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BREAST-DCIS.html
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html>
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>DCIS</title>
<link rel="stylesheet" type="text/css" href="view.css" media="all">
<script type="text/javascript" src="view.js"></script>
<script>
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<style>
table, th, td {
border: 1px solid silver;
border-collapse: collapse;
padding: 4px;
}
</style>
</head>
<body>
<img id="top" src="top.png" alt="">
<div id="form_container">
<div class="form_description">
<h2>
<a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf" target="_blank">
<div class="tooltip">
Ductal carcinoma <i>in situ</i> of the breast
<span class="tooltiptext">click to access explanations in the original CAP template</span>
</div>
</a>
</h2>
</div>
<form>
<p>
There is different protocol for <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS.Bx_1.0.1.0.REL_CAPCP.pdf" target="_blank">biopsy specimen</a>
</p>
<p>
Non-essential elements are identified by "+" sign.</a>
</p>
<!--
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Gross descriptions:</label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- Procedure:</label>
</td>
<td>
<select class="element select large" ID="A01">
<option value=""></option>
<option value=" - Excision (less than total mastectomy)">Excision (less than total mastectomy)</option>
<option value=" - Total mastectomy (including nipple-sparing and skin-sparing mastectomy)">Total mastectomy (including nipple-sparing and skin-sparing mastectomy)</option>
<option value=" - Other (specify):">Other (specify):</option>
<option value=" - Not specified">Not specified</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Specimen laterality:</label>
</td>
<td>
<select class="element select large" ID="A02">
<option value=""></option>
<option value=" - Right">Right</option>
<option value=" - Left">Left</option>
<option value=" - Not specified">Not specified</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- Tumor site:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A03" value=" - Upper outer quadrant"><label >Upper outer quadrant</label><br>
<input class="element checkbox" type="checkbox" id="A04" value=" - Lower outer quadrant"><label >Lower outer quadrant</label><br>
<input class="element checkbox" type="checkbox" id="A05" value=" - Upper inner quadrant"><label >Upper inner quadrant</label><br>
<input class="element checkbox" type="checkbox" id="A06" value=" - Lower inner quadrant"><label >Lower inner quadrant</label><br>
<input class="element checkbox" type="checkbox" id="A07" value=" - Central"><label >Central</label><br>
<input class="element checkbox" type="checkbox" id="A08" value=" - Nipple"><label >Nipple</label><br>
<input class="element checkbox" type="checkbox" id="A09" value=" - Position (specify): o’clock"><label >Position (specify): o’clock</label><br>
<input class="element checkbox" type="checkbox" id="A10" value=" - Other (specify):"><label >Other (specify):</label><br>
<input class="element checkbox" type="checkbox" id="A11" value=" - Not specified"><label >Not specified</label><br>
</td>
</tr>
<tr>
<td rowspan="2" valign="top">
<label class="description">- Tumor size:</label>
</td>
<td>
<select class="element select large" ID="A12">
<option value=""></option>
<option value=" - Greatest dimension (mm): ">Greatest dimension (mm): </option>
<option value=" - All dimensions (mm x mm x mm): ">All dimensions (mm x mm x mm):</option>
<option value=" - Cannot be determined (explain):">Cannot be determined (explain):</option>
</select>
</td>
</tr>
<tr>
<td>- Number of blocks with DCIS out of total:
<input type="text" class="element text small" ID="A13" size="10">
</td>
</tr>
</table>
</p>
</fieldset>
</p>
-->
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description">Microscopic descriptions:</label></legend>
<p>
<label class="description">- Tumor histology and immunohistochemical studies: </label>
<textarea ID="A14" class="element textarea medium"></textarea>
</p>
<p>
<table border="1">
<col width="40%">
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=13" target="_blank">Histologic type</a>:</label>
</td>
<td>
<select class="element select large" ID="A14A">
<option value=""></option>
<option value="Ductal carcinoma in situ">Ductal carcinoma in situ</option>
<option value="Paget disease ">Paget disease </option>
<option value="Encapsulated papillary carcinoma without invasive carcinoma">Encapsulated papillary carcinoma without invasive carcinoma</option>
<option value="Solid papillary carcinoma without invasive carcinoma">Solid papillary carcinoma without invasive carcinoma</option>
<option value="Other (specify):">Other (specify):</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=16" target="_blank">Sizes (Extent) of DCIS</a>:</label>
</td>
<td align="right">
<label>Size (mm x mm x mm) :</label>
