ID

1032

Description

Disease recurrence Genetic Testing or Clinical Assessment in Determining the Need for Chemotherapy in Women With Breast Cancer That Involves No More Than 3 Lymph Nodes Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1966F1B5-7BF7-3D46-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1966F1B5-7BF7-3D46-E044-0003BA3F9857

Keywords

Versions (2)
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
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August 26, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00433589 Treatment - Disease recurrence - 2498795v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Disease recurrence
    1. No Instruction available.
Header
Description

Header

Patient Birth Date
Description

PatientBirthDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C25155
UMLS 2011AA Property
C0005615
Patient Hospital Number
Description

HospitalPatientIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C16960
UMLS 2011AA Property
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
Institution Name
Description

InstitutionName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus ValueDomain
C21541
UMLS 2011AA ValueDomain
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Institution No.
Description

InstitutionIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Physician of Record
Description

RegisteredInvestigatorName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C17089
UMLS 2011AA ObjectClass
C0035173
NCI Thesaurus ObjectClass
C25644
Disease Recurrence
Description

Disease Recurrence

Date of Assessment
Description

AssessmentPerformedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Metastasis Diagnosis Date
Description

MetastasisDiagnosisDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Loco-regional Recurrence
Description

Loco-regional Recurrence

Site of first local-regional recurrence
Description

BreastCarcinomaLocal-RegionalRecurrentDiseaseAnatomicSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus Property
C25388
UMLS 2011AA Property
C1947913
NCI Thesaurus Property
C38155
UMLS 2011AA Property
C0277556
NCI Thesaurus ObjectClass
C4872
UMLS 2011AA ObjectClass
C0678222
Method of Evaluation
Description

AssessmentMethodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Other Specify
Description

AssessmentMethodSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Distant Metastasis
Description

Distant Metastasis

Metastatic Site
Description

BreastMalignantNeoplasmMetastaticInvolvementSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C14174
UMLS 2011AA Property
C0036525
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Other specify
Description

MalignantNeoplasmMetastaticInvolvementSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C14174
UMLS 2011AA Property
C0036525
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
Method of Evaluation
Description

AssessmentMethodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Other Specify
Description

AssessmentMethodSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Comments
Description

Comments

Date
Description

InvestigatorSignatureDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus ObjectClass
C17089
UMLS 2011AA ObjectClass
C0035173
Investigator Signature
Description

InvestigatorSignatureText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
NCI Thesaurus ObjectClass
C17089
UMLS 2011AA ObjectClass
C0035173
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No Instruction available.

