Ospital ng Maynila Medical Center
Memorandum of Cooperation

between Department of Surgery and Department of Pathology

in an effort to reduce the discrepancy rate in the clinical and pathological tumor and node evaluation in patients with breast cancer


Whereas, there exists a significant discrepancy rate in the clinical and pathological tumor and node evaluation in patients with breast cancer which needs to and can be reduced to within acceptable limits;

Whereas, an acceptable discrepancy rate is a parameter of quality patient care;

Whereas, one of the root causes of the discrepancy is lack of communication and understanding between the staff of the Department of Surgery and that of the Department of Pathology;

Be it resolved, and hereby resolved, that a memorandum of understanding and cooperation be forged between the Department of Surgery and the Department of Pathology with the following stipulations:


I. In the clinical examination, surgeon will

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

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

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


II. After the total mastectomy and axillary dissection, surgeon will do the following:

A. Measure the tumor (sT)

1. 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.

2. 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.

B. 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.


III. Role of the pathologists after receiving the specimen and request:

A. Study the pathology request of surgeon.

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

2. Verify the sTN data.

Make the necessary adjustment and corrections for sT and sN.

B. Make a histopathological report after conducting a microscopic examination of all specimens submitted.

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

2. 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.


Reynaldo O. Joson, MD

Sergio Paguio, MD

Department of Surgery

Department of Pathology