X hits on this document

56 views

0 shares

0 downloads

0 comments

11 / 27

For Information OnlyBreast

a.Relevant history

b.Physical or mammographic findings

c.Clinical diagnoses, if known

d.Procedure(s) (eg, percutaneous core biopsy, image-guided stereotactically guided core biopsy, incisional biopsy)

e. Operative findings, as appropriate

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

B.Macroscopic Examination

1.Specimen(s)

a.Unfixed/fixed (specify fixative)

b. Size (3 dimensions, or number and size of cores/fragments)

c. Descriptive features (eg, color, consistency)

d. Other features (eg, prior biopsy site[s])

e.

Results of intraoperative consultation

f.

Single tumor or multiple tumors

2.Tissue submitted for microscopic evaluation

a.Submit entire specimen including tissue used for frozen section (unless saved for special studies)

3.Special studies (specify) (Note B)

C.Microscopic Evaluation

1.Tumor

a.Histologic type(s) (Note C)

b.Histologic grade (Note D)

c.Mitotic figure count

d.Extent of any associated ductal carcinoma in situ (DCIS) (Note E)

e.Microcalcifications (Note F)

f.Vascular invasion (Note G)

2.Result/status of special studies

a.Hormonal receptors

b.Other(s) (specify)

3.Additional pathologic findings, if present

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

III.Complete Excision of Tumor Less Than Total Mastectomy (With or Without Axillary Contents; Includes Wire-Guided [Localization] Excision)

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.Clinical diagnosis, if known

Document info
Document views56
Page views56
Page last viewedFri Dec 02 20:16:33 UTC 2016
Pages27
Paragraphs698
Words8500

Comments