Appendix3GenericCaseQualityControlForm.pdf

Pathology Re

TCGA Form A1.034v2 Proposed Draft Generic version 1 draft#2

The Cancer Genome Atlas

Case Quality Control Form – GENERIC

Tumor Identifier: ______________________ Normal Identifier: _____________________ Completed By: ____________________________

TSS Name: ___________________________ TSS#: Completion Date: //

Surgical Procedure:____________________________ Procedure Date: // (MM/DD/YYYY) Is this a recurrent case? Yes No If yes, please indicate TCGA number of previously qualified case: TCGA‐ __ __ __ __ ‐ __ __ __ __

Submission of additional tumor or matching normal as requested by the BCR? Yes, select one: Matching normal Tumor No

If yes, please indicate TCGA number of previously qualified case: TCGA‐__ __ __ __ ‐ __ __ __ __

To Be Completed By Pathologist

Pathologist Signature: ________________________________________________ Date: __________________

Diagnosis:

Subtype

The following histologies may be included in __________ category. Please select histological subtype of specimen being submitted:

Primary (primary, untreated malignant biospecimen) Metastatic Untreated* Metastatic Treated** Recurrence Untreated* Recurrence Treated**

* (biospecimen that has not been treated with chemotherapy or radiation)

** (biospecimen that has been treated with chemotherapy or radiation)

Vessel used: Cryovial Cassette FFPE Other:____________

Was sample prescreened at site? Yes No

Is a top‐slide being submitted to the BCR? Yes No

Top‐slide definition: Slide cut directly from frozen biospecimen = mirror image of inked surface.

Slide ID# ________________________

Weight of frozen tumor ____________mg

Tumor Nuclei__________% (refer to Working Instructions)

Necrosis____________% (refer to Working Instructions)

Digital image sent to the BCR?* Yes No

* ( please note that physical top‐slides are preferred)

Anatomic Site of Frozen Biospecimen

TBD

Tumor specific annotation TBD.

Matching Normal Anatomic Site of Matching Normal Tissue

Matching Normal (must be present to qualify)

Type: Normal Tissue, please indicate matching normal site Whole Blood

Lymphocytes

Cell line________

Extracted DNA

If extracted DNA provide:

Quantity ________ µg Concentration ________ µg/uL

Quantification Method____________________ Volume

________µL

TBD

To Be Completed By Principal Investigator

1. Pathology Confirmation (all must be checked to qualify)

Tumor Nuclei ≥ 70% Necrosis ≤ 30% Diagnosis Confirmed Pathology Report Attached

2. Prior Treatments (any treatments prior to resection is exclusionary)

None Radiation prior to resection Chemotherapy prior to resection

3. Consent Status: (one must be provided to qualify)

Date of Consent // OR Date of Death // (Consent not required)

PI Signature: ________________________________________________ Date: ___________________

I acknowledge that the above information provided by my institution is true and correct and has been quality controlled.