CAP Cancer Protocol and ecc Summary of Changes for August 2014 Thyroid Agile Release

CAP Cancer Protocol and ecc Summary of Changes for August 2014 Thyroid Agile Release

2 REVISION HISTORY Date Author / Editor Comments 5/19/2014 Jaleh Mirza Created the document 8/12/2014 Samantha Spencer/Jaleh Mirza Reviewed and edited 8/13/2014 Jaleh Mirza Document released for distribution

3 CONTENTS REVISION HISTORY... 2 INTRODUCTION... 5 THYROID RESECTION... 6 Procedure... 6 Lymph Node Sampling... 6 Specimen Integrity... 7 Specimen Size... 7 Specimen Weight... 7 Dominant Tumor... 7 Tumor Focality... 8 Tumor Laterality... 8 Histologic Type... 8 Histologic Grade... 9 Margins... 10 Tumor Capsule... 10 Tumor Capsular Invasion... 10 Lymph-Vascular Invasion... 10 Perineural Invasion... 11 Extrathyroidal Extension... 11 Second Tumor... 11 Pathologic Staging... 14 Primary Tumor... 14 Regional Lymph Nodes... 14 Lymph Node, Extranodal Extension... 15

4 Distant Metastasis... 15 Additional Pathologic Findings... 15 Ancillary Studies... 16 Clinical History... 16

5 INTRODUCTION This Summary of Changes document provides information about updates to the Thyroid major revision for the corresponding CAP Cancer Protocol (CCP) and electronic cancer checklist (ecc) for the August 2014 release. This release contains more than 100 ecc data element changes. Changes to the Explanatory Notes in the updated CCP are not covered in this document. Additions and minor changes to the CCP text are shown in green. Removed sections are shown with a strikeout font. Each change is flagged in this document as ecc only or CCP only where appropriate. In some cases, ecc content may differ from the case summary content in the CCP. The ecc content changes that differ from the CCP text were approved before release by the CAP Pathology Electronic Reporting Committee and/or the CAP Cancer Committee. Please address any comments to capecc@cap.org or call (847) 832-7700 to contact a member of the CAP ecc Team.

6 THYROID RESECTION Procedure Procedure was updated, as follows: Procedure (select all that apply) (Note A) Reoperative resection (ie, completion thyroidectomy) Specify Prior Procedure: (Added for ecc only) Partial excision (anything less than a lobectomy, including substernal excision) Right Left Other (specify): Partial thyroidectomy (anything less than a lobectomy) Right Left Lobectomy (This data element already existed in ecc. For ecc changed Thyroid lobectomy to Lobectomy and changed position. For CCP removed lobe for Right and Left options) Right lobe Left lobe Hemithyroidectomy (lobe and part or all of isthmus) Right Left Lobectomy with Isthmusectomy (hemithyroidectomy) Right lobe Left lobe Subtotal or near total thyroidectomy (lobectomy with isthmusectomy and partial contralateral lobectomy) Right lobe with partial left lobectomy Left lobe with partial right lobectomy Total thyroidectomy Other (specify): (Remove this option in paper, keep this in ecc only) Not specified Total thyroidectomy with central compartment dissection Total thyroidectomy with right neck dissection Total thyroidectomy with left neck dissection Total thyroidectomy with bilateral neck dissection Lymph Node Sampling Lymph Node Sampling data element was added, as follows: Lymph Node Sampling (required only if applicable) Focused or single lymph node resection (Answer Fill-in (AF) in ecc only)

7 Central compartment dissection (level VI-pretracheal, paratracheal and prelaryngeal/delphian, perithyroidal) (AF in ecc only) Lateral neck dissection (level I-V) (AF in ecc only) Right Left Superior mediastinal lymph nodes (level VII) Other (specify): Not performed: (Added for ecc only) Specimen Integrity Divided data element was added, as follows: Specimen Integrity Intact Divided (thyroidectomy performed as lobectomy and completion thyroidectomy) Fragmented Specimen Size Changed status of Specimen Size from Required to Optional. Central compartment, Right neck dissection and Left neck dissection measurement were removed. Overall or Aggregate specification was added. + Specimen Size + Right lobe: x x cm + Left lobe: x x cm + Isthmus ± pyramidal lobe: x x cm Central compartment: x x cm Right neck dissection: x x cm Left neck dissection: x x cm + Additional dimensions (specify) (i.e. overall or aggregate): x x cm Specimen Weight Overall or Aggregate and Individual specimen or fragment weights measurements were added. + Specimen Weight(s) + Specimen Weight (g) (specify) + Overall or aggregate weight (specify) g Note: Repeat this option for each specimen as needed. (Added in ecc only) + Individual specimen or fragment weights: g + Not available (AF in ecc only) Dominant Tumor

