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Lung - College of American Pathologists - CAP Home

By Ray Lawrence,2014-05-09 20:52
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Lung - College of American Pathologists - CAP Home

Lung

    Protocol applies to all invasive carcinomas of the lung.

    Protocol revision date: January 2005

    Based on AJCC/UICC TNM, 6th edition

Procedures

    • Biopsy

    • Resection

Authors

    Anthony A. Gal, MD

    Department of Pathology and Laboratory Medicine, Emory University Hospital,

    Atlanta, Georgia

    Alberto Marchevsky, MD

    Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California William D. Travis, MD

    Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of

    Pathology, Washington, DC

    For the Members of the Cancer Committee, College of American Pathologists

Previous contributors: Gerald Nash, MD; Robert V.P. Hutter, MD;

    Donald E. Henson, MD

Thorax • Lung CAP Approved

    ? 2005. College of American Pathologists. All rights reserved.

    The College does not permit reproduction of any substantial portion of these protocols without its written authorization. The College hereby authorizes use of these protocols by physicians and other health care providers in reporting on surgical specimens, in teaching, and in carrying out medical research for nonprofit purposes. This authorization does not extend to reproduction or other use of any substantial portion of these protocols for commercial purposes without the written consent of the College.

    The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations of surgical specimens. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.

    The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with the document. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.

     2

CAP Approved Thorax • Lung

    Summary of Changes to Checklist(s)

    Protocol revision date: January 2005

    No changes have been made to the data elements of the checklist(s) since the January 2004 protocol revision.

     3

Thorax • Lung CAP Approved

    Surgical Pathology Cancer Case Summary (Checklist)

    Protocol revision date: January 2005

    Applies to invasive carcinomas only thBased on AJCC/UICC TNM, 6 edition

*LUNG: Biopsy

    (Note: Use of checklist for biopsy specimens is optional)

*Patient name:

    *Surgical pathology number:

    Note: Check 1 response unless otherwise indicated.

*MACROSCOPIC

*Specimen Type

    *___ Fiberoptic bronchoscopic biopsy

    *___ Transbronchial biopsy

    *___ Mediastinoscopic biopsy

    *___ Computed tomography-guided needle biopsy

    *___ Wedge biopsy

    *___ Other (specify): ____________________________ *___ Not specified

*Laterality

    *___ Right

    *___ Left

    *___ Not specified

*Tumor Site

    *___ Upper lobe

    *___ Middle lobe

    *___ Lower lobe

    *___ Other (specify): ____________________________ *___ Not specified

    * Data elements with asterisks are not required for accreditation purposes for 4

    the Commission on Cancer. These elements may be clinically important,

    but are not yet validated or regularly used in patient management.

    Alternatively, the necessary data may not be available to the pathologist

    at the time of pathologic assessment of this specimen.

CAP Approved Thorax • Lung

    *MICROSCOPIC

*Histologic Type

    *___ Carcinoma, non-small cell type

    *___ Small cell carcinoma

    *___ Squamous cell carcinoma

    *___ Squamous cell carcinoma, variant (specify): ____________________________ *___ Combined small cell carcinoma (small cell carcinoma and non-small cell

    component)

    *___ Adenocarcinoma, not otherwise characterized

    *___ Bronchioloalveolar carcinoma

    *___ Bronchioloalveolar carcinoma variant (specify): ____________________________

    *___ Adenocarcinoma, other variant (specify): ____________________________ *___ Large cell undifferentiated carcinoma

    *___ Large cell neuroendocrine carcinoma

    *___ Large cell carcinoma, other variant (specify): ____________________________

    *___ Basaloid carcinoma

    *___ Adenosquamous carcinoma

    *___ Typical carcinoid tumor

    *___ Atypical carcinoid tumor

    *___ Adenoid cystic carcinoma

    *___ Mucoepidermoid carcinoma

    *___ Other tumor of salivary gland type (specify): ____________________________

    *___ Carcinoma with pleomorphic, sarcomatoid, or sarcomatous elements

    (specify variant): ____________________________

    *___ Other (specify): ____________________________

    *___ Carcinoma, type cannot be determined

*Histologic Grade

    *___ Not applicable

    *___ GX: Cannot be assessed

    *___ G1: Well differentiated

    *___ G2: Moderately differentiated

    *___ G3: Poorly differentiated

    *___ G4: Undifferentiated

    *___ Other (specify): ____________________________

*Visceral Pleura Invasion (document if identified)

    *___ Not applicable

    *___ Absent

    *___ Present

    *___ Indeterminate

* Data elements with asterisks are not required for accreditation purposes for 5

    the Commission on Cancer. These elements may be clinically important, but are not yet validated or regularly used in patient management. Alternatively, the necessary data may not be available to the pathologist at the time of pathologic assessment of this specimen.

