ID

3139

Beskrivning

Breast Pathology - Tumor Marker Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=13EAB392-277F-3887-E044-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=13EAB392-277F-3887-E044-0003BA3F9857

Nyckelord

Uppladdad den

19 september 2012

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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Pathology - Breast Pathology - Tumor Marker Form - 2020194v3.0

model
Detaljer

No Instruction available.

1 Formulär

StudyEvent: Breast Pathology - Tumor Marker Form
1. No Instruction available.

Name

Typ

Description | Question | Decode (Coded Value)

Datatyp

Alias

CRF Header

Item Group

Crf Header

ProtocolCoordinatingIdentifierNumber

Item

Coordinating Group Protocol No.

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

CoordinatingGroupIdentifierCode

Item

Coordinating Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus ObjectClass)
C0700114 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

ProtocolTitleName

Item

Protocol Title

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C42774 (NCI Thesaurus Property)
C1705823 (UMLS 2011AA Property)

PatientCoordinatingIdentifierNumber

Item

Patient Study ID

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

PatientParticipatingIdentifierNumber

Item

Other Patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

CombinedInstitutionName

Item

Institution/Affiliate

text

C25454 (NCI Thesaurus ObjectClass)
C0205195 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)

ParticipatingGroupIdentifierCode

Item

Participating Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

PatientName

Item

Patient Name (initials acceptable)

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

Pathology: Form Administration

Item Group

Breast: Form Administration

ResponsiblePersonName

Item

Person Completing Form

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

DataAmendedInd-3

Item

Are data amended (If data are amended, please circle in red when using paper form)

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)

CL.1

Code List

Are data amended (If data are amended, please circle in red when using paper form)

CL Item

Yes (yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (no)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

Pathology: Estrogen and Progesterone Receptors

Item Group

Pathology: Estrogen And Progesterone Receptors

TissueType

Item

Tissue Type

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12801 (NCI Thesaurus ObjectClass)
C0040300 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

CL.21

Code List

Tissue Type

CL Item

Primary (Primary)

C25251 (NCI Thesaurus)
C0205225 (UMLS 2011AA)

CL Item

Distant Metastases (Metastasis)

CL Item

Regional Nodal (Regional nodal)

CL Item

Other, Specify (Other)

TissueType,Other

Item

Other, specify

text

SpecimenBlockNumber

Item

Blocks

double

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25436 (NCI Thesaurus Property)
C1533157 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)

SpecimenBlockNumber

Item

Blocks

double

SpecimenAccessionNumber

Item

Accession Number

double

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25402 (NCI Thesaurus Property)
C1510755 (UMLS 2011AA Property)

AssessmentMethodType

Item

Method of Evaluation

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)

CL.22

Code List

Method of Evaluation

CL Item

Fine Needle Aspiration Biopsy (Fine needle aspiration biopsy)

CL Item

Needle Biopsy (tru-cut Or Core) (Needle biopsy (tru-cut or core))

CL Item

Ductoscopic Biopsy (Ductoscopic biopsy)

CL Item

Incisional Biopsy (Incisional biopsy)

C15386 (NCI Thesaurus)
C0184922 (UMLS 2011AA)

CL Item

Excisional Biopsy Or Lumpectomy (Excisional biopsy or lumpectomy)

CL Item

Sentinel Node Biopsy (Sentinel node biopsy)

CL Item

Mastectomy (Mastectomy)

C15277 (NCI Thesaurus)
C0024881 (UMLS 2011AA)

CL Item

Prophalactic Mastectomy (Prophalactic mastectomy)

CL Item

Axillary Dissection (Axillary dissection)

CL Item

Resection/re-excision Of Lumpectomy Margins (Resection/re-excision of lumpectomy margins)

CL Item

Ductal Lavage (Ductal lavage)

CL054589 (NCI Metathesaurus)

CL Item

Nipple Fluid (Nipple fluid)

CL Item

Fluid Cytology, Cerebrospinal Fluid (Fluid cytology, cerebrospinal fluid)

CL Item

Fluid Cytology, Ascites (Fluid cytology, ascites)

CL Item

Fluid Cytology, Pleural (Fluid cytology, pleural)

CL Item

Autopsy (Autopsy)

