ID

8541

Description

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

Link

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

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Pathology - Breast Pathology - Tumor Marker Form - 2020194v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Breast Pathology - Tumor Marker Form
    1. No Instruction available.
Crf Header
Description

Crf Header

Coordinating Group Protocol No.
Description

Protocol ID Coordinating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1711341
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Coordinating Group Code
Description

Coordinating Group Code

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS CUI-1
C1711341
NCI Thesaurus ObjectClass
C17005
UMLS CUI-2
C0805701
NCI Thesaurus ObjectClass-2
C25462
NCI Thesaurus Property
C25364
Protocol Title
Description

Protocol Title

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986303
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C42774
Patient Study ID
Description

Patient Study ID

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Other Patient ID
Description

Trial subject ID Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Institution/Affiliate
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Participating Group Code
Description

ParticipatingGroupIdentifierCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass-2
C17005
UMLS 2011AA ObjectClass-2
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Name (initials acceptable)
Description

Patient Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1299487
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25364
Breast: Form Administration
Description

Breast: Form Administration

Person Completing Form
Description

Person Completing Form

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Are data amended (If data are amended, please circle in red when using paper form)
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Pathology: Estrogen And Progesterone Receptors
Description

Pathology: Estrogen And Progesterone Receptors

Tissue Type
Description

TissueType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12801
UMLS 2011AA ObjectClass
C0040300
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Other, specify
Description

TissueType,Other

Data type

text

Blocks
Description

SpecimenBlockNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25436
UMLS 2011AA Property
C1533157
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Blocks
Description

SpecimenBlockNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25436
UMLS 2011AA Property
C1533157
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Accession Number
Description

SpecimenAccessionNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25402
UMLS 2011AA Property
C1510755
Method of Evaluation
Description

Evaluation method

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
Other Specify
Description

Evaluation method, specify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
UMLS CUI-2
C1521902
NCI Thesaurus Property
C16847
Marker Test Method
Description

TumorMarkerTestType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus ObjectClass
C17220
UMLS 2011AA ObjectClass
C0041365
Other specify
Description

TumorMarkerTestSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus ObjectClass
C17220
UMLS 2011AA ObjectClass
C0041365
Type of Hormone Receptor (mark all that apply)
Description

BreastHormoneReceptorPresentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass-2
C28154
UMLS 2011AA ObjectClass-2
C0019929
Other specify
Description

BreastHormoneReceptorPresentSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass-2
C28154
UMLS 2011AA ObjectClass-2
C0019929
Other, specify
Description

StainingAntibody,Other

Data type

text

Antigen Retrieval
Description

AntigenRetrievalInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C268
UMLS 2011AA ObjectClass
C0003320
NCI Thesaurus Property
C25659
UMLS 2011AA Property
C1514918
Yes specify
Description

AntigenRetrievalText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C268
UMLS 2011AA ObjectClass
C0003320
NCI Thesaurus Property
C25659
UMLS 2011AA Property
C1514918
Intensity of Stained Malignant Nuclei, Description
Description

StainedMalignantNucleiIntensityDescription

Data type

text

Percentage of Invasive Tumor Cells with Nuclear Staining
Description

NuclearStainCellPercentageAmount

Data type

float

Alias
NCI Thesaurus ObjectClass
C13361
UMLS 2011AA ObjectClass
C0521447
NCI Thesaurus ObjectClass-2
C841
UMLS 2011AA ObjectClass-2
C0038128
NCI Thesaurus Property
C12508
UMLS 2011AA Property
C0007634
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25417
Stained Malignant Nuclei Intensity Scaled (__ of __ - Note: Scale for intensity will be protocol specific.)
Description

StainedMalignantNucleiIntensityScaled

Data type

float

Percentage of DCIS Cells with Nuclear Staining
Description

StainedDCISCellPercentage,Nuclear

Data type

float

Final Receptor Status Diagnosis
Description

ReceptorStatus

Data type

text

Pathology: Breast Tumor Markers
Description

Pathology: Breast Tumor Markers

Marker Name (s)
Description

BreastTumorMarkerAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass-2
C17220
UMLS 2011AA ObjectClass-2
C0041365
Other specify
Description

TumorMarkerAssessmentSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17220
UMLS 2011AA ObjectClass
C0041365
Tissue Type
Description

TissueType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12801
UMLS 2011AA ObjectClass
C0040300
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Other, specify
Description

TissueType,Other

Data type

text

Blocks
Description

SpecimenBlockNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25436
UMLS 2011AA Property
C1533157
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Accession Number
Description

SpecimenAccessionNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25402
UMLS 2011AA Property
C1510755
Method of Evaluation
Description

Evaluation method

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
Other Specify
Description

Evaluation method, specify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
UMLS CUI-2
C1521902
NCI Thesaurus Property
C16847
Marker Test Method
Description

TumorMarkerTestType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus ObjectClass
C17220
UMLS 2011AA ObjectClass
C0041365
Other specify
Description

TumorMarkerTestSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus ObjectClass
C17220
UMLS 2011AA ObjectClass
C0041365
Staining Antibody
Description

StainingAntibody

Data type

text

Other, specify
Description

StainingAntibody,Other

Data type

text

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

MembraneStainCellPercentageAmount

Data type

float

Alias
NCI Thesaurus ObjectClass
C12749
UMLS 2011AA ObjectClass
C0025255
NCI Thesaurus ObjectClass-2
C841
UMLS 2011AA ObjectClass-2
C0038128
NCI Thesaurus Property
C12508
UMLS 2011AA Property
C0007634
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25417
Intensity of Stained Malignant Nuclei, Description
Description

StainedMalignantNucleiIntensityDescription

Data type

text

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

StainedMalignantNucleiIntensityScaled

Data type

float

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

HerceptestScore

Data type

text

Ventana Scoring System (Score)
Description

VentanaScore

Data type

text

Kit or Test Type (If FISH,)
Description

FISHAssessmentTestType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
Other, specify
Description

FISHAssessmentTestSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
FISH Result
Description

FISHCytologyResultProcedure

Data type

text

Alias
NCI Thesaurus ObjectClass
C16491
UMLS 2011AA ObjectClass
C0010819
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus ValueDomain
C25218
UMLS 2011AA ValueDomain
C1948041
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
FISH HER2/neu chromosome 17 Ratio
Description

FISHAssessmentChromosome17ResultHER2NeuNumber

Data type

float

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C13212
UMLS 2011AA Property-2
C0008659
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C17756
UMLS 2011AA ValueDomain-2
C0242957
Mean Number of HER2/neu Signals/Cell (Note: Enter 99.9 or 999 if unknown)
Description

HER2/neuSignals/CellMeanNumber

Data type

float

Amplification Cutpoint
Description

FISHAssessmentAmplificationValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C20589
UMLS 2011AA Property
C1517480
Final Diagnosis with HER2/neu
Description

DiseaseFinalDiagnosisHER2/neuType

Data type

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus Property-2
C25508
UMLS 2011AA Property-2
C0205088
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain-2
C17756
UMLS 2011AA ValueDomain-2
C0242957
Pathology: Immunohistochemistry
Description

Pathology: Immunohistochemistry

Marker Name (s)
Description

BreastTumorMarkerAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass-2
C17220
UMLS 2011AA ObjectClass-2
C0041365
Other specify
Description

TumorMarkerAssessmentSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17220
UMLS 2011AA ObjectClass
C0041365
Tissue Type
Description

TissueType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12801
UMLS 2011AA ObjectClass
C0040300
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Other, specify
Description

TissueType,Other

Data type

text

Blocks
Description

SpecimenBlockNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25436
UMLS 2011AA Property
C1533157
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Accession Number
Description

SpecimenAccessionNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25402
UMLS 2011AA Property
C1510755
Method of Evaluation
Description

Evaluation method

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
Other Specify
Description

Evaluation method, specify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
UMLS CUI-2
C1521902
NCI Thesaurus Property
C16847
Primary Antibody
Description

