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Dept Ba=   ThisWorkbook=xZG{*8X@"1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1" Wingdings1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1Tahoma1" Wingdings1Tahoma1Tahoma""#,##0;\-""#,##0""#,##0;[Red]\-""#,##0""#,##0.00;\-""#,##0.00#""#,##0.00;[Red]\-""#,##0.005*0_-""* #,##0_-;\-""* #,##0_-;_-""* "-"_-;_-@_-,)'_-* #,##0_-;\-* #,##0_-;_-* "-"_-;_-@_-=,8_-""* #,##0.00_-;\-""* #,##0.00_-;_-""* "-"??_-;_-@_-4+/_-* #,##0.00_-;\-* #,##0.00_-;_-* "-"??_-;_-@_-[$-809]dd\ mmmm\ yyyy mmmm\ yyyy                + ) , *   "@  " @      ` 1     ""@ @ +     1 "    1  1  `""@ @     (""@ @      (""@ @         #    ""@ @ +    ""@ @  ("@  ( " @    h  興@ @ + 1 ""@ @ +  ""@ @   ("@@   "    H "X 1 L 1 1"  ""@ @ +    H    (    `@ @  #    h""@ @  @ @ +  @@+  @   @  @     @   # ` ?CoverZ Section A Section B Section C Section D  Section E$ Section FO Section F2} Section GZ Section H, J    ;A   ;0   ;T  ; M   ;7   ;H   ;J   ;9  ;  TX(   3 A@@   "CERVICAL SCREENING AUDIT SECTION A&SECTION A. Personal and Cancer DetailsSTUDY IDSurnameFirst ForenameOther ForenamesSurname at Birth/Maiden Name NHS Number GP NumberAddress Post Code6---------------------- (CUT HERE)---------------------DDMMYYYY*(date provided by Open Exeter and AJ-CRUK)Date First Registered with GP Date of Birth.(derived from postcode by electronic database)Index of Multiple Deprivation CASES ONLYDate of DiagnosisStage of Timour (FIGO) FIGO STAGE1A1A11A21B1B11B22A2B3A3B4A4B#HISTOLOGY (As obtained from Exeter) HistologyXScreen Detected * (1=Yes 2=No)Screen Detected*Laboratory Code (where case was identifiedm* Screen detected means that the discovery of cancer resulted originaslly from a woman having a routine smearNoneSimple hysterectomyRadical hysterectomy TrachylectomyHysterectomy plus radiotherapyHysterectomy plus chemotherapyplus chemotherapyRadiotherapy onlyChemotherapy onlyRadiotherapy plus chemotherapy1Treatment received - please tick one only (use x)-PART A1. FOR LOCAL, REGIONAL AND NATIONAL USE SECTION B CYTOLOGYceased Age Absence of cervix Not yet called Informed Choice Other/unknownNo Cytology Reason Not on Exeter System Invited but did not attend Ceased Unclear$CYTOLOGY HISTORY (most recent first)Date smear was takenResult of Smear Result codes Inadequate Negative Mild Dyskaryosis Severe Dyskaryosis ?invasive cancer ? glandular neoplasia Moderate dyskaryosis Borderline dyskaryosis Action CodeAHRS Routine Screening/Call/Recall5 Result Recorded but no change in current action code* Early recall at interval specified by lab Suspend recall pending referralSource Source (not provided by AJ-CRUK) GP Private NHS Community Clinic NHS Hospital (Colp) GUM clinic Other 1 Inadequate 2 Negative3 Mild Dyskaryosis4 Severe Dyskaryosis5 ?invasive cancer6 ? glandular neoplasia7 Moderate dyskaryosis8 Borderline dyskaryosisA Routine Screening/Call/Recall6H Result Recorded but no change in current action code+R Early recall at interval specified by lab!S Suspend recall pending referral1 Not on Exeter System2 Invited but did not attend3 Not yet called4 Ceased 5 UnclearIf Ceased Reason1 Age2 Absence of cervix3 Informed Choice4 Other/unknown(not provided by AJ-CRUK)Source 1 GP 2 Private3 NHS Community Clinic4 NHS Hospital (Colp) 5 GUM clinic6 Other[End]/If ceased prior to diagnosis please give reason )"CERVICAL SCREENING AUDIT SECTION B"CERVICAL SCREENING AUDIT SECTION CSECTION C COLPOSCOPYTNumber of colposcopic appointments, for cases, prior to diagnosis of invasive cancerBPlease enter 0 if number is known to be zero. Cross out if unknown Date of Colp Appointment Satisfactory Examination ColposcopistColp ImpressionSurgical Procedure Pathological Diagnosis If Pregnant Follow-up