C25153 (NCI Thesaurus)
C0004398 (UMLS 2011AA)

CL Item

Other, Specify (Other, specify)

AssessmentMethodSpecify

Item

Other Specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)

TumorMarkerTestType

Item

Marker Test Method

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C17220 (NCI Thesaurus ObjectClass)
C0041365 (UMLS 2011AA ObjectClass)

CL.12

Code List

Marker Test Method

CL Item

Immunohistochemistry (ihc) (Immunohistochemistry (IHC))

CL Item

Fluorescence In Situ Hybridization (fish) (Fluorescence in situ hybridization (FISH))

CL Item

Elisa (ELISA)

C16553 (NCI Thesaurus)
C0014441 (UMLS 2011AA)

CL Item

Other, Specify (Other)

TumorMarkerTestSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C17220 (NCI Thesaurus ObjectClass)
C0041365 (UMLS 2011AA ObjectClass)

BreastHormoneReceptorPresentType

Item

Type of Hormone Receptor (mark all that apply)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C28154 (NCI Thesaurus ObjectClass)
C0019929 (UMLS 2011AA ObjectClass)

CL.5

Code List

Type of Hormone Receptor (mark all that apply)

CL Item

Estrogen Receptor (er) (Estrogen receptor)

CL Item

Progesterone Receptor (pr) (Progesterone receptor)

CL Item

Other Specify (Other)

BreastHormoneReceptorPresentSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C28154 (NCI Thesaurus ObjectClass)
C0019929 (UMLS 2011AA ObjectClass)

StainingAntibody,Other

Item

Other, specify

text

AntigenRetrievalInd-3

Item

Antigen Retrieval

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C268 (NCI Thesaurus ObjectClass)
C0003320 (UMLS 2011AA ObjectClass)
C25659 (NCI Thesaurus Property)
C1514918 (UMLS 2011AA Property)

CL.23

Code List

Antigen Retrieval

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

AntigenRetrievalText

Item

Yes specify

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C268 (NCI Thesaurus ObjectClass)
C0003320 (UMLS 2011AA ObjectClass)
C25659 (NCI Thesaurus Property)
C1514918 (UMLS 2011AA Property)

StainedMalignantNucleiIntensityDescription

Item

Intensity of Stained Malignant Nuclei, Description

text

CL.26

Code List

Intensity of Stained Malignant Nuclei, Description

CL Item

Negative (Negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Scant (Scant)

CL Item

Intermediate (Intermediate)

C0205103 (NCI Metathesaurus)

CL Item

Intense (Intense)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

NuclearStainCellPercentageAmount

Item

Percentage of Invasive Tumor Cells with Nuclear Staining

double

C13361 (NCI Thesaurus ObjectClass)
C0521447 (UMLS 2011AA ObjectClass)
C841 (NCI Thesaurus ObjectClass)
C0038128 (UMLS 2011AA ObjectClass)
C12508 (NCI Thesaurus Property)
C0007634 (UMLS 2011AA Property)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25417 (NCI Thesaurus ValueDomain)

StainedMalignantNucleiIntensityScaled

Item

Stained Malignant Nuclei Intensity Scaled (__ of __ - Note: Scale for intensity will be protocol specific.)

double

StainedDCISCellPercentage,Nuclear

Item

Percentage of DCIS Cells with Nuclear Staining

double

ReceptorStatus

Item

Final Receptor Status Diagnosis

text

CL.8

Code List

Final Receptor Status Diagnosis

CL Item

Positive (Positive)

C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)

CL Item

Negative (Negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Indeterminate (Indeterminate)

C48658 (NCI Thesaurus)
C0205258 (UMLS 2011AA)

Pathology: Breast Tumor Markers

Item Group

Pathology: Breast Tumor Markers

BreastTumorMarkerAssessmentType

Item

Marker Name (s)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C17220 (NCI Thesaurus ObjectClass)
C0041365 (UMLS 2011AA ObjectClass)

CL.20

Code List

Marker Name (s)

CL Item

P53 (p53)

CL Item

Other Specify (Other)

TumorMarkerAssessmentSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17220 (NCI Thesaurus ObjectClass)
C0041365 (UMLS 2011AA ObjectClass)