1 forms
  1. StudyEvent: Disease recurrence
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
PatientBirthDate
Item
Patient Birth Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
HospitalPatientIdentifierNumber
Item
Patient Hospital Number
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
InstitutionName
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
InstitutionIdentifierNumber
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
RegisteredInvestigatorName
Item
Physician of Record
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
C25644 (NCI Thesaurus ObjectClass)
Item Group
Disease Recurrence
AssessmentPerformedDate
Item
Date of Assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
MetastasisDiagnosisDate
Item
Metastasis Diagnosis Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Loco-regional Recurrence
Item
Site of first local-regional recurrence
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25388 (NCI Thesaurus Property)
C1947913 (UMLS 2011AA Property)
C38155 (NCI Thesaurus Property)
C0277556 (UMLS 2011AA Property)
C4872 (NCI Thesaurus ObjectClass)
C0678222 (UMLS 2011AA ObjectClass)
CL.1
Code List
Site of first local-regional recurrence
CL Item
At The Site Of The Primary Tumor (At the site of the primary tumor)
CL Item
Ipsilateral Chest Wall (Ipsilateral chest wall)
CL Item
Ipsilateral Axillary Lymph Nodes And/or Soft Tissue (Ipsilateral axillary lymph nodes and/or soft tissue)
CL Item
Ipsilateral Infraclavicular Nodes (Ipsilateral infraclavicular nodes)
CL Item
Ipsilateral Supraclavicular Nodes (Ipsilateral suparclavicular nodes)
CL Item
Ipsilateral Internal Mammary Nodes (Ipsilateral internal mammary nodes)
CL Item
Elsewhere In The Breast (Elsewhere in the breast)
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.4
Code List
Method of Evaluation
CL Item
Autopsy (Autopsy)
C25153 (NCI Thesaurus)
C0004398 (UMLS 2011AA)
CL Item
Axillary Dissection (Axillary dissection)
CL Item
Bilateral Mammogram (Bilateral mammogram)
CL Item
Bimanual Examination (Bimanual examination)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
CL Item
Biopsy (Biopsy, other)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
CL Item
Bone Scan (Bone scan)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
CL Item
Chest X-ray (Chest x-ray)
CL Item
Clinical (Clinical)
C25398 (NCI Thesaurus)
C0205210 (UMLS 2011AA)
CL Item
Clinical Examination (pe) (Clinical examination)
CL Item
Colposcopy (Colposcopy)
CL Item
Contrast Enhanced Ct Scan (Contrast enhanced CT scan/CT perfusion exam)
CL Item
Ct Scan (CT scan)
CL Item
Cystoscopy (Cystoscopy)
C16482 (NCI Thesaurus)
C0010702 (UMLS 2011AA)
CL Item
Cytologic Confirmation (Cytologic confirmation)
CL Item
Cytology (Cytology)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Cytoscopy (Cytoscopy)
CL Item
Differential (Differential)
CL Item
Direct Inspection (Direct inspection)
CL Item
Ductal Lavage (Ductal lavage)
CL054589 (NCI Metathesaurus)
CL Item
Ductoscopic Biopsy (Ductoscopic biopsy)
CL Item
Echocardiogram (Echocardiogram)
C37945 (NCI Thesaurus)
C2243117 (UMLS 2011AA)
CL Item
Ekg (EKG)
CL Item
Endoscopy (Endoscopy)
C16546 (NCI Thesaurus)
C0014245 (UMLS 2011AA)
CL Item
Excisional Biopsy Or Lumpectomy (Excisional biopsy or lumpectomy)
CL Item
Lumpectomy, With Wire Localization (Excisional biopsy or lumpectomy, with wire localization)
CL Item
Fine Needle Aspiration Biopsy (Fine needle aspiration biopsy)
CL Item
Fine Needle Aspiration Biopsy With Wire Localization (Fine needle aspiration biopsy, with wire localization)
CL Item
Fluid Cytology, Ascites (Fluid cytology, ascites)
CL Item
Fluid Cytology, Cerebrospinal Fluid (Fluid cytology, cerebrospinal fluid)
CL Item
Fluid Cytology, Pleural (Fluid cytology, pleural)
CL Item
Gallium Scan (Gallium scan)
C38087 (NCI Thesaurus)
C0521316 (UMLS 2011AA)
CL Item
Histologic (Histologic)
CL Item