Thorax • Lung CAP Approved

    *Venous (Large Vessel) Invasion (V) (document if identified) *___ Absent

    *___ Present

    *___ Indeterminate

*Lymphatic (Small Vessel) Invasion (L)

    *___ Absent

    *___ Present

    *___ Indeterminate

    *Additional Pathologic Findings (check all that apply) *___ None identified

    *___ Metaplasia (specify type): ____________________________ *___ Squamous cell carcinoma in situ

    *___ Inflammation (specify type): ____________________________ *___ Other (specify): ____________________________

*Comment(s)

    * Data elements with asterisks are not required for accreditation purposes for 6

    the Commission on Cancer. These elements may be clinically important,

    but are not yet validated or regularly used in patient management.

    Alternatively, the necessary data may not be available to the pathologist

    at the time of pathologic assessment of this specimen.

CAP Approved Thorax • Lung

    Surgical Pathology Cancer Case Summary (Checklist)

    Protocol revision date: January 2005

    Applies to invasive carcinomas only thBased on AJCC/UICC TNM, 6 edition

LUNG: Resection

Patient name:

    Surgical pathology number:

    Note: Check 1 response unless otherwise indicated.

MACROSCOPIC

Specimen Type

    ___ Major airway resection

    ___ Wedge resection

    ___ Segmentectomy

    ___ Lobectomy

    ___ Pneumonectomy

    ___ Other (specify): ____________________________ ___ Not specified

Laterality

    ___ Right

    ___ Left

    ___ Not specified

Tumor Site

    ___ Upper lobe

    ___ Middle lobe

    ___ Lower lobe

    ___ Other(s) (specify): ____________________________ ___ Not specified

Tumor Size

    Greatest dimension: ___ cm

    *Additional dimensions: ___ x ___ cm

    ___ Cannot be determined (see Comment)

* Data elements with asterisks are not required for accreditation purposes for 7

    the Commission on Cancer. These elements may be clinically important,

    but are not yet validated or regularly used in patient management.

    Alternatively, the necessary data may not be available to the pathologist

    at the time of pathologic assessment of this specimen.

Thorax • Lung CAP Approved

    MICROSCOPIC

Histologic Type

    ___ Squamous cell carcinoma

    ___ Squamous cell carcinoma, variant (specify): ____________________________ ___ Small cell carcinoma

    ___ Combined small cell carcinoma (small cell carcinoma and non-small cell component)

    ___ Adenocarcinoma, not otherwise characterized

    ___ Bronchioloalveolar carcinoma

    ___ Bronchioloalveolar carcinoma variant (specify): ____________________________ ___ Adenocarcinoma, other variant (specify): ____________________________ ___ Large cell undifferentiated carcinoma

    ___ Large cell neuroendocrine carcinoma

    ___ Large cell carcinoma, other variant (specify): ____________________________ ___ Basaloid carcinoma

    ___ Adenosquamous carcinoma

    ___ Typical carcinoid tumor

    ___ Atypical carcinoid tumor

    ___ Adenoid cystic carcinoma

    ___ Mucoepidermoid carcinoma

    ___ Other tumor of salivary gland type (specify): ____________________________ ___ Carcinoma with pleomorphic, sarcomatoid, or sarcomatous elements

    (specify variant): ____________________________

    ___ Other (specify): ____________________________

    ___ Carcinoma, type cannot be determined

Histologic Grade

    ___ Not applicable

    ___ GX: Cannot be assessed

    ___ G1: Well differentiated

    ___ G2: Moderately differentiated

    ___ G3: Poorly differentiated

    ___ G4: Undifferentiated

    ___ Other (specify): ____________________________

    * Data elements with asterisks are not required for accreditation purposes for 8

    the Commission on Cancer. These elements may be clinically important,

    but are not yet validated or regularly used in patient management.

