The CAP Checklists included below reflect the most recent version available at the
time of publication of the CAP/CS-Aligned Data Standard. The CAP/CS-Aligned
Data Standards, however, are based on a forthcoming edition of the CAP
Checklists, which have not yet been published.
CAP CHECKLIST – LOOKUP TABLE – BREAST
BREAST: Excision Less Than Total Mastectomy (Includes Wire-Guided
Localization Excisions), Total Mastectomy, Modified Radical Mastectomy,
Radical Mastectomy
Note: Check 1 response unless otherwise indicated.
MACROSCOPIC
Specimen Type
___ Excision
___ Mastectomy
___ Other (specify): ____________________________
___ Not specified
Lymph Node Sampling
___ No lymph node sampling
___ Sentinel lymph node(s) only
___ Sentinel lymph node with axillary dissection
___ Axillary dissection
Specimen Size (for excisions less than total mastectomy)
Greatest dimension: ___ cm
*Additional dimensions: ___ x ___ cm
___ Cannot be determined (see Comment)
Laterality
___ Right
___ Left
___ Not specified
Tumor Site (check all that apply)
___ Upper outer quadrant
___ Lower outer quadrant
___ Upper inner quadrant
___ Lower inner quadrant
___ Central
___ Not specified
* Data elements with asterisks are not required for accreditation purposes for
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
MICROSCOPIC
Size of Invasive Component
Greatest dimension: ___ cm
*Additional dimensions: ___ x ___ cm
___ Cannot be determined (see Comment)
Note: The size of the tumor, as measured by gross examination, must be verified
by microscopic examination. If there is a discrepancy between gross and microscopic
tumor measurement, the microscopic measurement of the invasive component takes precedence
and should be used for tumor staging.
Histologic Type (check all that apply)
___ Noninvasive carcinoma (NOS)
___ Ductal carcinoma in situ
___ Lobular carcinoma in situ
___ Paget disease without invasive carcinoma
___ Invasive carcinoma (NOS)
___ Invasive ductal carcinoma
___ Invasive ductal carcinoma with an extensive intraductal component
___ Invasive ductal carcinoma with Paget disease
___ Invasive lobular
___ Mucinous
___ Medullary
___ Papillary
___ Tubular
___ Adenoid cystic
___ Secretory (juvenile)
___ Apocrine
___ Cribriform
___ Carcinoma with squamous metaplasia
___ Carcinoma with spindle cell metaplasia
___ Carcinoma with cartilaginous/osseous metaplasia
___ Carcinoma with metaplasia, mixed type
___ Other(s) (specify): ____________________________
___ Carcinoma, type cannot be determined
* Data elements with asterisks are not required for accreditation purposes for
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
Histologic Grade (any grading system may be used; mitotic count is also required
independent of the grading system)
Nottingham Histologic Score
(If not used, see Other Grading System below)
Tubule Formation
___ Majority of tumor greater than 75% (score = 1)
___ Moderate 10% to 75% (score = 2)
___ Minimal less than 10% (score = 3)
Nuclear Pleomorphism
___ Small regular nuclei (score = 1)
___ Moderate increase in size, etc (score = 2)
___ Marked variation in size, nucleoli, chromatin clumping, etc (score = 3)
Mitotic Count (for those using Nottingham system)
For a 25x objective with a field area of 0.274 mm2
___ Less than 10 mitoses per 10 HPF (score = 1)
___ 10 to 20 mitoses per 10 HPF (score = 2)
___ Greater than 20 mitoses per 10 HPF (score = 3)
or
For a 40x objective with a field area of 0.152 mm2
___ 0 to 5 mitoses per 10 HPF (score = 1)
___ 6 to 10 mitoses per 10 HPF (score = 2)
___ Greater than 10 mitoses per 10 HPF (score = 3)
Total Nottingham Score
___ Grade I: 3-5 points
___ Grade II: 6-7 points
___ Grade III: 8-9 points
___ Score cannot be determined
Other Grading System
Specify grading system: ____________________________
___ Grade 1
___ Grade 2
___ Grade 3
___ Grade cannot be determined
Mitotic Count (for those using other grading systems)
* Data elements with asterisks are not required for accreditation purposes for
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
___ Number of mitoses per 10 HPF
Pathologic Staging (pTNM)
Primary Tumor (pT)
