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For Information OnlyBreast

Background Documentation

Protocol revision date: January 2005

I.Cytologic Material

A.Clinical Information

1.Patient identification

a. Name

b. Identification number

c. Age (birth date)

d. Sex

2.Responsible physician(s)

3.Date of procedure

4.Other clinical information (Note A)

a. Relevant history

b.Physical or mammographic findings

c.Procedure (eg, fine-needle aspiration)

d.Anatomic site(s) of specimen(s) (eg, right breast, upper outer quadrant, subareolar)

e.Type(s) of specimen(s) (eg, nipple discharge, aspirate)

B.Macroscopic Examination

1.Specimen

a.Unfixed/fixed (specify fixative)

b. Number of slides received, if appropriate

c. Quantity and appearance of fluid specimen, if appropriate

d. Other (eg, cytologic preparation from tissue)

e. Results of intraprocedural consultation

2.Material submitted for microscopic evaluation (eg, smear; cytocentrifuge, touch, or filter preparation; other liquid based cytology preparations; cell block)

3.Special studies (specify)

C.Microscopic Evaluation

1.Adequacy of specimen (if unsatisfactory for evaluation, specify reason)

2.Tumor

a.Histologic type, if possible

b.Other features (eg, nuclear grade, necrosis)

3.Additional pathologic findings, if present

4.Results/status of special studies (specify)

5.Comments, as appropriate, including correlation with intraprocedural consultation, results of other specimens, and clinical information

II.Biopsy (Incisional, Core Needle)

A.Clinical Information

1.Patient identification

a.Name

b.Identification number

c.Age (birth date)

d.Sex

2.Responsible physician(s)

3.Date of procedure

4.Other clinical information (Note A)

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