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2/23/2016

Survey to assess the feasibility of establishing a gynecologic specimen bank for research

Survey to assess the feasibility of
establishing a gynecologic
specimen bank for research
OMB No.: 0925-XXXX
Expiration Date: XX/XX/XXXX
Public reporting burden for this collection of information is estimated to average 10 minutes per
response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX). Do not return
the completed form to this address.

1. Would you consider your practice to be primarily:
academic (primary activity within medical school teaching hospital or
research institute)
private laboratory (not at hospital)
private hospital (not affiliated with medical center or research institute)
laboratory affiliated with managed health organization

2. What is the approximate annual surgical pathology
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2/23/2016

Survey to assess the feasibility of establishing a gynecologic specimen bank for research

specimen volume at the laboratory where you practice (if
multiple, give largest):
<10K
10-25K
>25-50K
>50K

3. What proportion of these specimens are gynecologic?
<10%
10-20%
>20-50%
>50-100%

4. Does your laboratory have a sub-specialty sign-out with a
designated gynecologic section?
No
Yes

5. Does your laboratory receive risk-reducing surgery
specimens from women at high-risk for gynecologic
disease/cancer?
No
Yes

5a. If you answered yes above, estimate annual number?
Your answer
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Your answer

Survey to assess the feasibility of establishing a gynecologic specimen bank for research

6. How are specimens for the following specific indications
(a-d below) processed?
a. High-Grade Serous Cancer Stage I, II, IIIAi
No

Yes,
partial

Yes, total

SEE-Fim (Sectioning and Extensively
Examining of the Fimbria)
submit fimbria
submit ovaries
endometrium (if uterus removed)

b. Risk-reducing salpingo-oophorectomy or salpingectomy
No

Yes,
partial

Yes, total

SEE-Fim (Sectioning and Extensively
Examining of the Fimbria)
submit fimbria
submit ovaries
endometrium (if uterus removed)

c. Surgery for benign indications, first sections reveal
equivocal or definite STIC (serous tubal intraepithelial
carcinoma), epithelial atypia in ovary or clinically occult cancer
No
SEE-Fim (Sectioning and Extensively

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Yes,
partial

Yes, total
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Survey to assess the feasibility of establishing a gynecologic specimen bank for research

SEE-Fim (Sectioning and Extensively
SEE-Fim
(Sectioning
and
Extensively
Examining
of the
Fimbria)
Examining of the Fimbria)
submit fimbria
submit fimbria
submit ovaries
submit ovaries
endometrium (if uterus removed)
endometrium (if uterus removed)

d. Surgery for benign indications, first sections reviewed are
negative
No

Yes,
partial

Yes, total

SEE-Fim (Sectioning and Extensively
Examining of the Fimbria)
submit fimbria
submit ovaries
endometrium (if uterus removed)

7. Does your laboratory stain sections of fimbria for Ki67, p53
or other markers (check all that apply):
On every specimen?
On every risk-reducing salpingo-oophorectomy or salpingectomy
specimen?
On selected risk-reducing salpingo-oophorectomy or salpingectomy
specimens based on H&E review?
On early stage high-grade serous cancer?
Markers not evaluated

8. Would your laboratory consider providing de-identified

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Survey to assess the feasibility of establishing a gynecologic specimen bank for research

8. Would your laboratory consider providing de-identified
blocks and matched pathology reports to a national specimen
bank organized by the National Cancer Institute (NCI) to
provide access to researchers throughout the world? Possible
specimens would include risk-reducing salpingooophorectomy or salpingectomy, early high-grade serous
cancer (HGSC), serous tubal intraepithelial carcinoma (STIC),
and a minor percentage (10%) of total benign tubes and
ovaries.
No
Yes

9. Other comments/clarifications?
Your answer

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