___ pTX:
Cannot be assessed
___ pT0:
No evidence of primary tumor
___ pTis:
Ductal carcinoma in situ
___ pTis:
Lobular carcinoma in situ
___ pTis:
Paget disease without invasive carcinoma
pT1: Tumor 2.0 cm or less in greatest dimension
___ pT1mic: Microinvasion 0.1 cm or less in greatest dimension
___ pT1a: Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension
___ pT1b: Tumor more than 0.5 cm but not more than 1.0 cm in greatest dimension
___ pT1c: Tumor more than 1.0 cm but not more than 2.0 cm in greatest dimension
___ pT2:
Tumor more than 2.0 cm but not more than 5.0 cm in greatest dimension
___ pT3:
Tumor more than 5.0 cm in greatest dimension
pT4: Tumor of any size with direct extension to chest wall or skin, but only as
described below.#
___ pT4a: Extension to chest wall, not including pectoralis muscle
___ pT4b: Edema (including peau d’orange) or ulceration of the skin of the breast or
satellite skin nodules confined to the same breast
___ pT4c: Both T4a and T4b
___ pT4d: Inflammatory carcinoma
#
Clinical information may be required to designate a tumor as pT4. Dermal invasion alone
(without ulceration, satellite nodules, or inflammatory breast cancer) does not alter T category.
Such cases are classified as T1, T2, or T3, depending on tumor size.
Regional Lymph Nodes (pN) (choose a category based on data
supplied with specimen; immunocytochemistry and molecular
studies are not required)
___ pNX:
Cannot be assessed (previously removed or not removed for pathologic
study)
___ pN0:
No regional lymph node metastasis histologically (ie, none greater than
0.2 mm), no examination for isolated tumor cells (ITCs)
___ pN0(i-):
No regional lymph node metastasis histologically, negative morphologic
(any morphologic technique, including hematoxylin-eosin and
immunohistochemistry) findings for ITCs
___ pN0(i+):
No regional lymph node metastasis histologically, positive morphologic
(any morphologic technique, including hematoxylin-eosin and
immunohistochemistry) findings for ITCs, no ITC cluster greater than
0.2 mm
___ pN0(mol-): No regional lymph node metastasis histologically, negative
nonmorphologic (molecular) findings for ITCs
* Data elements with asterisks are not required for accreditation purposes for
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
___ pN0(mol+): No regional lymph node metastasis histologically, positive
nonmorphologic (molecular) findings for ITCs
___ pN1:
Metastasis in 1 to 3 axillary lymph nodes, and/or internal mammary
nodes with microscopic disease detected by sentinel lymph node
dissection but not clinically apparent
___ pN1mi:
Micrometastasis (greater than 0.2 mm, none greater than 2.0 mm)
___ pN1a:
Metastasis in 1 to 3 axillary lymph nodes (at least 1 tumor deposit
greater than 2.0 mm)
___ pN1b:
Metastasis in internal mammary lymph nodes with microscopic disease
detected by sentinel lymph node dissection but not clinically apparent
___ pN1c:
Metastasis in 1 to 3 axillary lymph nodes and in internal mammary
nodes with microscopic disease detected by sentinel lymph node
dissection but not clinically apparent
___ pN2a:
Metastasis in 4 to 9 axillary lymph nodes (at least 1 tumor deposit
greater than 2.0 mm)
___ pN2b:
Metastasis in clinically apparent internal mammary lymph nodes in the
absence of axillary lymph node metastases
___ pN3a:
Metastasis in 10 or more axillary lymph nodes (at least 1 tumor deposit
greater than 2.0 mm), or metastasis to the infraclavicular lymph nodes
___ pN3b:
Metastasis in clinically apparent ipsilateral internal mammary lymph
nodes in the presence of 1 or more positive axillary lymph nodes; or in
more than 3 axillary lymph nodes and in internal mammary lymph nodes
with microscopic disease detected by sentinel lymph node dissection
but not clinically apparent
___ pN3c:
Metastasis in ipsilateral supraclavicular lymph nodes
Specify: Number examined: ____
Number involved: ____
Distant Metastasis (pM)
___ pMX: Cannot be assessed
___ pM1: Distant metastasis
*Specify site(s), if known: __________________________
Margins (check all that apply)
___ Margins cannot be assessed
___ Margins uninvolved by invasive carcinoma
Distance from closest margin: ___ mm