<input type="text" ID="A21a" class="element text medium" size="20"><br>
<label>Number of blocks with DCIS :</label>
<input type="text" ID="A22a" class="element text medium" size="20"><br>
<label>Number of blocks examined :</label>
<input type="text" ID="A23a" class="element text medium" size="20"><br>
</td>
</tr>
<tr>
<td valign="top">
<label class="">+ <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=16" target="_blank">Architectural patterns</a>:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A15" value=" - Comedo"><label class="choice">Comedo</label>
<input class="element checkbox" type="checkbox" id="A16" value=" - Paget disease (DCIS involving nipple skin)"><label class="choice">Paget disease (DCIS involving nipple skin)</label>
<input class="element checkbox" type="checkbox" id="A17" value=" - Cribriform"><label class="choice">Cribriform</label>
<input class="element checkbox" type="checkbox" id="A18" value=" - Micropapillary"><label class="choice">Micropapillary</label>
<input class="element checkbox" type="checkbox" id="A19" value=" - Papillary"><label class="choice">Papillary</label>
<input class="element checkbox" type="checkbox" id="A20" value=" - Solid"><label class="choice">Solid</label>
<input class="element checkbox" type="checkbox" id="A21" value=" - Other, specify:"><label class="choice">Other, specify:</label>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=16" target="_blank">Nuclear grade</a>:</label>
</td>
<td>
<select class="element select large" ID="A22">
<option value=""></option>
<option value="Grade I (low)">Grade I (low)</option>
<option value="Grade II (intermediate)">Grade II (intermediate)</option>
<option value="Grade III (high)">Grade III (high)</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=17" target="_blank">Necrosis</a>: </label>
</td>
<td>
<select class="element select large" ID="A23">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present, focal (small foci or single cell necrosis)">Present, focal (small foci or single cell necrosis)</option>
<option value="Present, central (expansive “comedo” necrosis)">Present, central (expansive “comedo” necrosis)</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="">+ <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=17" target="_blank">Microcalcifications</a>:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A72" value=" - Not identified"><label class="choice">Not identified</label>
<input class="element checkbox" type="checkbox" id="A73" value=" - Present in DCIS"><label class="choice">Present in DCIS</label>
<input class="element checkbox" type="checkbox" id="A75" value=" - Present in non-neoplastic tissue"><label class="choice">Present in non-neoplastic tissue</label>
<input class="element checkbox" type="checkbox" id="A76" value=" - Other (specify):"><label class="choice">Other (specify):</label>
</td>
</tr>
</table>
</p>
<p>
+ Please use the <a href="Biomarker-Breast-markers.html" target="_blank">Breast IHC/DISH template</a> for reporting ER and PR.
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend><label class="description"><a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=18" target="_blank">Surgical margins</a> (distance of the closest margin is required): </label></legend>
<p>
<table border="1">
<col width="60%">
<tr>
<td>
<label class="description">- Anterior margin:</label>
</td>
<td>
<select class="element select large" ID="A24">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by DCIS (>2 mm), closest distance:">Uninvolved by DCIS (>2 mm), closest distance:</option>
<option value="Involved by DCIS, closest distance:">Involved by DCIS, closest distance:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Posterior margin:</label>
</td>
<td>
<select class="element select large" ID="A25">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by DCIS (>2 mm), closest distance:">Uninvolved by DCIS (>2 mm), closest distance:</option>
<option value="Involved by DCIS, closest distance:">Involved by DCIS, closest distance:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Superior margin:</label>
</td>
<td>
<select class="element select large" ID="A26">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by DCIS (>2 mm), closest distance:">Uninvolved by DCIS (>2 mm), closest distance:</option>
<option value="Involved by DCIS, closest distance:">Involved by DCIS, closest distance:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Inferior margin:</label>
</td>
<td>
<select class="element select large" ID="A27">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by DCIS (>2 mm), closest distance:">Uninvolved by DCIS (>2 mm), closest distance:</option>
<option value="Involved by DCIS, closest distance:">Involved by DCIS, closest distance:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Medial margin:</label>
</td>
<td>
<select class="element select large" ID="A28">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by DCIS (>2 mm), closest distance:">Uninvolved by DCIS (>2 mm), closest distance:</option>