    Alternatively, the necessary data may not be available to the pathologist

    at the time of pathologic assessment of this specimen.

CAP Approved Thorax • Lung

    Pathologic Staging (pTNM)

Primary Tumor (pT)

    ___ pTX: Cannot be assessed, or tumor proven by presence of malignant cells in

    sputum or bronchial washings but not visualized by imaging or

    bronchoscopy

    ___ pT0: No evidence of primary tumor

    ___ pTis: Carcinoma in situ

    ___ pT1: Tumor 3 cm or less in greatest dimension, surrounded by lung or visceral

    pleura, without bronchoscopic evidence of invasion more proximal than the

    lobar bronchus (ie, not in the main bronchus)

    ___ pT2: Tumor with any of the following features of size or extent: greater than 3 cm

    in greatest dimension; involves main bronchus, 2 cm or more distal to the

    carina; invades the visceral pleura; associated with atelectasis or obstructive

    pneumonitis that extends to the hilar region but does not involve the entire

    lung

    ___ pT3: Tumor of any size that directly invades any of the following: chest wall

    (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal

    pericardium; or

    Tumor of any size in the main bronchus less than 2 cm distal to the carina

    but without involvement of the carina; or

    Tumor of any size associated atelectasis or obstructive pneumonitis of the

    entire lung

    ___ pT4: Tumor of any size that invades any of the following: mediastinum, heart,

    great vessels, trachea, esophagus, vertebral body, carina; or

    Tumor of any size with separate tumor nodule(s) in same lobe; or

    Tumor of any size with a malignant pleural effusion

Regional Lymph Nodes (pN)

    ___ pNX: Cannot be assessed

    ___ pN0: No regional lymph node metastasis

    ___ pN1: Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes,

    including intrapulmonary nodes involved by direct extension of the

    primary tumor

    ___ pN2: Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s) ___ pN3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or

    contralateral scalene, or supraclavicular lymph node(s)

    Specify: Number examined: ___

     Number involved: ___

Distant Metastasis (pM)

    ___ pMX: Cannot be assessed

    ___ pM1: Distant metastasis; includes separate tumor nodule(s) in a different lobe

    (ipsilateral or contralateral)

     *Specify site(s), if known: ____________________________

* Data elements with asterisks are not required for accreditation purposes for 9

    the Commission on Cancer. These elements may be clinically important, but are not yet validated or regularly used in patient management.

    Alternatively, the necessary data may not be available to the pathologist at the time of pathologic assessment of this specimen.

Thorax • Lung CAP Approved

    Margins (check all that apply)

    ___ Cannot be assessed

    ___ Margins uninvolved by invasive carcinoma

     Distance of invasive carcinoma from closest margin: ___ mm

     Specify margin: ____________________________

    ___ Squamous cell carcinoma in situ present at bronchial margin ___ Margin(s) involved by invasive carcinoma

    ___ Bronchial margin

    ___ Vascular margin

    ___ Parenchymal margin

    ___ Parietal pleural margin

    ___ Chest wall margin

    ___ Other attached tissue margin (specify): ____________________________

Direct Extension of Tumor (check all that apply)

    ___ None identified

    ___ Chest wall (including superior sulcus tumors)

    ___ Diaphragm

    ___ Mediastinal pleura

    ___ Visceral pleura

    ___ Parietal pericardium

    ___ Tumor in the main bronchus less than 2 cm distal to the carina ___ Tumor-associated atelectasis or obstructive pneumonitis of the entire lung

    ___ Mediastinum

    ___ Heart

    ___ Great vessels

    ___ Other (specify): ____________________________

Venous (Large Vessel) Invasion (V)

    ___ Absent

    ___ Present

    ___ Indeterminate

Arterial (Large Vessel) Invasion

    ___ Absent

    ___ Present

    ___ Indeterminate

*Lymphatic (Small Vessel) Invasion (L)

    *___ Absent

    *___ Present

    *___ Indeterminate

    *Additional Pathologic Findings (check all that apply) *___ None identified

    *___ Metaplasia (specify type): ____________________________ *___ Inflammation (specify type): ____________________________

    * Data elements with asterisks are not required for accreditation purposes for 10

    the Commission on Cancer. These elements may be clinically important,

    but are not yet validated or regularly used in patient management.

    Alternatively, the necessary data may not be available to the pathologist

    at the time of pathologic assessment of this specimen.

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