*Specify which margin: ____________________________
___ Margins uninvolved by DCIS (if present)
Distance from closest margin: ___ mm
*Specify which margin: ____________________________
___ Margin(s) involved by invasive carcinoma
Specify which margin: _____________________________
___ Margin(s) involved by DCIS
Specify which margin: _____________________________
*Extent of Margin Involvement for Invasive Carcinoma
*___ Cannot be assessed
* Data elements with asterisks are not required for accreditation purposes for
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
*___ Unifocal
*___ Multifocal
*___ Extensive
*___ Other (specify): ____________________________
*Extent of Margin Involvement for DCIS
*___ Cannot be assessed
*___ Unifocal
*___ Multifocal
*___ Extensive
*___ Other (specify): ____________________________
*Venous/Lymphatic (Large/Small Vessel) Invasion (V/L)
*___ Absent
*___ Present
*___ Indeterminate
*Microcalcifications (check all that apply)
*___ Not identified
*___ Present in DCIS
*___ Present in invasive carcinoma
*___ Present in non-neoplastic tissue
*___ Present in both tumor and non-neoplastic tissue
*Additional Pathologic Findings
*Specify: ____________________________
*Comment(s)
* Data elements with asterisks are not required for accreditation purposes for
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 CHECKLIST – LOOKUP TABLE - COLORECTAL
COLON AND RECTUM: Resection
Note: Check 1 response unless otherwise indicated.
MACROSCOPIC
Specimen Type
___ Right hemicolectomy
___ Transverse colectomy
___ Left hemicolectomy
___ Sigmoidectomy
___ Rectal/rectosigmoid colon (low anterior resection)
___ Total abdominal colectomy
___ Abdominoperineal resection
___ Other (specify): ____________________________
___ Not specified
*Specimen Length (if applicable)
*Specify: ___ cm
Tumor Site
___ Cecum
___ Right (ascending) colon
___ Hepatic flexure
___ Transverse colon
___ Splenic flexure
___ Left (descending) colon
___ Sigmoid colon
___ Rectosigmoid
___ Rectum
___ Colon, not otherwise specified
___ Cannot be determined (see Comment)
*Tumor Configuration
*___ Exophytic (polypoid)
*___ Infiltrative
*___ Ulcerating
*___ Other (specify): ___________________________
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
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
*Intactness of Mesorectum
*___ Not applicable
*___ Complete
*___ Near complete
*___ Incomplete
MICROSCOPIC
Histologic Type
___ Adenocarcinoma
___ Mucinous adenocarcinoma (greater than 50% mucinous)
___ Medullary carcinoma
___ Signet-ring cell carcinoma (greater than 50% signet-ring cells)
___ Small cell carcinoma
___ Undifferentiated carcinoma
___ Other (specify): ____________________________
___ Carcinoma, type cannot be determined
Histologic Grade
___ Not applicable
___ Cannot be assessed
___ Low-grade (well to moderately differentiated)
___ High-grade (poorly differentiated to undifferentiated)
___ Other (specify): ____________________________
Pathologic Staging (pTNM)
Primary Tumor (pT)
___ pTX:
___ pT0:
___ pTis:
___ pTis:
___ pT1:
___ pT2:
___ pT3:
Cannot be assessed
No evidence of primary tumor
Carcinoma in situ, intraepithelial (no invasion)
Carcinoma in situ, invasion of lamina propria
Tumor invades submucosa
Tumor invades muscularis propria
Tumor invades through the muscularis propria into the subserosa or the
nonperitonealized pericolic or perirectal soft tissues
*___ pT3a/b: Tumor invades through the muscularis propria into the subserosa or the
nonperitonealized pericolic or perirectal soft tissues, invades 5 mm or less
beyond the border of the muscularis propria
*___ pT3c/d: Tumor invades through the muscularis propria into the subserosa or the
nonperitonealized pericolic or perirectal soft tissues, invades greater than
5 mm beyond the border of the muscularis propria
___ pT4a:
Tumor directly invades other organs or structures
___ pT4b:
Tumor penetrates the visceral peritoneum
* Data elements with asterisks are not required for accreditation purposes for
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
Regional Lymph Nodes (pN)