Histologic Confirmation (Histologic confirmation)
CL Item
Histology (Histology)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Incisional Biopsy (Incisional biopsy)
C15386 (NCI Thesaurus)
C0184922 (UMLS 2011AA)
CL Item
Incisional Biopsy, With Wire Localization (Incisional biopsy, with wire localization)
CL Item
Intraoperative Ultrasound (Intraoperative ultrasound)
CL Item
Laparoscopy (Laparoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparotomy (Laparotomy)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Mammogram (Mammogram)
C20178 (NCI Thesaurus)
C0024671 (UMLS 2011AA)
CL Item
Mastectomy (Mastectomy)
C15277 (NCI Thesaurus)
C0024881 (UMLS 2011AA)
CL Item
Mri (MRI (NMR))
CL Item
Mri Scan (MRI scan)
CL Item
Nomograms (MSK Nomogram)
C1450294 (NCI Metathesaurus)
CL Item
Muga Scan (MUGA)
CL Item
Needle Biopsy (tru-cut Or Core) (Needle biopsy (tru-cut or core))
CL Item
Needle Biopsy (tru-cut Or Core), With Wire Localization (Needle biopsy (tru-cut or core), with wire localization))
CL Item
Nipple Fluid (Nipple fluid)
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Not Evaluated (Not evaluated)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Other, Specify (Other, specify)
CL Item
Palpation (Palpation)
CL Item
Pathologic (Pathologic)
C25610 (NCI Thesaurus)
C1521733 (UMLS 2011AA)
CL Item
Pet Scan (PET scan)
CL Item
Physical Exam (Physical exam)
CL Item
Plain Film/x-ray With Contrast (Plain film/X-ray with contrast)
CL Item
Plain Film/x-ray Without Contrast (Plain film/X-ray without contrast)
CL Item
Ct Scan (Preoperative CT scan)
CL Item
Primary Surgery (Primary surgery)
CL Item
Prophalactic Mastectomy (Prophalactic mastectomy)
CL Item
Radiograph (Radiograph)
CL Item
Radiographic (Radiographic)
CL Item
Radioisotope Scan (Radioisotope scan)
CL Item
Resection/re-excision Of Lumpectomy Margins (Resection/re-excision of lumpectomy margins)
CL Item
Sentinel Node Biopsy (Sentinel node biopsy)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Surgery (Surgery)
C17173 (NCI Thesaurus)
C0038894 (UMLS 2011AA)
CL Item
Tumor Marker (Tumor Marker)
CL Item
Tumor Markers (Tumor markers)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Visual Assessment (Visual assessment)
CL Item
Visualization (Visualization)
CL Item
X-ray (X-ray)
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)
Item Group
Distant Metastasis
Item
Metastatic Site
text
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.3
Code List
Metastatic Site
CL Item
Lung (Lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Bone (Bone)
C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)
CL Item
Pleura (Pleura)
CL Item
Brain (Brain)
CL Item
Other Cns (Other Central Nervous System)
CL Item
Distant Skin/subcutaneous Tissue (Distant skin/subcutaneous tissue)
CL Item
Distant Nodes (Distant nodes)
CL Item
Other Specify (Other)
MalignantNeoplasmMetastaticInvolvementSpecify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
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.4
Code List
Method of Evaluation
CL Item
Autopsy (Autopsy)
C25153 (NCI Thesaurus)
C0004398 (UMLS 2011AA)
CL Item
Axillary Dissection (Axillary dissection)
CL Item
Bilateral Mammogram (Bilateral mammogram)
CL Item
Bimanual Examination (Bimanual examination)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
CL Item
Biopsy (Biopsy, other)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
CL Item
Bone Scan (Bone scan)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
CL Item
Chest X-ray (Chest x-ray)
CL Item
Clinical (Clinical)
C25398 (NCI Thesaurus)
C0205210 (UMLS 2011AA)
CL Item
Clinical Examination (pe) (Clinical examination)
CL Item
Colposcopy (Colposcopy)
CL Item
Contrast Enhanced Ct Scan (Contrast enhanced CT scan/CT perfusion exam)
CL Item
Ct Scan (CT scan)
CL Item
Cystoscopy (Cystoscopy)
C16482 (NCI Thesaurus)
C0010702 (UMLS 2011AA)
CL Item
