Quantitative Report Template by ugb91096

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									ER/PR/Her-2 AUTOMATED IHC IMAGE ANALYSIS TEMPLATE
FOR BREAST RESIDENTS/FELLOWS
ACCESSION # _________________ Name: _______________________
                               CPI: _______________________

Type paragraphs if [type->] is circled, do not type if crossed out.
Use ACIS template number [ 1 ] for ER/PR/Her-2
                              [ 2 ] for ER/PR
                              [ 3 ] for Her-2

[type ]      [Invasive/in-situ] carcinoma cells are [___]% ER
             positive and [___]% PR positive.

      [type ]        Controls appropriate.

      [type ]        Visual review of the slides reveals
                     [lesser/greater] expression of [ER/PR] than
                     detected by ACIS.
                     [ER/PR] is called [positive/negative] based on
                     manual review.


[type ]      The average staining intensity for HER-2/neu is [__.__],
             which is [negative/positive/equivocal] for
             overexpression. Controls appropriate.

      [type ]        The level of expression of Her-2/neu detected by ACIS
                     is equivocal for overexpression. If available, a
                     tissue block will be sent for Her-2/neu amplification
                     FISH analysis.

      [type ]        Visual review of the slides reveals
                     [lesser/greater] expression of Her-2/neu than
                     detected by ACIS. If available, a tissue block will
                     be sent for Her-2/neu amplification FISH analysis.

Please see diagnosis below:
Diagnosis #[    ]: See above for immunostain results. The previous
diagnosis remains unchanged, see previous report [type acc #].

Fee Code: 88361 x [1/2/3]
If visual review only: bill 88342 x [1/2/3]

FILLED OUT BY:_________________pager________
ATTENDING ON SERVICE:_______________________
MJH9.19.06

PDS Code:     ERPR

								
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