___ pNX:
___ pN0:
___ pN1:
___ pN2:
Specify:
Cannot be assessed
No regional lymph node metastasis
Metastasis in 1 to 3 regional lymph nodes
Metastasis in 4 or more regional lymph nodes
Number examined: ___
Number involved: ___
Distant Metastasis (pM)
___ pMX: Cannot be assessed
___ pM1: Distant metastasis
*Specify site(s): ______________________________
Margins (check all that apply)
Proximal Margin
___ Cannot be assessed
___ Uninvolved by invasive carcinoma
___ Involved by invasive carcinoma
___ Carcinoma in situ/adenoma absent at proximal margin
___ Carcinoma in situ/adenoma present at proximal margin
Distal Margin
___ Cannot be assessed
___ Uninvolved by invasive carcinoma
___ Involved by invasive carcinoma
___ Carcinoma in situ/adenoma absent at distal margin
___ Carcinoma in situ/adenoma present at distal margin
Circumferential (Radial) Margin
___ Not applicable
___ Cannot be assessed
___ Uninvolved by invasive carcinoma
___ Involved by invasive carcinoma (tumor present 0-1 mm from CRM)
*Mesenteric Margin
*___ Cannot be assessed
*___ Uninvolved by invasive carcinoma
*___ Involved by invasive carcinoma
If all margins uninvolved by invasive carcinoma:
Distance of invasive carcinoma from closest margin: ___ mm OR ___ cm
* Data elements with asterisks are not required for accreditation purposes for
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
Specify margin: __________________________
Lymphatic (Small Vessel) Invasion (L) (check all that apply)
___ Absent
___ Present
*___ Intramural
*___ Extramural
___ Indeterminate
Venous (Large Vessel) Invasion (V) (check all that apply)
___ Absent
___ Present
*___ Intramural
*___ Extramural
___ Indeterminate
*Perineural Invasion
*___ Absent
*___ Present
*Tumor Border Configuration
*___ Pushing
*___ Infiltrating
*Intratumoral/Peritumoral Lymphocytic Response
*___ None
*___ Mild to moderate
*___ Marked (including Crohn-like response)
*Additional Pathologic Findings (check all that apply)
*___ None identified
*___ Adenoma(s)
*___ Chronic ulcerative proctocolitis
*___ Crohn disease
*___ Dysplasia
*___ Other polyps (type[s]): ___________________________
*___ Other (specify): ___________________________
*Comment(s)
* Data elements with asterisks are not required for accreditation purposes for
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 CHECKLIST – LOOKUP TABLE – ENDOMETRIUM
ENDOMETRIUM: Hysterectomy, With or Without Other Organs or Tissues
Note: Check 1 response unless otherwise indicated.
MACROSCOPIC
Specimen Type
___ Hysterectomy
___ Radical hysterectomy (includes parametria)
___ Pelvic exenteration
___ Other (specify): ____________________________
___ Not specified
*Tumor Site
*Specify location(s), if known: _____________________________
*___ Not specified
Tumor Size
Greatest dimension: ___ cm
*Additional dimensions: ___ x ___ cm
___ Cannot be determined (see Comment)
Other Organs Present (check all that apply)
___ None
___ Right ovary
___ Left ovary
___ Right fallopian tube
___ Left fallopian tube
___ Urinary bladder
___ Vagina
___ Rectum
___ Other(s) (specify): _________________________
* Data elements with asterisks are not required for accreditation purposes for
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
MICROSCOPIC
Histologic Type
___ Endometrioid adenocarcinoma, not otherwise characterized
___ Endometrioid adenocarcinoma, secretory (variant)
___ Endometrioid adenocarcinoma, ciliated cell (variant)
___ Endometrioid adenocarcinoma, with squamous metaplasia
___ Adenosquamous carcinoma
___ Serous adenocarcinoma
___ Clear cell adenocarcinoma
___ Mucinous adenocarcinoma
___ Squamous cell carcinoma
___ Mixed carcinoma (specify types and percentages): ________________________
___ Undifferentiated carcinoma
___ Other (specify): ____________________________
___ Carcinoma, type cannot be determined
Histologic Grade (if applicable)
(Grading system below applies primarily to endometrioid carcinoma)
___ Not applicable
___ GX: Cannot be assessed
___ G1: 5% or less nonsquamous solid growth
___ G2: 6% to 50% nonsquamous solid growth
___ G3: More than 50% nonsquamous solid growth
___ Other (specify): ____________________________
Myometrial Invasion
