Understanding your diagnostic workup report

Healthcare professionals use breast cancer prognosis factors to determine an appropriate treatment plan (surgery, radiation, endocrine therapy, chemotherapy, etc.) for afflicted patients.

Your doctors will consider multiple factors when assessing your best treatment, including your risk of recurrence. Your initial diagnostic workup will probably include assessment of tissue from a tumor biopsy, plus determination of lymph node involvement, tumor size and stage, and histological grade.

The following information will help you understand assessments described on your diagnostic workup report.

Lymph node involvement

Node Positive: The tumor has spread to the lymph nodes at the time of diagnosis
Node Negative: The tumor has not spread to the lymph nodes at the time of diagnosis

Your doctors think in terms of three types of lymph node involvement when they look at an individual node:

Minimal (or microscopic) lymph node involvement: Only a small number of cancer cells can be found in the lymph nodes.
Significant (or macroscopic) involvement: A particular lymph node or group of nodes has become involved with the cancer. These can often be felt by hand or seen without a microscope.
Extra-capsular extension: A breast cancer tumor takes over a whole lymph node and spills beyond the wall of the lymph node into the surrounding fat.

In most cases, the more extensive the lymph node involvement, the more aggressive the cancer. But the extent of disease within a particular lymph node is less important than the total number of lymph nodes affected. The more lymph nodes that are involved, the more threatening the cancer may be.

Stage and tumor size

Stage 0:
Lobular carcinoma in situ (LCIS) refers to abnormal cells lining a gland in the breast. This is a risk factor for the future development of cancer, but this does not represent a cancer itself. .

Ductal carcinoma in situ (DCIS) refers to abnormal cells lining a duct. Women with DCIS have an increased risk of getting invasive breast cancer in that breast. Treatment options are similar to patients with Stage I breast cancers.

Stage I:
Early stage breast cancer where the tumor is less that 2 cm across and has not spread beyond the breast.

Stage II:
Early stage breast cancer where the tumor is either less than 2 cm across and has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm (with or without spread to the lymph nodes under the arm); or the tumor is greater than 5 cm and hasn’t spread outside the breast.

Stage III:
Locally advanced breast cancer where the tumor is greater than 5 cm across and has spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast.

Stage IV:
Metastatic breast cancer where the cancer has spread outside the breast to other organs in the body.  Depending on the stage of your cancer, your physician may require additional tests to determine if you have metastatic disease. If you have stage III breast cancer, a chest x-ray, CT scan and bone scan may be used to look for potential metastases. Your physician will decide what is necessary to adequately stage cancer on an individual basis.

Histological grade

Grade is a calculation based on how abnormal the cancer cells look under a microscope and how fast they are growing.

Three features determine a cancer’s grade: The rate of cell division; the percentage of cancer composed of tubular structures; the change in cell size and uniformity.

If a tumor has been determined to be Grade 3, there is a higher risk of recurrence than if the tumor was determined to be Grade 1. Grade 2 (intermediate) tumors are often treated as Grade 3 in order to avoid potential under-treatment.

HER2/neu (a growth-promoting protein) status

HER2/neu is a gene that helps guide the growth of cells, as well as how they divide and repair themselves. Whether a patient is positive or negative HER2/neu has important implications for treatment. Positive HER2/neu status suggests the potential for a more aggressive, faster-growing cancer.

Lymphatic vessel invasion (LVI)

When pathologists look directly at cancerous tissue under a microscope they determine whether cancer cells are found in the lymphatic vessels within the cancer itself.

Hormone receptor status

This status reflects whether a cancer is estrogen receptor positive (ER+) or negative (ER-) or progesterone receptor positive (PR+) or negative (PR-). This status may provide some prognostic information and, at this time, is used to plan treatment. There are several laboratory methods used to determine receptor status.

Ask your physician if you have any questions about the methodology used for your diagnostic workup. Additional resources are listed below:

American Cancer Society
Learn About Cancer

Breast Cancer Network of Strength
(formerly known as Y-ME National Breast Cancer Organization)
Home Page

Facing Our Risk of Cancer Empowered (FORCE)
Home Page

John W. Nick Foundation
Dedicated to male breast cancer awareness

National Breast Cancer Foundation
Home Page

National Breast Coalition
Home Page

National Cancer Institute
Breast Cancer

Susan G. Komen for the Cure
Home Page

Young Survival Coalition
Home Page