Department of Surgery
Ospital ng Maynila Medical Center

March 10, 2002

Dr. Sergio Paguio
Department of Pathology
Ospital ng Maynila Medical Center

Dear Dr. Paguio:

The Department of Surgery of OMMC is conducting an action research with the objective of finding ways on how to reduce the discrepancy of clinical and pathological tumor and node evaluation in patients with breast cancer.

Attached is a draft of the research proposal cum partial report (a draft).

As part of our strategy to reduce the discrepancy rate, we will like to enter into a memo of understanding with your department on the following stipulations:


In the clinical examination, surgeon will

1. Measure the size(s) of the primary breast tumor(s) using a stiff ruler.

2. Note down presence or absence of palpable axillary lymph nodes; if present, size of smallest and largest node palpated.

The clinical T and clinical N data should be noted down in the pathology request.


After the total mastectomy and axillary dissection, at the operating room, surgeon will do the following:

-Measure the tumor (sT)

In tumor with no previous open biopsy or frozen section biopsy, cut the

tumor along the widest diameter in one direction only and then using a stiff ruler measure the length of the widest diameter in cm. Note down size (length) of sT in pathology request.


In tumor with frozen section biopsy, determine the sT in its widest

diameter using a stiff ruler taking into consideration the size of the specimen removed and submitted for frozen section. Note down size (length) of sT in pathology request.

-Identify and isolate nodes in the axillary dissection specimen.

Note down in pathology request number of grossly palpable nodes isolated

and their sizes in greatest diameter using stiff ruler.


Role of the pathologists after receiving the specimen and request:

-Study the pathology request of surgeon.

-Take note of the clinical and surgical T and N.

Verify the sTN data.

Make the necessary adjustment and corrections for sT and sN.

Conduct microscopic examination of all the specimens submitted.

Make a histopathological report.

Include the data submitted by surgeon in the report (cTcN and sTsN)

Place a pTpN report.

The pT and sT should gibe. The cT may not gibe with the sT or pT depending on the accuracy of clinical measurement of T by the surgeon.

The pN and cN and sN may not gibe.


Hoping for a favorable response for the sake of the patients we both serve, I remain


Sincerely yours,


Reynaldo O. Joson, MD
Department of Surgery