requestedSatisfactory Examination Yes No Not Recorded DNA (Did not attend) Consultant Non-consultant (Registrar/SHO) Nurse TraineeColp Impression Normal HPV only Low Grade High Grade Invasive CancerSurgical Procedure None Punch Biopsy LLETZ (loop) Knife ConeLaser AblationCold Coagulation Cryotherapy Hysterectomy Not RecordedPathological Diagnosismissed appointments1 Yes2 No3 Not Recorded4 DNA (Did not attend) 1 Consultant 2 Non-consultant (Registrar/SHO)3 Nurse 4 Trainee1 Normal 2 HPV only 3 Low Grade 4 High Grade5 Invasive Cancer6 Not Recorded0 None1 Punch Biopsy2 LLETZ (loop) 4 Knife Cone5 Laser Ablation6 Cold Coagulation 7 Cryotherapy8 Hysterectomy9 Not RecordedX. Inadequate Biopsy 7. all other Cervical Malignancy"CERVICAL SCREENING AUDIT SECTION DSECTION D HISTOLOGYHISTOLOGY HISTORYPART D1. CANCER DIAGNOSISDate of BiopsyType of Specimen FIGO Stage(as recorded inhistology notes)DetailsENumber of histology specimens found for this woman. Cross out if NONE Laser excision/cone Clear Margins(Yes/No)YesNo3 Laser excision/cone.Site for non-cervical cancer or type of other cervical malignancySECTION E CYTOLOGY REVIEWLab CodeSlide IDDate of Original Smear Test Type Cytology TypeOriginal SmearResultFirst Referral(Y/N) Routine Screening Repeat (following abnormal) Surveillance (following Colp) Symptomatic Colposcopy Conventional LBC (SurePath) LBC (ThinPrep) LBC (Other) Reviewed at (1 Local/2 Regional level)Type of ReviewerDate Review ResultFactors likely to lead*to false positive resultsto false negative results Screener Checker Advanced PractitionerM* Please enter as many factors as necessary. Leave blank if it does not apply 1 Screener 2 Checker3 Advanced Practitioner 4 ConsultantPotential False Negatives1 Small Cell Dysk2 Pale Cell Dysk3 Microbiopsies4 Small Keratinized cells5 Sparse Dysk (<200 cells)6 Other (Specify)Potential False PostivesA Normal Endometrial Cells$B Endometriosis/tubo-endo metaplasiaC LUS Endometrial Sampling D Histiocytes#E Follicular Lymphocytic cervicitus F IUCD EffectG Other (Specify)1 Routine Screening2 Repeat (following abnormal)3 Surveillance (following Colp) 4 Symptomatic 5 Colposcopy1 Conventional2 LBC (SurePath)3 LBC (ThinPrep) 4 LBC (Other)#In how many pieces was the specimen received ? Specimen IDDate of Original SampleType ofSpecimenOriginal Pathological Diagnosis*Biopsy Size (Length x Width x Depth) in mmxReview Pathological DiagnosisDifficulties ininterpretationDifficulties in InterpretationOpen field. Some examples are:Diathermy ArtefactEpithelial Stripping Fragmented [Continued]Tumour Size (in mm)Maximum Horizontal DimensionDepth of Invasion,Site for non-cervical cancer, type of other ,cervical malignancy or extra information not+covered by the Pathological Diagnosis codesOn review use 1B+ for allnon-invasive cancers in which clinical staging is not possibleSECTION G GP NOTESorYCERVICAL SCREENING AUDIT SECTION G SENT FROMSENT TOAction/Contents Sent From/To Patient Cytology Lab Histology Lab Gynaecologist PCT Private DoctorActions/Contents8 Referral Discharge Invitation Complaint Opted for private care Postpone Opted out of recall Other (please specifiy)PART G2 SPECIAL PERIOD/EVENT FROMTOReasons for Special Period Pregnant Abroad Hospitalized HysterectomyOther relevant information 2 Patient3 Cytology Lab4 Histology Lab5 Gynaecologist6 PCT7 Private Doctor 1 Referral 2 Discharge 3 Invitation 4 Complaint5 Opted for private care 6 Postpone7 Opted out of recall8 Other (please specifiy) 1 Pregnant2 Abroad3 Hospitalized4 Hysterectomy5 Other (please specifiy)YCERVICAL SCREENING AUDIT SECTION HDate of Sample Type of Test Name of Study Other Details(+/-) (eg HC-II,GP5+/6+)(HART, Triage pilot,ARTISTIC, TOMBOLA)(Threshold (if non-standard), HPV types,Context(dual