PrimaryAntibodyName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25251
UMLS 2011AA ObjectClass
C0205225
NCI Thesaurus ObjectClass-2
C16295
UMLS 2011AA ObjectClass-2
C0003241
Cell Type Stained (check all that apply)
Description

StainedCellType

Data type

text

Antigen Retrieval
Description

AntigenRetrievalInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C268
UMLS 2011AA ObjectClass
C0003320
NCI Thesaurus Property
C25659
UMLS 2011AA Property
C1514918
Other, specify
Description

StainedCellType,Other

Data type

text

Yes specify
Description

AntigenRetrievalText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C268
UMLS 2011AA ObjectClass
C0003320
NCI Thesaurus Property
C25659
UMLS 2011AA Property
C1514918
Pattern of Staining
Description

StainingPattern

Data type

text

Intensity of Stained Malignant Nuclei, Description
Description

StainedMalignantNucleiIntensityDescription

Data type

text

Other, specify
Description

StainingPattern,Other

Data type

text

Percentage of Invasive Tumor Cells with Nuclear Staining
Description

NuclearStainCellPercentageAmount

Data type

float

Alias
NCI Thesaurus ObjectClass
C13361
UMLS 2011AA ObjectClass
C0521447
NCI Thesaurus ObjectClass-2
C841
UMLS 2011AA ObjectClass-2
C0038128
NCI Thesaurus Property
C12508
UMLS 2011AA Property
C0007634
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25417
Stained Malignant Nuclei Intensity Scaled (__ of __ - Note: Scale for intensity will be protocol specific.)
Description