<option value="Involved by DCIS, closest distance:">Involved by DCIS, closest distance:</option>
</select>
</td>
</tr>
<tr>
<td>
<label class="description">- Lateral margin:</label>
</td>
<td>
<select class="element select large" ID="A29">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by DCIS (>2 mm), closest distance:">Uninvolved by DCIS (>2 mm), closest distance:</option>
<option value="Involved by DCIS, closest distance:">Involved by DCIS, closest distance:</option>
</select>
</td>
</tr>
<tr>
<td>
<label>- Other margins (specify):</label>
</td>
<td>
<select class="element select large" ID="A30">
<option value=""></option>
<option value="Cannot be assessed">Cannot be assessed</option>
<option value="Uninvolved by DCIS (>2 mm), closest distance:">Uninvolved by DCIS (>2 mm), closest distance:</option>
<option value="Involved by DCIS, closest distance:">Involved by DCIS, closest distance:</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=19" target="_blank">Regional lymph nodes</a>: </label></legend>
<p>
<table border="1">
<col width="80%">
<tr>
<td>
<label class="description">- Number of regional lymph nodes examined:</label>
</td>
<td>
<input type="text" class="element text large" ID="A31" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of sentinel lymph nodes examined:</label>
</td>
<td>
<input type="text" class="element text large" ID="A32" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes with macrometastasis (>2 mm):</label>
</td>
<td>
<input type="text" class="element text large" ID="A33" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes with micrometastasis <br>(> 0.2 to 2 mm and/or > 200 cells):</label>
</td>
<td>
<input type="text" class="element text large" ID="A34" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Number of lymph nodes with isolated tumor cells <br>(0.2 mm or less and < or = 200 cells):</label>
</td>
<td>
<input type="text" class="element text large" ID="A35" size="10">
</td>
</tr>
<tr>
<td>
<label class="description">- Size of largest metastatic deposit (mm), specify site:</label>
</td>
<td>
<input type="text" class="element text large" ID="A36" size="20">
</td>
</tr>
<tr>
<td>
<label class="description">- Size of largest lymph node involved (mm), specify site:</label>
</td>
<td>
<input type="text" class="element text large" ID="A37" size="20">
</td>
</tr>
<tr>
<td>
<label class="description">- Extranodal extension:</label>
</td>
<td>
<select class="element select large" ID="A38">
<option value=""></option>
<option value="Not identified">Not identified</option>
<option value="Present">Present</option>
<option value="Cannot be determined">Cannot be determined</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> Distant Metastasis: </label></legend>
<input class="element checkbox" type="checkbox" id="A47" value=" - Not applicable"><label class="choice" >Not applicable</label>
<input class="element checkbox" type="checkbox" id="A48" value=" - Not identified"><label class="choice" >Not identified</label>
<input class="element checkbox" type="checkbox" id="A49" value=" - Non-regional lymph node(s) (specify):"><label class="choice" >Non-regional lymph node(s) (specify):</label>
<input class="element checkbox" type="checkbox" id="A50" value=" - Lung (specify):"><label class="choice" >Lung (specify):</label>
<input class="element checkbox" type="checkbox" id="A51" value=" - Liver (specify):"><label class="choice" >Liver (specify):</label>
<input class="element checkbox" type="checkbox" id="A52" value=" - Bone (specify):"><label class="choice" >Bone (specify):</label>
<input class="element checkbox" type="checkbox" id="A53" value=" - Brain (specify):"><label class="choice" >Brain (specify):</label>
<input class="element checkbox" type="checkbox" id="A54" value=" - Other (specify):"><label class="choice" >Other (specify):</label>
<input class="element checkbox" type="checkbox" id="A55" value=" - Cannot be determined: "><label class="choice" >Cannot be determined: </label>
</fieldset>
</p>
<p>
<fieldset style="border-color:#e6e6ff;">
<legend> <label class="description"> <a href=".\cap\Cancer-Protocols-2021-06-Update\Breast-Protocol-Folder\Breast.DCIS_4.4.0.0.REL_CAPCP.pdf#page=21" target="_blank">Pathologic Stage Classification (AJCC 8e)</a>:</label></legend>
<p>
<table border="1">
<col width="40%">
<tr>
<td valign="top">
<label class="description">- TNM Descriptors:</label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A39" value=" r (recurrent) "><label class="choice">r (recurrent)</label>
<input class="element checkbox" type="checkbox" id="A40" value=" y (post treatment) "><label class="choice">y (post treatment)</label>
</td>
<tr>
<tr>
<td>
<label class="description">- Primary tumor (pT):</label>
</td>
<td>
<select class="element select large" ID="A41">
<option value=""></option>
<option value=" - pTis(DCIS): Ductal carcinoma in situ">pTis(DCIS): Ductal carcinoma in situ</option>