TissueType

Item

Tissue Type

text

CL.21

Code List

Tissue Type

CL Item

Primary (Primary)

C25251 (NCI Thesaurus)
C0205225 (UMLS 2011AA)

CL Item

Distant Metastases (Metastasis)

CL Item

Regional Nodal (Regional nodal)

CL Item

Other, Specify (Other)

TissueType,Other

Item

Other, specify

text

SpecimenBlockNumber

Item

Blocks

double

SpecimenAccessionNumber

Item

Accession Number

double

AssessmentMethodType

Item

Method of Evaluation

text

CL.22

Code List

Method of Evaluation

CL Item

Fine Needle Aspiration Biopsy (Fine needle aspiration biopsy)

CL Item

Needle Biopsy (tru-cut Or Core) (Needle biopsy (tru-cut or core))

CL Item

Ductoscopic Biopsy (Ductoscopic biopsy)

CL Item

Incisional Biopsy (Incisional biopsy)

C15386 (NCI Thesaurus)
C0184922 (UMLS 2011AA)

CL Item

Excisional Biopsy Or Lumpectomy (Excisional biopsy or lumpectomy)

CL Item

Sentinel Node Biopsy (Sentinel node biopsy)

CL Item

Mastectomy (Mastectomy)

C15277 (NCI Thesaurus)
C0024881 (UMLS 2011AA)

CL Item

Prophalactic Mastectomy (Prophalactic mastectomy)

CL Item

Axillary Dissection (Axillary dissection)

CL Item

Resection/re-excision Of Lumpectomy Margins (Resection/re-excision of lumpectomy margins)

CL Item

Ductal Lavage (Ductal lavage)

CL054589 (NCI Metathesaurus)

CL Item

Nipple Fluid (Nipple fluid)

CL Item

Fluid Cytology, Cerebrospinal Fluid (Fluid cytology, cerebrospinal fluid)

CL Item

Fluid Cytology, Ascites (Fluid cytology, ascites)

CL Item

Fluid Cytology, Pleural (Fluid cytology, pleural)

CL Item

Autopsy (Autopsy)

C25153 (NCI Thesaurus)
C0004398 (UMLS 2011AA)

CL Item

Other, Specify (Other, specify)

AssessmentMethodSpecify

Item

Other Specify

text

TumorMarkerTestType

Item

Marker Test Method

text

CL.12

Code List

Marker Test Method

CL Item

Immunohistochemistry (ihc) (Immunohistochemistry (IHC))

CL Item

Fluorescence In Situ Hybridization (fish) (Fluorescence in situ hybridization (FISH))

CL Item

Elisa (ELISA)

C16553 (NCI Thesaurus)
C0014441 (UMLS 2011AA)

CL Item

Other, Specify (Other)

TumorMarkerTestSpecify

Item

Other specify

text

StainingAntibody

Item

Staining Antibody

text

CL.13

Code List

Staining Antibody

CL Item

Dako Herceptest [tm] (DAKO Herceptest [TM])

CL Item

Cb-11/ventana Kit (CB-11/Ventana Kit)

CL Item

Cb-11 Other (CB-11 other)

CL Item

Tab-250 (TAB-250)

CL Item

Other, Specify (Other, specify)

StainingAntibody,Other

Item

Other, specify

text

MembraneStainCellPercentageAmount

Item

Percentage of Invasive Tumor Cells with Membrane Staining (If IHC, )

double

C12749 (NCI Thesaurus ObjectClass)
C0025255 (UMLS 2011AA ObjectClass)
C841 (NCI Thesaurus ObjectClass)
C0038128 (UMLS 2011AA ObjectClass)
C12508 (NCI Thesaurus Property)
C0007634 (UMLS 2011AA Property)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25417 (NCI Thesaurus ValueDomain)

StainedMalignantNucleiIntensityDescription

Item

Intensity of Stained Malignant Nuclei, Description

text

CL.26

Code List

Intensity of Stained Malignant Nuclei, Description

CL Item

Negative (Negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Scant (Scant)

CL Item

Intermediate (Intermediate)

C0205103 (NCI Metathesaurus)

CL Item

Intense (Intense)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

StainedMalignantNucleiIntensityScaled

Item

Stained Malignant Nuclei Intensity Scaled (__ of __ - Note: Scale for intensity will be protocol specific.)