8 Dominant Tumor header was removed. In ecc subheaders were updated, as follows: Dominant Tumor (Note B) Specimen Tumor TUMOR Accessory Findings ACCESSORY FINDINGS Extent EXTENT Margins (Note F) MARGINS (Note I) Tumor Focality Data elements under Multifocal were removed, as follows: Tumor Focality (select all that apply) (Note B) Unifocal Multifocal (specify): Ipsilateral Bilateral Midline (isthmus) Tumor Laterality Tumor Laterality was updated, as follows: Tumor Laterality (select all that apply) (Note B) Right lobe Left lobe Isthmus Pyramidal lobe Not specified Other (specify): Histologic Type Histologic Type was updated following the latest WHO terminology, as follows: Histologic Type (select all that apply) (Note D, E) Papillary carcinoma Variant, specify: Common Significant Variants (Note F) (required only if applicable): Classic (usual, conventional) Clear cell variant Columnar cell variant Follicular variant Follicular variant, encapsulated/well demarcated Tumor capsular invasion Yes No Follicular variant, infiltrative Macrofollicular variant

9 Microcarcinoma (occult, latent, small, papillary microtumor) Oncocytic or oxyphilic variant Solid variant Tall cell variant (Position changed) Cribriform-morular variant Diffuse sclerosing variant Warthin-like variant Other, specify: Architecture: Classical (papillary) Cribriform-morular Diffuse sclerosing Follicular Other variant (specify) (Note F): Macrofollicular Solid Other, specify: Cytomorphology: Classical Clear cell Columnar cell Oncocytic or oxyphilic Tall cell Follicular carcinoma (Note G) Variant (required only if applicable): Clear cell Oncocytic (Hürthle cell) Other variant (specify): Extent of Tumor Invasion: Minimally invasive Widely invasive Poorly differentiated thyroid carcinomas, including insular (Note H) Undifferentiated (anaplastic) carcinoma (Note H) (Position changed) Focal or minor component without extrathyroidal extension Major component Medullary carcinoma Other (specify): Carcinoma, type cannot be determined Histologic Grade The question and answers for Histologic Grade were removed. + Histologic Grade (Note E) + Not applicable + GX: Cannot be assessed + G1: Well differentiated + G2: Moderately differentiated + G3: Poorly differentiated + G4: Undifferentiated

10 + Other (specify): Margins (Note F) was changed to (Note I). Margins uninvolved data elements were added only in CCP, as follows: Margins (Note F) (Note I) Margins uninvolved by carcinoma (Added only in CCP) + Distance of invasive carcinoma to closest margin: mm Margin(s) involved by carcinoma + Site(s) of involvement: Tumor Capsule The data elements for Tumor Capsule were removed. Tumor Capsule Totally encapsulated Partially encapsulated None Tumor Capsular Invasion The data elements for Tumor Capsular Invasion were removed. Tumor Capsular Invasion (select all that apply) (Note G) Not identified Present: Extent: Minimal Widely invasive Indeterminate Lymph-Vascular Invasion Lymph-Vascular Invasion was removed and replaced with two new data elements Angioinvasion (vascular invasion) and Lymphatic Invasion, as follows: Lymph-Vascular Invasion (select all that apply) (Note G) Not identified Present: Extent: Focal (less than 4 vessels) Extensive (4 or more vessels)

11 Indeterminate Angioinvasion (vascular invasion) (Note J) Cannot be determined Not identified Present: + Extent: + Focal (less than 4 vessels) + Extensive (4 or more vessels) Lymphatic Invasion (Note J) Cannot be determined Not identified Present Perineural Invasion Cannot be assessed was removed. Indeterminate was changed to Cannot be determined, as follows: + Perineural Invasion + + Indeterminate Cannot be determined + Not identified + Present Extrathyroidal Extension (Note H) was changed to (Note K) and under Present, Extent section was changed to be Optional status. Cannot be assessed was removed and Cannot be determined was added, as follows: Extrathyroidal Extension (select all that apply) (Note HK) Cannot be determined Not identified Present + Extent: + Minimal + Extensive Second Tumor Second Tumor section and all data elements for this section were removed. Second Tumor (for multifocal tumors only) Tumor Laterality (select all that apply) Right lobe

12 Left lobe Isthmus Not specified Tumor Size Greatest dimension: cm + Additional dimensions: x cm Cannot be determined Histologic Type (select all that apply) Papillary carcinoma Variant, specify: Classical (usual) Clear cell variant Columnar cell variant Cribriform-morular variant Diffuse sclerosing variant Follicular variant Macrofollicular variant Microcarcinoma (occult, latent, small, papillary microtumor) Oncocytic or oxyphilic variant Solid variant Tall cell variant Warthin-like variant Other, specify: Architecture: Classical (papillary) Cribriform-morular Diffuse sclerosing Follicular Macrofollicular Solid Other, specify: Cytomorphology: Classical Clear cell Columnar cell Oncocytic or oxyphilic Tall cell Follicular carcinoma Variant, specify: Clear cell Oncocytic (Hürthle cell) Other, specify: Poorly differentiated thyroid carcinomas, including insular carcinoma Medullary carcinoma Undifferentiated (anaplastic) carcinoma Other (specify): Carcinoma, type cannot be determined + Histologic Grade

