Description:

CALGB: 40601 POST SURGERY HISTOPATHOLOGY REVIEW FORM NCT00770809 Paclitaxel and Trastuzumab With or Without Lapatinib in Treating Patients With Stage II or Stage III Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A58BBD2-8485-72B0-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A58BBD2-8485-72B0-E044-0003BA3F9857

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Versions (4) ▾
  1. 8/27/12
  2. 1/9/15
  3. 6/18/15
  4. 9/20/21
Uploaded on:

September 20, 2021

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License:
Creative Commons BY-NC 3.0 Legacy
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CALGB: 40601 POST SURGERY HISTOPATHOLOGY REVIEW FORM NCT00770809

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

Header
Are data amended
Patient demographics
Specimen Details
Breast Specimen
Type
cm
cm
cm
Main specimen entirely submitted for histology?
Gross Findings
Gross pathology present? (Mark all that apply)
Histologic Findings
Invasive cancer
Size
cm
cm
cm
%
Histologic Type
Nuclear Grade
Tubule Formation
Histologic Grade
Lymphovascular Invasion
Margins
Does the tumor involve the surgical margin
Tumor distance from margin
Dcis
Is DCIS present?
cm
Histologic type of DCIS
Nuclear Grade of DCIS
Lymph Nodes
Was sentinel node sampling performed
Was axillary dissection performed?
Disease Staging
Pathologic T Stage
Pathologic N Stage
Pathologic M Stage
Stage
Final status of T4 tumor (If patient diagnosed with T4 at baseline, indicate)
Comments

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