double

HerceptestScore

Item

Scoring System (Score) (If Herceptest[TM])

text

CL.15

Code List

Scoring System (Score) (If Herceptest[TM])

CL Item

0 (0)

C0919414 (NCI Metathesaurus)

CL Item

1+ (1+)

CL Item

2+ (2+)

CL Item

3+ (3+)

VentanaScore

Item

Ventana Scoring System (Score)

text

CL.16

Code List

Ventana Scoring System (Score)

CL Item

0 (0)

C0919414 (NCI Metathesaurus)

CL Item

1+ (1+)

CL Item

2+ (2+)

CL Item

3+ (3+)

FISHAssessmentTestType

Item

Kit or Test Type (If FISH,)

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass)
C0162789 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)

CL.17

Code List

Kit or Test Type (If FISH,)

CL Item

Vysis/path Vysion[tm] (Vysis/PathVysion)

CL Item

Ventana/oncorprobe[tm] (Ventana/Oncorprobe)

CL Item

Other Specify (Other, specify)

FISHAssessmentTestSpecify

Item

Other, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass)
C0162789 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)

FISHCytologyResultProcedure

Item

FISH Result

text

C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass)
C0162789 (UMLS 2011AA ObjectClass)
C25218 (NCI Thesaurus ValueDomain)
C1948041 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)

CL.18

Code List

FISH Result

CL Item

Amplified (Amplified)

CL Item

Not Amplified (Not amplified)

FISHAssessmentChromosome17ResultHER2NeuNumber

Item

FISH HER2/neu chromosome 17 Ratio

double

C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass)
C0162789 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C13212 (NCI Thesaurus Property)
C0008659 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C17756 (NCI Thesaurus ValueDomain)
C0242957 (UMLS 2011AA ValueDomain)

HER2/neuSignals/CellMeanNumber

Item

Mean Number of HER2/neu Signals/Cell (Note: Enter 99.9 or 999 if unknown)

double

FISHAssessmentAmplificationValue

Item

Amplification Cutpoint

double

C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass)
C0162789 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C20589 (NCI Thesaurus Property)
C1517480 (UMLS 2011AA Property)

DiseaseFinalDiagnosisHER2/neuType

Item

Final Diagnosis with HER2/neu

text

C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25508 (NCI Thesaurus Property)
C0205088 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C17756 (NCI Thesaurus ValueDomain)
C0242957 (UMLS 2011AA ValueDomain)

CL.19

Code List

Final Diagnosis with HER2/neu

CL Item

Positive (Positive)

C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)

CL Item

Negative (Negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Equivocal (Equivocal)

C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)

Pathology: Immunochemistry

Item Group

Pathology: Immunohistochemistry

BreastTumorMarkerAssessmentType

Item

Marker Name (s)

text

CL.20

Code List

Marker Name (s)

CL Item

P53 (p53)

CL Item

Other Specify (Other)

TumorMarkerAssessmentSpecify

Item

Other specify

text

TissueType

Item

Tissue Type

text

CL.21

Code List

Tissue Type

CL Item

Primary (Primary)

C25251 (NCI Thesaurus)
C0205225 (UMLS 2011AA)

CL Item

Distant Metastases (Metastasis)

CL Item

Regional Nodal (Regional nodal)

CL Item

Other, Specify (Other)

TissueType,Other

Item

Other, specify

text

SpecimenBlockNumber

Item

Blocks

double

SpecimenAccessionNumber

Item

Accession Number

double

AssessmentMethodType

Item

Method of Evaluation

text

CL.22

Code List

Method of Evaluation

CL Item

Fine Needle Aspiration Biopsy (Fine needle aspiration biopsy)

CL Item

Needle Biopsy (tru-cut Or Core) (Needle biopsy (tru-cut or core))

CL Item

Ductoscopic Biopsy (Ductoscopic biopsy)

CL Item

Incisional Biopsy (Incisional biopsy)

C15386 (NCI Thesaurus)
C0184922 (UMLS 2011AA)

CL Item

Excisional Biopsy Or Lumpectomy (Excisional biopsy or lumpectomy)

CL Item

Sentinel Node Biopsy (Sentinel node biopsy)