___ No invasion
___ Invasion present
Specify depth of invasion: ___ mm
Specify myometrial thickness: ___ mm
* Data elements with asterisks are not required for accreditation purposes for
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
Pathologic Staging (pTNM [FIGO])
Primary Tumor (pT)
___ pTX [--]:
Primary tumor cannot be assessed
___ pT0 [--]:
No evidence of primary tumor
___ pTis [0]:
Carcinoma in situ
pT1 [I]: Tumor confined to corpus uteri
___ pT1a [IA]: Tumor limited to endometrium
___ pT1b [IB]: Tumor invades less than one-half of the myometrium
___ pT1c [IC]: Tumor invades one-half or more of the myometrium
pT2 [II]: Tumor invades cervix, but does not extend beyond uterus
___ pT2a [IIA]: Tumor limited to the glandular epithelium of the endocervix. There is no
evidence of connective tissue stromal invasion.
___ pT2b [IIB]: Invasion of the stromal connective tissue of the cervix
pT3 [III]: Local and/or regional spread as specified in T3a and T3b, and FIGO IIIA and
IIIB
___ pT3a [IIIA]: Tumor involves serosa, parametria, and/or adnexa (direct extension or
metastasis)
*___ pT3a [IIIA]: Tumor involves serosa and/or adnexa (direct extension or metastasis)
and/or cancer cells in ascites or peritoneal washings
___ pT3b [IIIB]: Involvement of vagina (direct extension or metastasis), rectal or bladder
wall (without mucosal involvement), or pelvic wall(s) (frozen pelvis)
___ pT4 [IVA]: Tumor invades bladder mucosa and/or bowel mucosa
Regional Lymph Nodes (pN)
___ pNX: Cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN1 [IIIC]: Regional lymph node metastasis to the pelvic and/or para-aortic lymph
nodes
Specify: Number examined: ___
Number involved: ___
Distant Metastasis (pM)
___ pMX: Cannot be assessed
___ pM1 [IVB]: Distant metastasis (includes metastasis to abdominal lymph nodes other
than para-aortic, and/or inguinal lymph nodes; excludes metastasis to vagina,
pelvic serosa, or adnexa)
*Specify site(s), if known: ______________________________
Margins
___ Cannot be assessed
___ Uninvolved by invasive carcinoma
*Distance of invasive carcinoma from closest margin: ___ mm
*Specify margin: _____________________________
___ Involved by invasive carcinoma
* Data elements with asterisks are not required for accreditation purposes for
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
Specify margin(s): ___________________________
* Data elements with asterisks are not required for accreditation purposes for
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
Venous/Lymphatic (Large/Small Vessel) Invasion (V/L)
___ Absent
___ Present
___ Indeterminate
*Additional Pathologic Findings (check all that apply)
*___ None identified
*___ Hyperplasia
*___ Simple
*___ Complex (adenomatous)
*___ Atypical hyperplasia
*___ Simple
*___ Complex (adenomatous)
*___ Other (specify): ___________________________
*Comment(s)
* Data elements with asterisks are not required for accreditation purposes for
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 CHECKLIST – LOOKUP TABLE – LUNG
LUNG: Resection
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
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
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): ____________________________
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
* Data elements with asterisks are not required for accreditation purposes for
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
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
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
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): ____________________________
*___ Other (specify): ____________________________
* Data elements with asterisks are not required for accreditation purposes for
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
*Comment(s)
* Data elements with asterisks are not required for accreditation purposes for
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 CHECKLIST – LOOKUP TABLE - PROSTATE
PROSTATE GLAND: Radical Prostatectomy
Note: Check 1 response unless otherwise indicated.