StainedMalignantNucleiIntensityScaled

Data type

float

Percentage of DCIS Cells with Nuclear Staining
Description

StainedDCISCellPercentage,Nuclear

Data type

float

Percentage of Non-Malignant Cells with Nuclear Staining
Description

StainedNon-MalignantCellPercentage,Nuclear

Data type

float

Final Interpretation of Results (for invasive component)
Description

TumorMarkerFinalResultProcedure

Data type

text

Alias
NCI Thesaurus ValueDomain
C25218
UMLS 2011AA ValueDomain
C1948041
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C25508
UMLS 2011AA Property-2
C0205088
NCI Thesaurus ObjectClass
C17220
UMLS 2011AA ObjectClass
C0041365
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1 forms
  1. StudyEvent: Breast Pathology - Tumor Marker Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Crf Header
Protocol ID Coordinating Group
Item
Coordinating Group Protocol No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1711341 (UMLS CUI-2)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Coordinating Group Code
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C1711341 (UMLS CUI-1)
C17005 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25462 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Protocol Title
Item
Protocol Title
text
C25191 (NCI Thesaurus ValueDomain)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Other Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
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-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Patient Name
Item
Patient Name (initials acceptable)
text
C25191 (NCI Thesaurus ValueDomain)
C1299487 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Item Group
Breast: Form Administration
Person Completing Form
Item
Person Completing Form
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Data amended
Item
Are data amended (If data are amended, please circle in red when using paper form)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Pathology: Estrogen And Progesterone Receptors
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
float
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
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25436 (NCI Thesaurus Property)
C1533157 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
SpecimenAccessionNumber
Item
Accession Number
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25402 (NCI Thesaurus Property)
C1510755 (UMLS 2011AA Property)
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus 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)
Evaluation method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C1521902 (UMLS CUI-2)
C16847 (NCI Thesaurus Property)
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)
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-2)
C0019929 (UMLS 2011AA ObjectClass-2)
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-2)
C0019929 (UMLS 2011AA ObjectClass-2)
StainingAntibody,Other
Item
Other, specify
text
AntigenRetrievalInd-3
Item
Antigen Retrieval
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C268 (NCI Thesaurus ObjectClass)
C0003320 (UMLS 2011AA ObjectClass)
C25659 (NCI Thesaurus Property)
C1514918 (UMLS 2011AA Property)
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)
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
float
C13361 (NCI Thesaurus ObjectClass)
C0521447 (UMLS 2011AA ObjectClass)
C841 (NCI Thesaurus ObjectClass-2)
C0038128 (UMLS 2011AA ObjectClass-2)
C12508 (NCI Thesaurus Property)
C0007634 (UMLS 2011AA Property)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25417 (NCI Thesaurus ValueDomain-2)
StainedMalignantNucleiIntensityScaled
Item
Stained Malignant Nuclei Intensity Scaled (__ of __ - Note: Scale for intensity will be protocol specific.)
float
StainedDCISCellPercentage,Nuclear
Item
Percentage of DCIS Cells with Nuclear Staining
float
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)
Item Group
Pathology: Breast Tumor Markers
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-2)
C0041365 (UMLS 2011AA ObjectClass-2)
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)
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
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25436 (NCI Thesaurus Property)
C1533157 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
SpecimenAccessionNumber
Item
Accession Number
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25402 (NCI Thesaurus Property)
C1510755 (UMLS 2011AA Property)
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus 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)
Evaluation method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C1521902 (UMLS CUI-2)
C16847 (NCI Thesaurus Property)
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)
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, )
float
C12749 (NCI Thesaurus ObjectClass)
C0025255 (UMLS 2011AA ObjectClass)
C841 (NCI Thesaurus ObjectClass-2)
C0038128 (UMLS 2011AA ObjectClass-2)
C12508 (NCI Thesaurus Property)
C0007634 (UMLS 2011AA Property)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25417 (NCI Thesaurus ValueDomain-2)
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.)
float
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+)
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+)
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-2)
C0162789 (UMLS 2011AA ObjectClass-2)
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-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
Item
FISH Result
text
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
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
float
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C13212 (NCI Thesaurus Property-2)
C0008659 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C17756 (NCI Thesaurus ValueDomain-2)
C0242957 (UMLS 2011AA ValueDomain-2)
HER2/neuSignals/CellMeanNumber
Item
Mean Number of HER2/neu Signals/Cell (Note: Enter 99.9 or 999 if unknown)
float
FISHAssessmentAmplificationValue
Item
Amplification Cutpoint
float
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C20589 (NCI Thesaurus Property)
C1517480 (UMLS 2011AA Property)
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-2)
C0205088 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C17756 (NCI Thesaurus ValueDomain-2)
C0242957 (UMLS 2011AA ValueDomain-2)
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)
Item Group
Pathology: Immunohistochemistry
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-2)
C0041365 (UMLS 2011AA ObjectClass-2)
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)
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
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25436 (NCI Thesaurus Property)
C1533157 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
SpecimenAccessionNumber
Item
Accession Number
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25402 (NCI Thesaurus Property)
C1510755 (UMLS 2011AA Property)
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus 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)
Evaluation method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C1521902 (UMLS CUI-2)
C16847 (NCI Thesaurus Property)
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-2)
C0003241 (UMLS 2011AA ObjectClass-2)
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
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C268 (NCI Thesaurus ObjectClass)
C0003320 (UMLS 2011AA ObjectClass)
C25659 (NCI Thesaurus Property)
C1514918 (UMLS 2011AA Property)
StainedCellType,Other
Item
Other, specify
text
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)
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)
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
float
C13361 (NCI Thesaurus ObjectClass)
C0521447 (UMLS 2011AA ObjectClass)
C841 (NCI Thesaurus ObjectClass-2)
C0038128 (UMLS 2011AA ObjectClass-2)
C12508 (NCI Thesaurus Property)
C0007634 (UMLS 2011AA Property)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25417 (NCI Thesaurus ValueDomain-2)
StainedMalignantNucleiIntensityScaled
Item
Stained Malignant Nuclei Intensity Scaled (__ of __ - Note: Scale for intensity will be protocol specific.)
float
StainedDCISCellPercentage,Nuclear
Item
Percentage of DCIS Cells with Nuclear Staining
float
StainedNon-MalignantCellPercentage,Nuclear
Item
Percentage of Non-Malignant Cells with Nuclear Staining
float
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-2)
C0205088 (UMLS 2011AA Property-2)
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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