Appendix A- Gastric Lymph Node Survey
1. What type of facility do you work in? teaching hospital private lab
community hospital other / 2. How many pathologists are in your pathology department?
1-4 5-9 10-14 >15
3. Of those pathologists in your department, how many sign-out gastric cancer resection specimens?
1-4 5-9 10-14 >15 / 4. On average, how many pathology residents do you have?
We do not have residents 3
0 at this time 4
1 5
2 >5
5. How many pathology assistants do you have?
0 at this time >3
1 N/A
2 / 6. Does your facility process gastric cancer resection specimens?
yes
no
We send our gastric cancer resection specimens out to another facility
7. Who does the grossing in your lab? Choose all that apply.
pathologist resident
pathology assistant other / 8. How many gastric cancer resections does your facility process per year?
1-3 4-6 7-9
10-12 >13
9. Do you routinely look for any of the following in the gastric cancer specimens: Choose all that apply.
vascular involvement perineural invasion
signet rings / 10. On average, what is the estimated time it takes to identify gastric cancer and dissect the lymph nodes in a gastric cancer resection specimen?
<10 min 10-30 min 30-60 min
>60 min
11. How often do you use keratin immunohistochemical stains on lymph nodes taken from gastric cancer resection specimens?
never rarely 25% of the time
50% of the time always / 12. How many lymph nodes do you TRY to harvest in a gastric cancer resection specimen?
<5 5-10 10-15
15-20 >20
13. How many lymph nodes on average do you (or PA/resident) ACTUALLY find per gastric cancer resection specimen?
<5 5-10 10-15
10-15 >20 / 14. Do you use lymph node clearing solutions?
yes no
15. If you chose “yes” in #14, which of the following clearing solutions do you use for lymph nodes from gastric cancer specimens? Choose all that apply.
Xylene clearance Wintergreen/cedar oil clearance Ether-ethanol-acetic acid (lymph node revealing solution) acetic acid- alcohol fixative (GEWF) Other / 16. Do you think finding 5 extra lymph nodes per gastric cancer resection specimen would be:
a) a significantly increased burden
b) not a burden
17. How much time do you think the 5 extra lymph nodes from gastric cancer specimens would take?
<10 min 10-30 min
30-60 min >60 min / 18. If you chose a) in #16, do you think finding 5 extra lymph nodes per gastric cancer specimen would be an increased burden because of: (Choose all that apply)
increased burden due to availability of clearing solution
increased burden due to cost of solution
increased burden due to increased processing time
increased burden due to poor surgical specimen
increased burden due to increase in PA processing time
Other (please specify): ______
19. Do you offer intra-operative consultation of gross/macroscopic margins for gastric cancer resections?
yes no / 20. Do you give frozen section proximal margins for gastric cancer resections?
yes no
21. Do you give frozen section distal margins for gastric cancer resections?
yes no / 22. What do you consider an adequate gross/macroscopic margin?
>1 cm >2 cm >3 cm
>4 cm >5 cm >6 cm
>7 cm >8 cm
23. Do you try to determine if a D1 or D2 gastric resection has been performed by the surgeon?
yes no
this is unfamiliar terminology / 24. Currently, what type of reporting system does your facility use? Choose all that apply.
dictation hand-typed synoptic
point and click other (please specify)____
25. Do you feel synoptic reporting is useful for (gastric) cancer specimens?
yes no / 26. If you do not think synoptic reporting is useful, please indicate why: (Choose all that apply)
time consuming loss of information
cumbersome
do not have computer/manpower for it
other (please specify) ______
27. Do you think that performance incentives may be helpful in getting more lymph nodes per specimen?
yes no / 28. Do you think that pathologists should have performance bonuses (for example pay) for achieving quality standards?
yes no
29. In relation to the above question, why or why not? ______ / 30. Do you think an educational/CME session on gastric pathology would be useful?
yes no
31. What is your age?
<30 30-39 40-49
50-59 60-69 >70 / 32. Years in practice:
<5 5-10 10-15
15-30 >30
33. Sex:
Female Male / 34. Type of practice:
rural urban community
urban academic
35. Please write any comments below:
1