PATIENT HOSPITAL #

SURGICAL PATHOLOGY #

DATE:

Procedure

Lymph Nodes

Bronchoscopy

Mediastinoscopy

Wedge Resection

Segmentectomy

N2 NODES

Total

Positive

Lobectomy

Bi-lobectomy

1. Highest mediastinal

Pneumonectomy

2. Upper paratracheal

Site

    right

Right lung

Left lung

    left

RU lobe

LU lobe

3. Pre and retrotracheal

RM lobe

LL lobe

4. Lower paratracheal

RL lobe

    right

Maximum tumor diameter

cm

    left

Bronchial involvement

5.    Aortopulmonary

Main

6.    Anterior mediastinal

Lobar

7.    Subcarinal

Segmental

8.    Paraesophageal

Subsegmental

9.    Pulmonary ligament

None

N1 NODES

Total

Positive

Histological type:

10. Hilar

Differentiation

    right

Well

Other

    left

Moderate

11. Interlobar

Poor

12. Lobar

Visceral pleura invaded

13. Segmental

Yes

No

Other: Significant pathology e.g. fibrosis, emphysema, granuloma etc.

Parietal pleura/chest wall invaded

Yes

No

Additional findings (specify)

. atelectasis/obstructive pneumonitis (extent/distribution)

. microscopic foci of abnormal epithelial proliferation involving airways

Bronchial resection margin

Distance from tumor

cm

Free

Invasive carcinoma

Ca in situ

Mediastinal/chest wall resection margin

Free

Involved

Pulmonary satellite nodules

Yes

No