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The size on the pathology report is the largest continuous lump of invasive cancer measured under the microscope, which is not the same as the size on the mammogram or the MRI. Separate deposits five millimetres or more apart are not added together, and the in-situ disease around the tumour is measured separately.
Size matters because it is a prognostic factor in its own right, a component of the Nottingham Prognostic Index and of PREDICT, and the T of the TNM category. The dataset asks for the maximum dimension of the invasive tumour in millimetres, measured macroscopically in the fresh or fixed specimen and microscopically where the borders are diffuse, with the microscopic measurement treated as the gold standard. The report gives the invasive size and, separately, the whole tumour size including any in-situ disease extending beyond it, because those two numbers answer different questions: the first feeds the stage and the prognosis, the second tells the surgeon how much has to come out.
Three rules explain most discrepancies a patient notices. Satellite deposits are not included in the maximum invasive dimension, and neither are foci of lymphovascular invasion or cells displaced along a needle track; the dataset says no distance can be defined that settles whether two nearby foci are one tumour cut in two planes or two tumours, but that if they are 5 mm or more apart they are unlikely to be one. Where the cancer was removed entirely by the needle or vacuum biopsy, the pathologist goes back to that specimen and estimates, and says that the estimate is likely to be inaccurate although the cancer was certainly small. And where size cannot be measured at all, the fallback order is the imaging size, MRI first, then ultrasound, then mammography, and last and least accurate the clinical size.
It is worth knowing how imprecise this number is. The dataset reports that the national breast screening programme's external quality assurance scheme finds poor concordance between pathologists on tumour size even on ready-prepared slides, which cannot be explained by slide-to-slide variation, and observes that the scope for error must be greater still once the difficulty of dissecting the specimen is added. A tumour reported as 21 mm rather than 19 mm crosses the boundary from T1 to T2, and the measurement is not precise to 2 mm. This is one reason the index and the tools that use size band it rather than treating it as exact.
Most cancers start in the ducts and drain first to the axillary nodes, which is why the armpit is checked and a sentinel node is sampled.
Same organ: Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer, HER2-positive breast cancer, Male breast cancer, Ductal carcinoma in situ (DCIS), High-risk early HR-positive breast cancer, HR-positive metastatic breast cancer after CDK4/6 inhibitors, HER2-low and HER2-ultralow metastatic breast cancer, Early HER2-positive breast cancer, HER2-positive breast cancer with brain metastases, Early triple-negative breast cancer, Metastatic triple-negative breast cancer, Basal-like 1 triple-negative breast cancer (BL1), Basal-like 2 triple-negative breast cancer (BL2), Mesenchymal triple-negative breast cancer (M), Mesenchymal stem-like triple-negative breast cancer (MSL), Luminal androgen receptor triple-negative breast cancer (LAR), Immunomodulatory triple-negative breast cancer (IM), Metaplastic breast carcinoma, Carcinoma with medullary pattern (medullary breast cancer), Adenoid cystic carcinoma of the breast, Apocrine carcinoma of the breast, Secretory carcinoma of the breast, BRCA-associated triple-negative breast cancer, Inflammatory breast cancer, Paget disease of the nipple, Phyllodes tumour of the breast, Invasive lobular carcinoma of the breast, Invasive breast carcinoma of no special type (invasive ductal carcinoma), Tubular carcinoma of the breast, Mucinous carcinoma of the breast, Papillary carcinomas of the breast (encapsulated, solid and invasive papillary), Invasive cribriform carcinoma of the breast, Invasive micropapillary carcinoma of the breast, Neuroendocrine neoplasms of the breast, Lobular carcinoma in situ (LCIS)
Showing the organ this term concerns: Breast cancer (all types).
Shares Invasive breast carcinoma of no special type (invasive ductal carcinoma), Invasive lobular carcinoma of the breast, Ductal carcinoma in situ (DCIS), Mammography & tomosynthesis.
Shares Nottingham grade (breast cancer grade 1, 2 and 3), Grade, stage and receptor status: three different things on one breast report, Stage, Breast cancer (all types).
Shares Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage, Invasive lobular carcinoma of the breast, Ductal carcinoma in situ (DCIS), Breast cancer (all types).
Shares Grade, stage and receptor status: three different things on one breast report, Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage, Breast cancer (all types).
Shares Invasive breast carcinoma of no special type (invasive ductal carcinoma), Nottingham grade (breast cancer grade 1, 2 and 3), Invasive lobular carcinoma of the breast, Breast cancer (all types).
Shares Lymphovascular invasion (LVI), Nottingham Prognostic Index (NPI), and PREDICT, Breast cancer (all types).
Shares Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage, Ductal carcinoma in situ (DCIS), Mammography & tomosynthesis, Breast cancer (all types).
Shares Invasive breast carcinoma of no special type (invasive ductal carcinoma), Nottingham grade (breast cancer grade 1, 2 and 3), Breast cancer (all types).