ID

10055

Beschreibung

NSABP PROTOCOL B-35 PATHOLOGIST'S REPORT FORM Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy NCT00053898 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01C3BB9-FE93-4CD3-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01C3BB9-FE93-4CD3-E034-080020C9C0E0

Stichworte

Versionen (2)
  1. 26.08.12 26.08.12 -
  2. 22.03.15 22.03.15 - Martin Dugas
Hochgeladen am

22. März 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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Breast cancer NCT00053898

Englisch

Form PRF (04-30-2002) This form is to be completed by the pathologist and submitted to the NSABP Biostatistical Center within 3 months of randomization. Please mail Form PRF separately from the slides and blocks.

1 Formulare  
Header
Beschreibung

Header

First Three Letters of Patient's Last Name
Beschreibung

FirstThreeLettersofPatient'sLastName

Datentyp

text

Patient Study ID
Beschreibung

PatientStudyID

Datentyp

text

Institution Name
Beschreibung

InstitutionName

Datentyp

text

Affiliate Name
Beschreibung

AffiliateName

Datentyp

text

Are data amended? (If Yes, circle the amended items in red.)
Beschreibung

AmendedDataInd

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Accession Number (enter all that apply 123)
Beschreibung

AccessionNumber

Datentyp

float

Pathology report
Beschreibung

Pathology report

Alias
UMLS CUI-1
C0807321
Pathologic Primary Tumor Size (cm leave blank if not directly measurable)
Beschreibung

PathologicPrimaryTumorSize

Datentyp

float

Maßeinheiten
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0475440
cm
Is measurement gross or microscopic? (mark one)
Beschreibung

DuctalBreastCarcinomainSituMicroscopicGrossSizeDocumentedStatus

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C2924
NCI Thesaurus Property
C25252
NCI Thesaurus Property-2
C43566
NCI Thesaurus Property-3
C25681
NCI Thesaurus Property-4
C25356
NCI Thesaurus ValueDomain
C25688
UMLS CUI-1
C0205288
UMLS CUI-2
C0439806
Estimated Size (cm best guess, if possible)
Beschreibung

EstimatedSize

Datentyp

text

Number of slides with DCIS present
Beschreibung

NumberofslideswithDCISpresent

Datentyp

integer

Total slides examined for DCIS
Beschreibung

TotalslidesexaminedforDCIS

Datentyp

integer

Type DCIS (mark one)
Beschreibung

TypeDCIS

Datentyp

text

Alias
UMLS CUI-1
C0007124
UMLS CUI-2
C0008902
Growth Patterns (mark all that apply)
Beschreibung

Growth Patterns (mark all that apply)

Datentyp

text

Alias
UMLS CUI-1
C0449574
Other, specify
Beschreibung

HistologicType,OtherName

Datentyp

text

Dominant Growth Pattern (mark only one)
Beschreibung

Dominant Growth Pattern (mark only one)

Datentyp

text

Other, specify
Beschreibung

HistologicType,Dominant,Other

Datentyp

text

Percent Central Necrosis (% estimated necrotic surface area of DCIS associated with any growth pattern)
Beschreibung

Percent Central Necrosis (% estimated necrotic surface area of DCIS associated with any growth pattern)

Datentyp

integer

Maßeinheiten
  • %
Alias
UMLS CUI-1
C1265871
%
Nuclear Grade (by SBR criteria; mark highest grade)
Beschreibung

NuclearGrade

Datentyp

text

Microcalcifications (mark one)
Beschreibung

Microcalcifications (mark one)

Datentyp

text

Alias
UMLS CUI-1
C0520594
Margins of DCIS Resection (after re-excision, if done mark one)
Beschreibung

DCIS,MarginResult

Datentyp

text

Nearest Margin (mm if margins are negative)
Beschreibung

SurgicalMarginDistance

Datentyp

float

Pathologist Completing Form (print name signature)
Beschreibung

PathologistCompletingForm

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus Property
C40988
NCI Thesaurus Property-2
C25250
NCI Thesaurus ObjectClass
C17723
UMLS CUI-1
C0334866
Pathologist's Phone Number
Beschreibung

Pathologist's Phone Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ValueDomain-2
C25395
NCI Thesaurus ObjectClass
C17723
NCI Thesaurus Property
C40978
UMLS CUI-1
C0334866
UMLS CUI-2
C1515258
Date Form Completed
Beschreibung

FormCompletionDate,Original

Datentyp

date

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Ähnliche Modelle

Form PRF (04-30-2002) This form is to be completed by the pathologist and submitted to the NSABP Biostatistical Center within 3 months of randomization. Please mail Form PRF separately from the slides and blocks.

