Breast Pathology Specialist

Complete breast cancer pathology workflow toolkit combining compliance checking, staging, biomarker reporting, and coding.

When to Use This Skill

Use this skill for:

• Breast cancer pathology report validation
• Invasive breast carcinoma specimens (mastectomy, lumpectomy, excision)
• CAP/ICCR compliance checking with severity scoring
• TNM staging calculation (AJCC 8th edition)
• Biomarker interpretation (ER/PR/HER2/Ki-67)
• Tumor board summary generation
• SNOMED CT coding assistance

Supported Specimen Types

• Total mastectomy
• Partial mastectomy / Lumpectomy
• Wide local excision
• Re-excision specimens
• Sentinel lymph node biopsy
• Axillary lymph node dissection

Key Features

1. Compliance Checking: Validates against CAP Breast.Invasive and ICCR Invasive Carcinoma of the Breast protocols
2. TNM Staging: AJCC 8th edition breast cancer staging with pT/pN/M calculation
3. Biomarker Reporting: ER/PR/HER2/Ki-67 validation per ASCO/CAP guidelines
4. Template Generation: Pre-filled or blank synoptic templates
5. Tumor Board Summaries: Concise 3-5 line MDT presentation format
6. SNOMED Coding: Breast-specific code suggestions

Reference Files

When processing reports, reference these files on-demand (DO NOT load at startup):

• Diagnosis guidelines: references/diagnosis/breast_invasive_carcinoma.md
• Macroscopy guidelines: references/macroscopy/breast_macroscopy.md
• TNM staging: ../../shared-references/staging/tnm_stage_calculator.md
• Synoptic templates: ../../shared-references/templates/synoptic_templates.md
• Biomarkers: ../../shared-references/biomarkers/BIOMARKERS_INDEX.md
• SNOMED codes: ../../shared-references/coding/snomed_ct_codes.md

Usage Examples

# Validate report compliance
claude "Check this breast report using breast-pathology-specialist" < report.txt

# Generate staging
claude "What stage is pT2 N1a M0 for breast using breast-pathology-specialist"

# Create template
claude "Generate blank breast lumpectomy template using breast-pathology-specialist"

# Tumor board summary
claude "Create tumor board summary using breast-pathology-specialist" < report.txt

Processing Instructions

When analyzing breast pathology reports:

1. Identify request type (compliance check, staging, template, summary, coding)
2. Read relevant reference file on-demand based on request
3. Process the report using appropriate guidelines
4. Generate output in requested format
5. DO NOT load all reference files upfront

Compliance Scoring

Use severity-based weighting:

• Critical elements (tumor size, grade, margins, nodes, ER/PR/HER2): -15 points each
• Major elements (LVI, PNI, ductal carcinoma in situ): -5 points each
• Minor elements (Ki-67, oncotype, tumor location): -2 points each

Scoring: 90-100 (Compliant) | 70-89 (Minor issues) | 50-69 (Major issues) | <50 (Critical)

Cross-Validation Checks

Always validate:

• pT category vs tumor size consistency
• pN category vs positive node count
• Stage group vs pT/pN/M combination
• Margin status vs R classification
• ER/PR/HER2 vs molecular subtype

Language Support

Supports English and Turkish - detect from user prompt and use appropriate template file.

Note: This is a minimal skill definition. Large reference files are loaded on-demand only when processing requests, not at skill startup.