Oncology Specialist Pathology Assessment Form
Complete this form to provide a structured pathology assessment for oncology cases. Please answer each section based on your expert evaluation.
Case Type
*
Please Select
New Diagnosis
Recurrence
Follow-up Assessment
Second Opinion
Tissue Source
*
Please Select
Breast
Lung
Colon
Prostate
Lymph Node
Other
Tumor Grade (WHO/Relevant System)
*
Grade 1 (Low)
Grade 2 (Intermediate)
Grade 3 (High)
Not Applicable
Pathology Findings Assessment
*
Rows
Absent
Present
Indeterminate
Lymphovascular Invasion
1
2
3
Perineural Invasion
4
5
6
Necrosis
7
8
9
Mitotic Activity
10
11
12
Tumor Stage (AJCC/UICC)
*
Please Select
Stage 0
Stage I
Stage II
Stage III
Stage IV
Not Staged
Molecular Marker Status
ER/PR Positive
HER2 Positive
ALK Rearrangement
EGFR Mutation
KRAS Mutation
Other
Immunohistochemistry (IHC) Marker Intensity
1
2
3
4
5
Overall Pathologist Impression
*
Benign
1
2
3
4
Highly Malignant
5
1 is Benign, 5 is Highly Malignant
Recommendation for Further Workup
*
No Further Workup Needed
Recommend Additional Immunostains
Recommend Molecular Testing
Recommend Second Pathology Review
Additional Comments
Submit Assessment
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