ID

11089

Beschreibung

CALGB: 40601 POST-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM NCT00770809 Paclitaxel and Trastuzumab With or Without Lapatinib in Treating Patients With Stage II or Stage III Breast Cancer That Can Be Removed by Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A7CAEA0-52A1-0226-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A7CAEA0-52A1-0226-E044-0003BA3F9857

Stichworte

  1. 26.08.12 26.08.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 18.06.15 18.06.15 -
Hochgeladen am

18. Juni 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy

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CALGB: 40601 POST-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM NCT00770809

INSTRUCTIONS: Complete all information on this form. Submit within one week of registration along with the On-Study Form.

Header
Beschreibung

Header

CALGB Form
Beschreibung

Form ID CALGB

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3262252
NCI Thesaurus ObjectClass
C19464
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass-2
C25442
CALGB Study No
Beschreibung

Protocol ID CALGB

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
CALGB Patient ID
Beschreibung

Trial subject ID CALGB

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
Date of evaluation
Beschreibung

Assessment Date

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985720
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C38000
Amended Data
Beschreibung

Data amended

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Patient demographics
Beschreibung

Patient demographics

Patient Initials (Last, First Middle)
Beschreibung

Patient Initials

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Hospital No.
Beschreibung

Medical Record Number

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301894
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25261
NCI Thesaurus Property-2
C25198
Institution/Affiliate
Beschreibung

Institution Name

Datentyp

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
Beschreibung

Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Participating Group Study No.
Beschreibung

Study Number Participating Group

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID
Beschreibung

Trial subject ID Participating Group

Datentyp

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
Breast Conserving Therapy
Beschreibung

Breast Conserving Therapy

Was the patient (after receiving neoadjuvant chemotherapy) a candidate for breast conserving treatment
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyQualificationInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15665
UMLS 2011AA Property-2
C0600558
NCI Thesaurus Property-3
C43608
UMLS 2011AA Property-3
C1709790
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Reason not a candidate (If no,)
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyNotQualificationReason

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus Property-4
C43608
UMLS 2011AA Property-4
C1709790
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyNotQualificationSpecify

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus Property-4
C43608
UMLS 2011AA Property-4
C1709790
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Absolute contraindication to radiation therapy
Beschreibung

BreastConservationTreatmentRadiationTherapyMedicalContraindicationReason

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass-2
C15280
UMLS 2011AA ObjectClass-2
C0917927
NCI Thesaurus Property
C50646
UMLS 2011AA Property
C1301624
Connective tissue disorder, specify
Beschreibung

BreastConservationTreatmentRadiationTherapyConnectiveTissueDisorderMedicalContraindicationSpecify

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass-2
C15280
UMLS 2011AA ObjectClass-2
C0917927
NCI Thesaurus Property
C26729
UMLS 2011AA Property
C0009782
NCI Thesaurus Property-2
C50646
UMLS 2011AA Property-2
C1301624
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Was breast conserving treatment attempted?
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyAttemptInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15665
UMLS 2011AA Property-2
C0600558
NCI Thesaurus Property-3
C39769
UMLS 2011AA Property-3
C1516084
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Reason not attempted?
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyNotAttemptReason

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15665
UMLS 2011AA Property-2
C0600558
NCI Thesaurus Property-3
C39769
UMLS 2011AA Property-3
C1516084
NCI Metathesaurus Property
CL052458
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyNotAttemptSpecify

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property-2
C15665
UMLS 2011AA Property-2
C0600558
NCI Thesaurus Property-3
C39769
UMLS 2011AA Property-3
C1516084
NCI Metathesaurus Property
CL052458
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Patient choice
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyRefuse

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C49161
UMLS 2011AA Property
C1705116
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Was BCT successful?
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapySuccessPerformedInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus Property-4
C25362
UMLS 2011AA Property-4
C0597535
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Reason BCT unsuccessful?
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyFailedPerformedReason

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus Property-4
C44281
UMLS 2011AA Property-4
C0231175
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Beschreibung

BreastConservationTreatmentPostNeoadjuvantTherapyFailedPerformedSpecify

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus Property-4
C44281
UMLS 2011AA Property-4
C0231175
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Axillary Node
Beschreibung