CL Item

Mastectomy (Mastectomy)

C15277 (NCI Thesaurus)
C0024881 (UMLS 2011AA)

CL Item

Prophalactic Mastectomy (Prophalactic mastectomy)

CL Item

Axillary Dissection (Axillary dissection)

CL Item

Resection/re-excision Of Lumpectomy Margins (Resection/re-excision of lumpectomy margins)

CL Item

Ductal Lavage (Ductal lavage)

CL054589 (NCI Metathesaurus)

CL Item

Nipple Fluid (Nipple fluid)

CL Item

Fluid Cytology, Cerebrospinal Fluid (Fluid cytology, cerebrospinal fluid)

CL Item

Fluid Cytology, Ascites (Fluid cytology, ascites)

CL Item

Fluid Cytology, Pleural (Fluid cytology, pleural)

CL Item

Autopsy (Autopsy)

C25153 (NCI Thesaurus)
C0004398 (UMLS 2011AA)

CL Item

Other, Specify (Other, specify)

AssessmentMethodSpecify

Item

Other Specify

text

PrimaryAntibodyName

Item

Primary Antibody

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C16295 (NCI Thesaurus ObjectClass)
C0003241 (UMLS 2011AA ObjectClass)

StainedCellType

Item

Cell Type Stained (check all that apply)

text

CL.24

Code List

Cell Type Stained (check all that apply)

CL Item

Epithelial, Non-malignant (Epithelial, non-malignant)

CL Item

Epithelail, Maligant (Epithelail, maligant)

CL Item

Stromal, Non-malignant (Stromal, non-malignant)

CL Item

Other, Specify (Other, specify)

AntigenRetrievalInd-3

Item

Antigen Retrieval

text

CL.23

Code List

Antigen Retrieval

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

StainedCellType,Other

Item

Other, specify

text

AntigenRetrievalText

Item

Yes specify

text

StainingPattern

Item

Pattern of Staining

text

CL.25

Code List

Pattern of Staining

CL Item

Nuclear (Nuclear)

C13361 (NCI Thesaurus)
C0521447 (UMLS 2011AA)

CL Item

Cytoplasmic (Cytoplasmic)

CL Item

Membrane (Membrane)

C12749 (NCI Thesaurus)
C0025255 (UMLS 2011AA)

CL Item

Mixed (nuclear/cytoplasmic) (Mixed (Nuclear/Cytoplasmic))

CL Item

Secreted (Secreted)

CL Item

Other, Specify (Other, specify)

StainedMalignantNucleiIntensityDescription

Item

Intensity of Stained Malignant Nuclei, Description

text

CL.26

Code List

Intensity of Stained Malignant Nuclei, Description

CL Item

Negative (Negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Scant (Scant)

CL Item

Intermediate (Intermediate)

C0205103 (NCI Metathesaurus)

CL Item

Intense (Intense)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

StainingPattern,Other

Item

Other, specify

text

NuclearStainCellPercentageAmount

Item

Percentage of Invasive Tumor Cells with Nuclear Staining

double

StainedMalignantNucleiIntensityScaled

Item

Stained Malignant Nuclei Intensity Scaled (__ of __ - Note: Scale for intensity will be protocol specific.)

double

StainedDCISCellPercentage,Nuclear

Item

Percentage of DCIS Cells with Nuclear Staining

double

StainedNon-MalignantCellPercentage,Nuclear

Item

Percentage of Non-Malignant Cells with Nuclear Staining

double

TumorMarkerFinalResultProcedure

Item

Final Interpretation of Results (for invasive component)

text

C25218 (NCI Thesaurus ValueDomain)
C1948041 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25508 (NCI Thesaurus Property)
C0205088 (UMLS 2011AA Property)
C17220 (NCI Thesaurus ObjectClass)
C0041365 (UMLS 2011AA ObjectClass)

CL.27

Code List

Final Interpretation of Results (for invasive component)

CL Item

Positive (Positive)

C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)

CL Item

Negative (Negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Indeterminate (Indeterminate)

C48658 (NCI Thesaurus)
C0205258 (UMLS 2011AA)

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Pathology - Breast Pathology - Tumor Marker Form - 2020194v3.0

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