testing, triage))+-INSECTION H HPV DNA TESTINGDate Completed: Section A Section B Section C Section D Section E Section F Section F2 Section G Section HPlease complete above boxesNotesJ(S=Squamous A=Adeno B=Adeno-squamous U=Undifferentiated O=Other X Unknown)BUO Trust: Name of HBPC: Study ID:PART A1. FOR LOCAL USE ONLY%Tick if no cytology was found (use x)#Please state reason for no cytology &COLPOSCOPY HISTORY (most recent first)(# of weeks) 2  (or DNA) 1months 3< ~1 If patient DNAs multiple appointments, use boxes for appointments she did attend and list dates of missed appointments belowB2 Leave blank if woman is NOT pregnant, or write "NK" if NOT KNOWN<3 Leave blank if unknown. Write 99 if patient was discharged:PART D2. COLPOSCOPIC SPECIMENS-HISTORY (most recent first)'<CERVICAL SCREENING AUDIT (USE ONE SHEET PER SLIDE) SECTION E2PART E1 ORIGINAL SLIDE DETAILSWPART E2 REVIEW RESULTS (please enter one line per reviewer. START with Local reviewers)<A?CERVICAL SCREENING AUDIT (USE ONE SHEET PER SPECIMEN) SECTION F51SECTION F HISTOLOGY REVIEW PRE DIAGNOSTIC SAMPLE!PART F1 ORIGINAL SPECIMEN DETAILSaPART F2 HISTOLOGY REVIEW RESULTS (please enter one line per reviewer. START with Local reviewers)FK,There is a separate form for cancer samples (see F3 and F4))SECTION F HISTOLOGY REVIEW CANCER REVIEW#PART F3 CANCER SPECIMEN DETAILSUPART F4 CANCER REVIEW RESULTS (use one line per reviewer. START with Local reviewers):?PART G1 CORRESPONDENCE]Please tick if no correspondence was found. Cross out if the GP records were not searched - fthe clinical management. If HPV testing becomes routine this information will be recorded in section BgThis section applies only to women who have had an HPV test the result of which might have impacted on Postcode:!(use Cancer Registries Algorithm)LLETZ/Cone BiopsyExam TZ TypeFully Visible (ectocervical)Fully Visible (endocervical)Not Fully VisibleUnsatisfactory0. Not Recorded1. Fully Visible (ectocervical)2. Fully Visible (endocervical)3. Not Fully Visible4. Unsatisfactory Exam7.1 Small Cell Carcinoma3.54.98.1)0. Normal (include cervicitis, infection)1. HPV Changes only 2. CIN - not otherwise specified 2.1 CIN 1 2.2 CIN 2 2.3 CIN 3!3. CGIN - not otherwise specified3.1 Low grade CGIN3.2 High grade CGIN>3.5 SMILE (Stratified Mucin-producing Intraepithelial Lesions)84. Invasive Squamous Carcinoma - not otherwise specified4.1 Keratinizing4.2 Non-keratinizing 4.3 Basaloid 4.4 Verrucous 4.5 Warty 4.6 Papillary4.7 Lymphoepithelioma-like4.8 Squamotransitional!4.9 Small Cell Squamous Carcinoma55. Adenocarcinoma of Cervix - not otherwise specified65.1 Mucinous (5.11 Endocervical, 5.12 Intestinal, 5.13>Signet-ring cell, 5.14 Minimal deviation, 5.15 Villoglandular)5.2 Endometroid5.3 Clear cell 5.4 Serous5.5 Mesonephric*6. Adenosquamous - not otherwise specified!6.1 Glassy cell carcinoma variant7.2 Other NeuroendocrineD8. Benign squamous cell lesions (include condyloma, papilloma,polyp)78.1 Benign glandular lesions (include mullerian, polyp)8.2 Non-cervical Atypia=8.3 BAUS (Borderline abnormalities of uncertain significance)69. Non-cervical Malignancy (include secondary tumours)6If the slide was not available for review state reason-(1. 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DeptMicrosoft Excel@G@@iN՜.+,0T PXd lt| iA Cover Section A Section B Section C Section D Section E Section F Section F2 Section G Section H'Section A'!Print_Area'Section B'!Print_Area'Section C'!Print_Area'Section D'!Print_Area'Section E'!Print_Area'Section F'!Print_Area'Section F2'!Print_Area'Section G'!Print_Area'Section H'!Print_Area  Worksheets  Named Ranges   !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FWorkbook}SummaryInformation(DocumentSummaryInformation8