Axillary Node

Was the patient's post-neoadjuvent chemotherapy treatment axillary nodal status evaluated?
Beschreibung

AxillaryLymphNodePostNeoadjuvantTherapyEvaluationInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C12904
UMLS 2011AA ObjectClass
C0729594
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Method of Evaluation
Beschreibung

Evaluation method

Datentyp

text

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

Evaluation method, specify

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
UMLS CUI-2
C1521902
NCI Thesaurus Property
C16847
Results
Beschreibung

AxillaryLymphNodePostNeoadjuvantTherapyEvaluationResult

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C12904
UMLS 2011AA ObjectClass
C0729594
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C38008
UMLS 2011AA Property-2
C0687676
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus ValueDomain
C20200
UMLS 2011AA ValueDomain
C1274040
Date of Evaluation
Beschreibung

LesionAssessmentDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain-2
C25367
Was blue dye used
Beschreibung

SentinelLymphNodeBiopsyBlueDyeUseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C15667
UMLS 2011AA ObjectClass
C0796693
NCI Thesaurus Property
C461
UMLS 2011AA Property
C0013343
NCI Thesaurus Property-2
C25340
UMLS 2011AA Property-2
C0457083
NCI Thesaurus Property-3
C48333
UMLS 2011AA Property-3
C1260957
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Was technetium used
Beschreibung

SentinelLymphNodeBiopsyTechnetium99mDextranUseInd-2

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15667
UMLS 2011AA ObjectClass
C0796693
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
NCI Thesaurus Property-2
C1243
UMLS 2011AA Property-2
C0076028
Footer Module
Beschreibung

Footer Module

Completed by (Last name, First name)
Beschreibung

Person Completing Form

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Date Form Completed (MM DD YYYY)
Beschreibung

Date Form Completed

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
Comments
Beschreibung

Research Comments

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393

Ähnliche Modelle

INSTRUCTIONS: Complete all information on this form. Submit within one week of registration along with the On-Study Form.