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header
FirstThreeLettersofPatient'sLastName
Item
First Three Letters of Patient's Last Name
text
PatientStudyID
Item
Patient Study ID
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
AmendedDataInd
Item
Are data amended? (If Yes, circle the amended items in red.)
boolean
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
AccessionNumber
Item
Accession Number (enter all that apply 123)
float
Item Group
Pathology report
C0807321 (UMLS CUI-1)
Tumor size
Item
Pathologic Primary Tumor Size (cm leave blank if not directly measurable)
float
C25209 (NCI Thesaurus ValueDomain)
C0475440 (UMLS CUI-1)
Item
Is measurement gross or microscopic? (mark one)
text
C2924 (NCI Thesaurus ObjectClass)
C25252 (NCI Thesaurus Property)
C43566 (NCI Thesaurus Property-2)
C25681 (NCI Thesaurus Property-3)
C25356 (NCI Thesaurus Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0205288 (UMLS CUI-1)
C0439806 (UMLS CUI-2)
CL.2
Code List
Is measurement gross or microscopic? (mark one)
CL Item
Gross (Gross)
C0439806 (UMLS CUI-1)
CL Item
Microscopic (Microscopic)
C25252 (NCI Thesaurus)
C0205288 (UMLS CUI-1)
CL Item
Not Directly Measurable (Not directly measurable)
C1518373 (UMLS CUI-1)
EstimatedSize
Item
Estimated Size (cm best guess, if possible)
text
Number of slides with DCIS
Item
Number of slides with DCIS present
integer
Total slides examined for DCIS
Item
Total slides examined for DCIS
integer
Item
Type DCIS (mark one)
text
C0007124 (UMLS CUI-1)
C0008902 (UMLS CUI-2)
CL.3
Code List
Type DCIS (mark one)
CL Item
Comedo (Comedo)
C26453 (NCI Thesaurus)
C0279559 (UMLS CUI-1)
CL Item
Non-comedo (Non-comedo)
C1334250 (UMLS CUI-1)
Item
Growth Patterns (mark all that apply)
text
C0449574 (UMLS CUI-1)
CL.4
Code List
Growth Patterns (mark all that apply)
CL Item
Solid (Solid)
C0205208 (UMLS CUI-1)
CL Item
Cribriform (Cribriform)
C1621425 (UMLS CUI-1)
CL Item
Micropapillary (Micropapillary)
C1334756 (UMLS CUI-1)
CL Item
Papillary (Papillary)
C0205312 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
HistologicType,OtherName
Item
Other, specify
text
Item
Dominant Growth Pattern (mark only one)
text
CL.4
Code List
Dominant Growth Pattern (mark only one)
CL Item
Solid (Solid)
C0205208 (UMLS CUI-1)
CL Item
Cribriform (Cribriform)
C1621425 (UMLS CUI-1)
CL Item
Micropapillary (Micropapillary)
C1334756 (UMLS CUI-1)
CL Item
Papillary (Papillary)
C0205312 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
HistologicType,Dominant,Other
Item
Other, specify
text
Percent Central Necrosis
Item
Percent Central Necrosis (% estimated necrotic surface area of DCIS associated with any growth pattern)
integer
C1265871 (UMLS CUI-1)
Item
Nuclear Grade (by SBR criteria; mark highest grade)
text
CL.6
Code List
Nuclear Grade (by SBR criteria; mark highest grade)
CL Item
Grade 1 (Grade 1)
CL Item
Grade 2 (Grade 2)
CL Item
Grade 3 (Grade 3)
Item
Microcalcifications (mark one)
text
C0520594 (UMLS CUI-1)
CL.7
Code List
Microcalcifications (mark one)
CL Item
Present, Involving Benign Ducts (Present, involving benign tissue elements)
CL Item
Present, Involving Dcis (Present, involving DCIS)
CL Item
Present, Involving Both Benign Ducts And Dcis (Present, involving both benign tissue elements and DCIS)
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
Item
Margins of DCIS Resection (after re-excision, if done mark one)
text
CL.8
Code List
Margins of DCIS Resection (after re-excision, if done mark one)
CL Item
Positive (Positive)
CL Item
Indefinite (Indefinite)
CL Item
Negative (Negative)
CL Item
Unable to evaluate margins (Unable to evaluate margins)
SurgicalMarginDistance
Item
Nearest Margin (mm if margins are negative)
float
Pathologist
Item
Pathologist Completing Form (print name signature)
text
C25191 (NCI Thesaurus ValueDomain)
C40988 (NCI Thesaurus Property)
C25250 (NCI Thesaurus Property-2)
C17723 (NCI Thesaurus ObjectClass)
C0334866 (UMLS CUI-1)
Pathologist Telephone Number
Item
Pathologist's Phone Number
text
C25337 (NCI Thesaurus ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C17723 (NCI Thesaurus ObjectClass)
C40978 (NCI Thesaurus Property)
C0334866 (UMLS CUI-1)
C1515258 (UMLS CUI-2)
FormCompletionDate,Original
Item
Date Form Completed
date
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