MACROSCOPIC (rarely applicable; see “Background Documentation”)
MICROSCOPIC
Histologic Type
___ Cannot be determined
___ Adenocarcinoma (conventional, not otherwise specified)
___ Prostatic duct adenocarcinoma
___ Mucinous (colloid) adenocarcinoma
___ Signet-ring cell carcinoma
___ Adenosquamous carcinoma
___ Small cell carcinoma
___ Sarcomatoid carcinoma
___ Other (specify): ____________________________
___ Undifferentiated carcinoma, not otherwise specified
* Data elements with asterisks are not required for accreditation purposes for
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
Histologic Grade
Gleason Pattern
(if 3 patterns are present, record the most predominant and second most
common patterns; the tertiary pattern should be recorded if higher than primary
and secondary patterns but does not get incorporated into the Gleason score)
___ Not applicable
___ Cannot be determined
Primary Pattern
___ Grade 1
___ Grade 2
___ Grade 3
___ Grade 4
___ Grade 5
Secondary Pattern
___ Grade 1
___ Grade 2
___ Grade 3
___ Grade 4
___ Grade 5
*Tertiary Pattern
*___ Grade 3
*___ Grade 4
*___ Grade 5
Total Gleason Score: ____
*Tumor Quantitation
*Proportion (percent) of prostate involved by tumor: ____%
*Tumor size (dominant nodule, if present):
*Greatest dimension: ___ cm
*Additional dimensions: ___ x ___ cm
Extraprostatic Extension (check all that apply)
___ Absent
___ Present
*___ Focal
*Specify site(s): ___________________
*___ Nonfocal (established, extensive)
*Specify site(s): ___________________
___ Indeterminate
* Data elements with asterisks are not required for accreditation purposes for
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
Seminal Vesicle Invasion (invasion of muscular wall required)
___ Absent
___ Present
___ No seminal vesicle present
Pathologic Staging (pTNM)
Primary Tumor (pT)
___ Not identified
___ pT2: Organ confined
*___ pT2a:Unilateral, involving one-half of 1 side (“lobe”) or less
*___ pT2b:Unilateral, involving more than one-half of 1 side (“lobe”) but not both sides
(“lobes”)
*___ pT2c: Bilateral disease
pT3: Extraprostatic extension
___ pT3a: Extraprostatic extension
___ pT3b: Seminal vesicle invasion
___ pT4: Invasion of bladder and/or rectum (see Explanatory Note J)
Note: Subdivision of pT2 disease is problematic and has not been proven to be of importance;
hence, the subcategories pT2a,b,c are considered optional.
Regional Lymph Nodes (pN)
___ pNX:
___ pN0:
___ pN1:
Specify:
Cannot be assessed
No regional lymph node metastasis
Metastasis in regional lymph node or nodes
Number examined: ___
Number involved: ___
Distant Metastasis (pM)
___ pMX: Distant metastasis cannot be assessed
pM1: Distant metastasis
___ pM1a: Distant metastasis, non-regional lymph node(s)
___ pM1b: Distant metastasis, bone(s)
___ pM1c: Distant metastasis, other site(s)
Note: When more than 1 site of metastasis is present,
the most advanced category (pM1c) is used.
* Data elements with asterisks are not required for accreditation purposes for
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
Margins (check all that apply)
___ Cannot be assessed
*___ Benign glands at surgical margin
___ Margins uninvolved by invasive carcinoma
___ Margin(s) involved by invasive carcinoma
*___ Unifocal
*___ Multifocal
___ Apical
___ Bladder neck
___ Anterior
___ Lateral
___ Postero-lateral (neurovascular bundle)
___ Posterior
___ Other(s) (specify): ___________________________
*Perineural Invasion
*___ Absent
*___ Present
*Venous (Large Vessel) Invasion (V)
*___ Absent
*___ Present
*___ Indeterminate
*Lymphatic (Small Vessel) Invasion (L)
*___ Absent
*___ Present
*___ Indeterminate
*Additional Pathologic Findings (check all that apply)
*___ None identified
*___ High-grade prostatic intraepithelial neoplasia (PIN)
*___ Inflammation (specify type): ____________________________
*___ Atypical adenomatous hyperplasia (adenosis)
*___ Nodular prostatic hyperplasia
*___ Other (specify): ____________________________
*Comment(s)
* Data elements with asterisks are not required for accreditation purposes for
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