Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
台灣病理學會主辦分子能力測試 ALK FISH 2016
Sign in to Google
to save your progress.
Learn more
* Indicates required question
請填寫貴單位 ID:
*
請参閱寄給貴單位的填表說明，裡面有附上貴單位之 ID
Your answer
Institute:
*
Your answer
Testing personnel:
*
Your answer
Lab directors:
*
Your answer
E-mail:
*
請填寫聯絡人的 E-mail 地址
Your answer
1.Which patients are tested for ALK translocation in your hospital/laboratory? (可複選)
*
A.Adenocarcinoma
B.Carcinoma with definitive adenocarcinoma component
C.Carcinoma with suspicious adenocarcinoma component
D.Squamous cell or small cell carcinoma in young age patients or patients lack of smoking history
Other:
Required
2.In which time point patients are tested for ALK translocation in your hospital/laboratory? (可複選)
*
A.Advanced-stage disease
B.Disease in progression
C.Recurrence
Other:
Required
3.Which of the following specimen types do you accept for the detection of ALK translocation? (可複選)
*
A.Fine needle aspiration (not cell clock)
B.Fresh tissue
C.Frozen tissue
D.Paraffin-embedded tissue
Other:
Required
4.Which method do your laboratory used for the detection of ALK translocation? (可複選)
*
A.Fluorescence in situ hybridization
B.Immunohistochemistry
C.Reverse-transcriptase PCR
Other:
Required
5.What is the turnaround time of ALK FISH analysis in your laboratory? (working days)
*
Your answer
Result
Please record the slide no. you received:
*
Your answer
Case 1
Total cell number counted (Case 1):
*
Your answer
Translocation positive cells (number) (Case 1)
*
Your answer
Translocation positive cells (%) (Case 1)
*
Your answer
Translocation negative cells (number) (Case 1)
*
Your answer
Translocation negative cells (%) (Case 1)
*
Your answer
Interpretation of results (Case 1)
*
Translocation Positive
Translocation Negative
Unable to analyze
Case 2
Total cell number counted (Case 2)
*
Your answer
Translocation positive cells (number) (Case 2)
*
Your answer
Translocation positive cells (%) (Case 2)
*
Your answer
Translocation negative cells (number) (Case 2)
*
Your answer
Translocation negative cells (%) (Case 2)
*
Your answer
Interpretation of results (Case 2)
*
Translocation Positive
Translocation Negative
Unable to analyze
請注意：結果一旦送出即無法修改，請再次檢視您填寫的答案，確認無誤之後再按底下的「提交」按鈕。
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
