Public Health Agency of Canada
www.publichealth.gc.ca
Home > Chronic Disease > Lung
Cancer > Guidelines for
processing Specimens and Reporting Tumor Stage > Appendix 1 - Primary Lung Cancer Check-Off
Sheet
Lung Cancer - Guidelines for Processing Specimesn and Reporting Tumor Stage
Appendix 1- Primary Lung Cancer Check-Off Sheet
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 |
|
|
|