Cytologic Confirmation (Cytologic confirmation)
CL Item
Cytology (Cytology)
C16491 (NCI Thesaurus)
C0010819 (UMLS 2011AA)
CL Item
Cytoscopy (Cytoscopy)
CL Item
Differential (Differential)
CL Item
Direct Inspection (Direct inspection)
CL Item
Ductal Lavage (Ductal lavage)
CL054589 (NCI Metathesaurus)
CL Item
Ductoscopic Biopsy (Ductoscopic biopsy)
CL Item
Echocardiogram (Echocardiogram)
C37945 (NCI Thesaurus)
C2243117 (UMLS 2011AA)
CL Item
Ekg (EKG)
CL Item
Endoscopy (Endoscopy)
C16546 (NCI Thesaurus)
C0014245 (UMLS 2011AA)
CL Item
Excisional Biopsy Or Lumpectomy (Excisional biopsy or lumpectomy)
CL Item
Lumpectomy, With Wire Localization (Excisional biopsy or lumpectomy, with wire localization)
CL Item
Fine Needle Aspiration Biopsy (Fine needle aspiration biopsy)
CL Item
Fine Needle Aspiration Biopsy With Wire Localization (Fine needle aspiration biopsy, with wire localization)
CL Item
Fluid Cytology, Ascites (Fluid cytology, ascites)
CL Item
Fluid Cytology, Cerebrospinal Fluid (Fluid cytology, cerebrospinal fluid)
CL Item
Fluid Cytology, Pleural (Fluid cytology, pleural)
CL Item
Gallium Scan (Gallium scan)
C38087 (NCI Thesaurus)
C0521316 (UMLS 2011AA)
CL Item
Histologic (Histologic)
CL Item
Histologic Confirmation (Histologic confirmation)
CL Item
Histology (Histology)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Incisional Biopsy (Incisional biopsy)
C15386 (NCI Thesaurus)
C0184922 (UMLS 2011AA)
CL Item
Incisional Biopsy, With Wire Localization (Incisional biopsy, with wire localization)
CL Item
Intraoperative Ultrasound (Intraoperative ultrasound)
CL Item
Laparoscopy (Laparoscopy)
C16969 (NCI Thesaurus)
C0031150 (UMLS 2011AA)
CL Item
Laparotomy (Laparotomy)
C15266 (NCI Thesaurus)
C0023038 (UMLS 2011AA)
CL Item
Mammogram (Mammogram)
C20178 (NCI Thesaurus)
C0024671 (UMLS 2011AA)
CL Item
Mastectomy (Mastectomy)
C15277 (NCI Thesaurus)
C0024881 (UMLS 2011AA)
CL Item
Mri (MRI (NMR))
CL Item
Mri Scan (MRI scan)
CL Item
Nomograms (MSK Nomogram)
C1450294 (NCI Metathesaurus)
CL Item
Muga Scan (MUGA)
CL Item
Needle Biopsy (tru-cut Or Core) (Needle biopsy (tru-cut or core))
CL Item
Needle Biopsy (tru-cut Or Core), With Wire Localization (Needle biopsy (tru-cut or core), with wire localization))
CL Item
Nipple Fluid (Nipple fluid)
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Not Evaluated (Not evaluated)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Other, Specify (Other, specify)
CL Item
Palpation (Palpation)
CL Item
Pathologic (Pathologic)
C25610 (NCI Thesaurus)
C1521733 (UMLS 2011AA)
CL Item
Pet Scan (PET scan)
CL Item
Physical Exam (Physical exam)
CL Item
Plain Film/x-ray With Contrast (Plain film/X-ray with contrast)
CL Item
Plain Film/x-ray Without Contrast (Plain film/X-ray without contrast)
CL Item
Ct Scan (Preoperative CT scan)
CL Item
Primary Surgery (Primary surgery)
CL Item
Prophalactic Mastectomy (Prophalactic mastectomy)
CL Item
Radiograph (Radiograph)
CL Item
Radiographic (Radiographic)
CL Item
Radioisotope Scan (Radioisotope scan)
CL Item
Resection/re-excision Of Lumpectomy Margins (Resection/re-excision of lumpectomy margins)
CL Item
Sentinel Node Biopsy (Sentinel node biopsy)
CL Item
Spiral Ct Scan (Spiral CT scan)
CL Item
Surgery (Surgery)
C17173 (NCI Thesaurus)
C0038894 (UMLS 2011AA)
CL Item
Tumor Marker (Tumor Marker)
CL Item
Tumor Markers (Tumor markers)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Visual Assessment (Visual assessment)
CL Item
Visualization (Visualization)
CL Item
X-ray (X-ray)
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)
Item Group
Comments
InvestigatorSignatureDate
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
InvestigatorSignatureText
Item
Investigator Signature
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C17089 (NCI Thesaurus ObjectClass)
C0035173 (UMLS 2011AA ObjectClass)
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