RCPA Protocols Flashcards

1
Q

Breast T staging

A

based on largest tumour (invasive component only):

  • size (2 and 5 cm cutoffs for T2, T3)
  • extension to chest wall (not just muscle) or skin ulceration (T4)

NB: tumours are separate if 5mm or more between

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2
Q

Breast N staging

A

i for isolated tumour cells (<0.2mm or <200 cells)

mol +/- for molecularly detected mets

mi for micromets (0.2 - 2mm)

cutoffs 4 (N2) and 10 (N3)

clinically detected nodes affect N stage

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3
Q

Breast - margins for which lesions?

A

invasive ca

DCIS

comedo- or pleomorphic LCIS

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4
Q

Breast - ancillary tests

A

ER: % nuclei and predominant intensity (>1 is +)

PR: % nuclei and predominant intensity (>1 is +)

HER2 ISH: copies >6 or ratio >2.2 (use FISH if ISH not definitive)

HER2 IHC: 0-3+

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5
Q

Breast - biomarker issues

A

can be on core or excision, but should repeat if negative

HER2 best on excision due to heterogeneity

prompt and adequate fixation (8-24 hrs) required

fix for at least 6-8 hours, even if a core!

use antigen retrieval, and internal and external controls

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6
Q

Breast - describe grading

A

nuclear grade: size, shape and chromatin

tubular differentiation: cutoffs 10% and 75%

mitotic count: use tables, based on field diameter (on mine: score 2 is 9-17/10HPF)

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7
Q

Breast - grading DCIS

A

use NHS BSP system:

low (monomorphic, 1-2x RBC)

intermediate (2-3x RBC)

high (pleomorphic, 3 xRBC, necrosis)

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8
Q

CRC - grading mesorectal completeness

A

incomplete (grade 1): defects down to muscularis

nearly complete (grade 2): irregular, clefts over 5mm

complete (grade 3): smooth, no coning, clefts under 5mm

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9
Q

CRC - grading

A

low or high

WHO: based on highest grade present, not including leading front of tumour

not graded: medullary, mucinous (low if MSI-H)

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10
Q

CRC - T stage

A

level of invasion

nb: T4a is serosa (use EVG if unsure) or perforation, T4b is adjacent structure
nb: serosal deposits are M1, therefore important to see continuity with tumour

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11
Q

CRC - which margins to measure?

A

end margins and circumferential margin

nb: +ve if <1mm (except for R status - needs to be at ink)
nb: margin is to tumour OR involved LN OR tumour deposit OR LVI

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12
Q

CRC - response to neoadjuvant therapy

A

complete response (G0): no viable tumour cells

moderate response (G1): single or small groups

minimal response (G2): tumour outgrown by fibrosis

poor response (G3): minimal or no tumour kill

nb: post therapy, acellular mucin pools and mucin in lymph nodes are considered negative for tumour

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13
Q

CRC - histologic features of MMR deficiency

A

TILs

medullary subtype

mucinous or signet ring subtype

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14
Q

CRC - routine ancillary tests

A

MMR IHC

if loss of MLH1: do BRAF (if positive, assume sporadic hypermethylation of MLH1)

Also RAS testing if requested, for metastatic disease (predicts response to anti-EGFR therapy)

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15
Q

CRC - R codes

A

R0: complete resection (margins/nodes negative)

R1: microscopic tumour only remains (at margin CAP, <1mm from margin RCP)

R2: macroscopic margin involved or gross disease

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16
Q

Melanoma - Breslow thickness

A

most important prognostic factor for localised melanoma

from top of granular layer (or top of ulcer), to 1 DP

dont include adnexal extension

17
Q

Melanoma - mitotic count

A

per mm2 (use stage micrometer/field diameter to calculate)

start at hot spot, assess adjacent fields up to 1mm2 (approx 4 HPF)

report as whole number

report in all, however affects staging only in thin non ulcerated tumours

18
Q

Melanoma - vs nodal nevi

A

nevi:

in fibrous capsule

bland cells, no mitoses

minimal HMB45 stain and low KI67 (melanA and s100 are +)

19
Q

Melanoma - sentinel node info

A

location within LN (subcapsular, intraparenchymal)

maximum dimension of metastasis

extranodal extension

20
Q

Melanoma - molecular tests

A

none are routine

BRAF and c-KIT most common

BRAF only for stage III or IV tumours (targeted therapy, not funded in NZ)

21
Q

Melanoma - T stage

A

need ulceration, thickness, mitoses

22
Q

Lung - T stage

A

based on:

size (3 and 7cm cutoffs)

invasion into local structures (pleura/pericardium/diaphragm OR main bronchus for T3, heart/trachea/oesophagus/carina etc for T4)

23
Q

Cervix T stage

A

(FIGO or TNM)

size (horizontal and lateral)

extension beyond uterus (corpus is ok) eg parametrium, pelvic wall, bladder, rectum, vagina

clinical visibility

Any LN = N1

Any met = M1

24
Q

measuring cervical tumours

A

from base of originating epithelium (surface or glandular)

from ulcer surface if ulcerated

measure thickness of cervix (from same point)

25
Q

pancreas - margins

A

proximal/distal

uncinate (superior mesenteric artery)

pancreatic parenchymal

vascular groove (superior mesenteric vein)

bile duct