Protocol for the Examination of Gist Specimens

Gastrointestinal Stromal Tumor (GIST): Biopsy
Surgical Pathology Cancer Case Summary (Checklist)
*Procedure*
	____Core needle biopsy
	____Endoscopic biopsy
	____Other (specify):_____________________________
	_____Not specified
^*Specimen Size
	^*Greatest dimension: __________cm
	^*Additional dimensions: __________ x __________ cm
	^*Cannot be determined
*Tumor Site*
	Specify:_____________________________
	____Not specified
^*Tumor Size
	^*Greatest dimension: __________cm
	^*Additional dimensions: __________ x __________cm
	^*____Cannot be determined
*GIST Subtype*
	____Spindle cell
	____Epithelioid
	____Mixed
	____Other (specify):______________________________
*Mitotic Rate*
	Specify:__________/50 high-power fields (HPF)
^*Necrosis
	^*____Not identified
	^*____Present
			^*Extent: __________%
	^*____Cannot be determined
*Histologic Grade*
	____GX: Grade cannot be assessed
	____G1: Low grade; mitotic rate ≤ 5/50 HPF
	____G2: High grade; mitotic rate > 5/50 HPF
*Risk Assessment*
	____None
	____Very low risk
	____Low risk
	____Intermediate risk
	____High risk
	____Overtly metastatic
	____Cannot be determined
*Distant Metastasis*
	____Cannot be assessed
	____Distant metastasis
			Specify site(s), if known:______________________________
*Additional Pathologic Findings*
		Specify:______________________________
*Ancillary Studies (select all that apply)*
	Immunohistochemical studies
		____KIT (CD117)
			____Positive
			____Negative
		____Others (specify):______________________________
		____Not performed
	Molecular genetic studies (e.g., KIT or PDGFRA mutational analysis)
		____Submitted for analysis; results pending
		____Performed, see separate report:______________________________
		____Performed
				Specify method(s) and results:______________________________
		____Not performed
*Pre-biopsy Treatment (select all that apply)*
	____No therapy
	____Systemic therapy performed
			Specify type:______________________________
	____Therapy performed, type not specified
	____Unknown
^*Treatment Effect
	^*Specify percentage of viable tumor: __________%
^*Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Gastrointestinal Stromal Tumor.” Web posting date February 2010, www.cap.org.

Gastrointestinal Stromal Tumor (GIST): Resection
Surgical Pathology Cancer Case Summary (Checklist)
*Procedure*
	____Excisional biopsy
	____Resection
		Specify type (e.g., partial gastrectomy):______________________________
	____Metastasectomy
	____Other (specify):___________________________
	____Not specified
*Tumor Site*
	Specify (if known):___________________________
	____Not specified
*Tumor Size*
	Greatest dimension: _________cm
	^*Additional dimensions: __________ x __________cm
	____Cannot be determined
*Tumor Focality*
	____Unifocal
	____Multifocal
		Specify number of tumors:__________
		Specify size of tumors:______________________________
*GIST Subtype*
	____Spindle cell
	____Epithelioid
	____Mixed
	____Other (specify):______________________________
*Mitotic Rate*
	Specify: __________/50 HPF
^*Necrosis
	^*____Not identified
	^*____Present
				^*Extent: __________%
	^*____Cannot be determined
*Histologic Grade*
	____GX: Grade cannot be assessed
	____G1: Low grade; mitotic rate ≤ 5/50 HPF
	____G2: High grade; mitotic rate > 5/50 HPF
*Risk Assessment*
	____None
	____Very low risk
	____Intermediate risk
	____High risk
	____Overtly malignant/metastatic
	____Cannot be determined
*Margins*
	____Cannot be assessed
	____Negative for GIST
			Distance of tumor from closest margin: __________cm
	____Margin(s) positive for GIST
			Specify margin(s):_____________________________
*Pathologic Staging (pTNM)*
	TNM descriptors (required only if applicable) (select all that apply)
		____m (multiple)
		____r (recurrent)
		____y (post-treatment)
	Primary tumor (pT)
		____pTX: Primary tumor cannot be assessed
		____pT0: No evidence for primary tumor
		____pT1: Tumor ≤ 2 cm
		____pT2: Tumor > 2 cm but ≤ 5 cm
		____pT3: Tumor > 5 cm but ≤ 10 cm
		____pT4: Tumor > 10 cm in greatest dimension
	Regional lymph nodes (pN)
		____Not applicable
		____pM1: Distant metastasis
				^*Specify site(s) if known:______________________________
^*Additional Pathologic Findings
	^*Specify:______________________________
*Ancillary Studies (select all that apply)*
	Immunohistochemical studies
	____KIT (CD117)
			____Positive
			____Negative
	____Others (specify):______________________________
	____Not performed
	Molecular genetic studies (e.g., KIT or PDGFRA mutational analysis)
		____Submitted for analysis; results pending
		____Performed, see separate report:______________________________
		____Performed
				Specify method(s) and results:______________________________
		____Not performed
*Pre-resection Treatment (select all that apply)*
	____No therapy
	____Previous biopsy or surgery
		Specify:______________________________
	____Systemic therapy performed
		Specify type:______________________________
	____Therapy performed, type not specified
	____Unknown
^*Treatment Effect
	^*Specify percentage of viable tumor: __________%
^*Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Gastrointestinal Stromal Tumor.” Web posting date February 2010, www.cap.org.