<option value=" - pTis (Paget): Paget disease of the nipple not associated with invasive carcinoma and/or DCIS in the underlying breast parenchyma">pTis (Paget): Paget disease of the nipple not associated with invasive carcinoma and/or DCIS in the underlying breast parenchyma</option>
</select>
</td>
</tr>
<tr>
<td valign="top">
<label class="description">- Regional lymph nodes modifier: </label>
</td>
<td>
<input class="element checkbox" type="checkbox" id="A42" value=" sn "><label class="choice">sn Sentinel node(s) evaluated (< 6 lymph nodes)</label>
<input class="element checkbox" type="checkbox" id="A43" value=" f "><label class="choice">f Nodal metastasis confirmed by FNA or biopsy</label>
</td>
</tr>
<tr>
<td>
<label class="description">- Regional lymph nodes (pN): </label>
</td>
<td>
<select class="element select large" ID="A44">
<option value=""></option>
<option value=" - pN not assigned (no nodes submitted or found)">pN not assigned (no nodes submitted or found)</option>
<option value=" - pN not assigned (cannot be determined based on available pathological information)"> pN not assigned (cannot be determined based on available pathological information)</option>
<option value=" - pN0: No regional lymph node metastasis or ITCs only">pN0: No regional lymph node metastasis or ITCs only</option>
<option value=" - pN0(i+): Isolated tumor cells in regional lymph node(s) < or = 0.2 mm">pN0(i+): Isolated tumor cells in regional lymph node(s) < or = 0.2 mm</option>
<option value=" - pN0(mol+): Positive molecular findings (RT-PCR), but no ITCs detected">pN0(mol+): Positive molecular findings (RT-PCR), but no ITCs detected</option>
<option value=" - pN1mi: Micrometastases (approximately 200 cells, > 0.2 mm to < or = 2.0 mm)">pN1mi: Micrometastases (approximately 200 cells, > 0.2 mm to < or = 2.0 mm)</option>
<option value=" - pN1a: Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis > 2.0 mm">pN1a: Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis > 2.0 mm</option>
<option value=" - pN1b: Metastases in ipsilateral internal mammary sentinel nodes, excluding ITCs">pN1b: Metastases in ipsilateral internal mammary sentinel nodes, excluding ITCs</option>
<option value=" - pN1c: pN1a and pN1b combined">pN1c: pN1a and pN1b combined</option>
<option value=" - pN2a: Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit > 2.0 mm)">pN2a: Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit > 2.0 mm)</option>
<option value=" - pN2b: Metastases in clinically detected internal mammary lymph nodes with or without microscopic confirmation; with pathologically negative axillary nodes">pN2b: Metastases in clinically detected internal mammary lymph nodes with or without microscopic confirmation; with pathologically negative axillary nodes</option>
<option value=" - pN3a: Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit > 2.0 mm) or metastases to the infraclavicular (Level III axillary lymph) nodes">pN3a: Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit < 2.0 mm) or metastases to the infraclavicular (Level III axillary lymph) nodes</option>
<option value=" - pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary nodes by imaging); or pN2a in the presence of pN1b">pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary nodes by imaging); or pN2a in the presence of pN1b</option>
<option value=" - pN3c: Metastases in ipsilateral supraclavicular lymph nodes">pN3c: Metastases in ipsilateral supraclavicular lymph nodes</option>
</select>
</td>
</tr>
<tr>
<td >
<label class="description">- Distant metastasis (pM): </label>
</td>
<td>
<select class="element select large" ID="A46">
<option value=""></option>
<option value=" - Not applicable - pM cannot be determined from the submitted specimen(s)">Not applicable - pM cannot be determined from the submitted specimen(s)</option>
<option value=" - pM1: Histologically proven metastases larger than 0.2 mm">pM1: Histologically proven metastases larger than 0.2 mm</option>
</select>
</td>
</tr>
</table>
</p>
</fieldset>
</p>
<p>
<label class="description">- Additional notes:</label>
<textarea ID="A45" class = "element textarea medium" style="border-color:Grey;"></textarea>
</p>
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<input type="button" name="copyform" value="Check your Report" onclick="updateDescription(this.form)"/>
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Last upated on 08-Nov-2022,<br>
based on <a href="https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates" target="_blank">US CAP cancer protocol templates</a>.<br>
Breast DCIS Resection 4.4.0.0 (June 2021).<br>
html form was created on <a href="https://www.phpform.org">pForm</a>, <a href="https://www.w3schools.com/">W3 School</a>, <a href="https://stackoverflow.com/">StackOverflow</a>, and <a href="https://icons8.com">Icons8</a>.<br><br>
Anatomical Pathology Division, Queen Mary Hospital, Hong Kong.
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