Sample, Sammy G ST0001

Biopsy Form 1234567890

If a new lesion is identified at a later point and new diagnostics are performed, please use a new form.

Biopsy

MM/DD/YYYY

Molecular Testing




Nodules

READ before completing the Nodule Grid

  • BASELINE: Include all nodules >= 6.0 mm in average diameter. Others are OPTIONAL.
  • ANNUAL REPEAT: include all NEW nodules >= 3.0 mm in average diameter.
  • For BASELINE CT, all nodules are new unless there is a CT more than 3 years earlier.
  • For BASELINE CT, the nodules will automatically be sorted with the largest non-calcified nodules with a solid component coming first.
  • Note: hilar masses and focal consolidation should be included in the nodule grid.
  • The same nodule ID will be used on all subsequent CT and other forms. NEW nodules, even if LARGER, must follow nodules already listed.
  • For nodules recommended for biopsy or antibiotics, list the reason in the comments field in the corresponding column.
If no nodules were detected, you may skip this section.