13 + Not applicable + GX: Cannot be assessed + G1: Well differentiated + G2: Moderately differentiated + G3: Poorly differentiated + G4: Undifferentiated + Other (specify): Margins Margins uninvolved by carcinoma + Distance of invasive carcinoma to closest margin: mm Margin(s) involved by carcinoma + Site(s) of involvement: Tumor Capsule Totally encapsulated Partially encapsulated None Tumor Capsular Invasion (select all that apply) Not identified Present: Extent: Minimal Widely invasive Indeterminate Lymph-Vascular Invasion (select all that apply) Not identified Present Extent: Focal (less than 4 vessels) Extensive (4 or more vessels) Indeterminate + Perineural Invasion + Not identified + Present + Indeterminate Extrathyroidal Extension (select all that apply) Not identified Present Extent: Minimal Extensive

14 Pathologic Staging (Notes J through N) was changed to (Notes L through P). Pathologic Staging (ptnm) (Notes J L through N P) Primary Tumor For pt3, perithyroid was changed to perithyroidal. For pt4a, anaplastic was replaced with undifferentiated, as follows: Primary Tumor (pt) ptx: Cannot be assessed pt0: No evidence of primary tumor pt1: Tumor size 2 cm or less, limited to thyroid pt1a: Tumor 1 cm or less in greatest dimension limited to the thyroid. pt1b: Tumor more than 1 cm but not more than 2 cm in greatest dimension, limited to the thyroid pt2: Tumor more than 2 cm, but not more than 4 cm, limited to thyroid pt3: Tumor more than 4 cm limited to thyroid or any tumor with minimal extrathyroid extension (eg, extension to sternothyroid muscle or perithyroid perithyroidal soft tissues) pt4a: Moderately advanced disease. Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus or recurrent laryngeal nerve pt4b: Very advanced disease. Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels Note: There is no category of carcinoma in situ (ptis) relative to carcinomas of thyroid gland. Undifferentiated (Anaplastic) Carcinoma pt4a: Intrathyroidal anaplastic undifferentiated (anaplastic) carcinoma pt4b: Anaplastic Undifferentiated carcinoma (anaplastic) with gross extrathyroid extension Regional Lymph Nodes (Note L) was changed to (Notes M and N). For pn1a, perithyroidal was added. The data element for size of largest metastatic focus was added as a conditional element, as follows: Regional Lymph Nodes (pn) # (Note LNotes M and N) pnx: Regional lymph nodes cannot be assessed ## pn0: No regional lymph node metastasis pn1a: Metastasis to Level VI (pretracheal, paratracheal and prelaryngeal/delphian, perithyroidal) lymph nodes pn1b: Metastasis to unilateral, bilateral or contralateral cervical (Levels I, II, III, IV, V) or retropharyngeal or superior mediastinal lymph nodes (Level VII). Specify: Number examined: Number involved: Size (greatest dimension) of the largest metastatic focus in the lymph node (required only if applicable):

15 # Superior mediastinal lymph nodes are considered regional lymph nodes (level VII). Midline nodes are considered ipsilateral nodes. Lymph Nodes with psammoma bodies only (In ecc this option was added under LYMPH NODES Regional Lymph Nodes No nodes submitted or found Number of Lymph Nodes Involved) ## As there are currently no guidelines for pn staging with psammoma bodies only, these cases are best classified as pnx. Lymph Node, Extranodal Extension The required status of Lymph Node, Extranodal Extension was changed from Optional to Required. Referential (Note L) was changed to (Notes M and N). Indeterminate was changed to Cannot be determined, as follows: + Lymph Node, Extranodal Extension (Note LNotes M and N) + Not identified + Present + Indeterminate Cannot be determined Distant Metastasis Source of pathologic metastatic specimen was removed. Distant Metastasis (pm) (required only if confirmed pathologically in this case) Not applicable pm1: Distant metastasis + Specify site(s), if known: + Source of pathologic metastatic specimen (specify): Additional Pathologic Findings The data elements for Thyroiditis and Parathyroid Gland were updated, as follows: + Additional Pathologic Findings (select all that apply) + Adenoma + Adenomatoid nodule(s) or Nnodular follicular disease (eg, nodular hyperplasia, goitrous thyroid) + Diffuse hyperplasia (Graves disease) + Thyroiditis: (specify type): + Parathyroid gland(s): + Not present + Present (specify number and location): (In ecc, drop down lists for Number of Parathyroid Glands and Location of Parathyroid Gland(s) were added) + Within normal limits + Hypercellular

16 + Other (specify): + C-cell hyperplasia + None identified + Other (specify): Ancillary Studies In ecc added a note to repeat this section for each test, as follows: + Ancillary Studies (Note Q) Repeat this section for each test (Added this note in ecc only) + Specify type (eg, histochemistry, immunohistochemistry, DNA analysis): + Specify results: Clinical History Indeterminate was changed to Unknown. + Clinical History (select all that apply) + Radiation exposure: + Yes (specify type): + No + Indeterminate Unknown + Family history + Other (specify):