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header
Form ID CALGB
Item
CALGB Form
text
C25337 (NCI Thesaurus ValueDomain)
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
Protocol ID CALGB
Item
CALGB Study No
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Trial subject ID CALGB
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Assessment Date
Item
Date of evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
Data amended
Item
Amended Data
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Patient demographics
Patient Initials
Item
Patient Initials (Last, First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Medical Record Number
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (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)
Participating Group
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group 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)
Item Group
Breast Conserving Therapy
BreastConservationTreatmentPostNeoadjuvantTherapyQualificationInd-2
Item
Was the patient (after receiving neoadjuvant chemotherapy) a candidate for breast conserving treatment
boolean
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15665 (NCI Thesaurus Property-2)
C0600558 (UMLS 2011AA Property-2)
C43608 (NCI Thesaurus Property-3)
C1709790 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Reason not a candidate (If no,)
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C43608 (NCI Thesaurus Property-4)
C1709790 (UMLS 2011AA Property-4)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
Code List
Reason not a candidate (If no,)
CL Item
Absolute Contraindication To Radiation Therapy (Absolute contraindication to radiation therapy)
CL Item
Diffuse Suspicious Microcalcifications (Diffuse suspicious microcalcifications)
CL Item
Multicentric Breast Cancer (Multicentric breast cancer)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Probable Poor Cosmetic Outcome (Probable poor cosmetic outcome)
CL Item
Breast Cancer Pt4 Tnm Finding (T4)
C48985 (NCI Thesaurus)
C1707033 (UMLS 2011AA)
CL Item
Tumor Is Too Large In Relation To Native Breast Size (Tumor is too large in relation to native breast size)
BreastConservationTreatmentPostNeoadjuvantTherapyNotQualificationSpecify
Item
Other, specify
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C43608 (NCI Thesaurus Property-4)
C1709790 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Absolute contraindication to radiation therapy
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C15280 (NCI Thesaurus ObjectClass-2)
C0917927 (UMLS 2011AA ObjectClass-2)
C50646 (NCI Thesaurus Property)
C1301624 (UMLS 2011AA Property)
Code List
Absolute contraindication to radiation therapy
CL Item
Connective Tissue Disorder (Connective Tissue Disorder)
C26729 (NCI Thesaurus)
C0009782 (UMLS 2011AA)
CL Item
Patient Access To Prescribed Radiation Therapy (Patient access to prescribed radiation therapy)
CL Item
Patient Compliance With Prescribed Radiation Therapy (Patient compliance with prescribed radiation therapy)
CL Item
Prior Radiation Therapy (Prior radiation therapy)
C15477 (NCI Thesaurus)
C0279134 (UMLS 2011AA)
BreastConservationTreatmentRadiationTherapyConnectiveTissueDisorderMedicalContraindicationSpecify
Item
Connective tissue disorder, specify
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C15280 (NCI Thesaurus ObjectClass-2)
C0917927 (UMLS 2011AA ObjectClass-2)
C26729 (NCI Thesaurus Property)
C0009782 (UMLS 2011AA Property)
C50646 (NCI Thesaurus Property-2)
C1301624 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
BreastConservationTreatmentPostNeoadjuvantTherapyAttemptInd-2
Item
Was breast conserving treatment attempted?
boolean
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15665 (NCI Thesaurus Property-2)
C0600558 (UMLS 2011AA Property-2)
C39769 (NCI Thesaurus Property-3)
C1516084 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Reason not attempted?
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15665 (NCI Thesaurus Property-2)
C0600558 (UMLS 2011AA Property-2)
C39769 (NCI Thesaurus Property-3)
C1516084 (UMLS 2011AA Property-3)
CL052458 (NCI Metathesaurus Property)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
Code List
Reason not attempted?
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Patient Choice (Patient choice)
BreastConservationTreatmentPostNeoadjuvantTherapyNotAttemptSpecify
Item
Other, specify
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15665 (NCI Thesaurus Property-2)
C0600558 (UMLS 2011AA Property-2)
C39769 (NCI Thesaurus Property-3)
C1516084 (UMLS 2011AA Property-3)
CL052458 (NCI Metathesaurus Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Patient choice
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C49161 (NCI Thesaurus Property)
C1705116 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
Code List
Patient choice
CL Item
Avoid Possible Radiation Therapy (Avoid possible radiation therapy)
CL Item
Avoid Possible Return Trip To The Operating Room (Avoid possible return trip to the operating room)
BreastConservationTreatmentPostNeoadjuvantTherapySuccessPerformedInd-2
Item
Was BCT successful?
boolean
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C25362 (NCI Thesaurus Property-4)
C0597535 (UMLS 2011AA Property-4)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Reason BCT unsuccessful?
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C44281 (NCI Thesaurus Property-4)
C0231175 (UMLS 2011AA Property-4)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
Code List
Reason BCT unsuccessful?
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Positive Surgical Margin (Positive Margins)
C48620 (NCI Thesaurus)
C1709603 (UMLS 2011AA)
BreastConservationTreatmentPostNeoadjuvantTherapyFailedPerformedSpecify
Item
Other, specify
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C44281 (NCI Thesaurus Property-4)
C0231175 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Axillary Node
AxillaryLymphNodePostNeoadjuvantTherapyEvaluationInd-2
Item
Was the patient's post-neoadjuvent chemotherapy treatment axillary nodal status evaluated?
boolean
C12904 (NCI Thesaurus ObjectClass)
C0729594 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C2911685 (UMLS CUI-1)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
Code List
Method of Evaluation
CL Item
Clinical Examination (pe) (Clinical examination)
CL Item
Fine Needle Aspiration Biopsy (Fine needle aspiration biopsy)
CL Item
Mri Scan (MRI scan)
CL Item
Pet Scan (PET scan)
CL Item
Sentinel Node Biopsy (Sentinel node biopsy)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Axillary Dissection (Axillary dissection)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
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
Results
text
C12904 (NCI Thesaurus ObjectClass)
C0729594 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C38008 (NCI Thesaurus Property-2)
C0687676 (UMLS 2011AA Property-2)
C15665 (NCI Thesaurus Property-3)
C0600558 (UMLS 2011AA Property-3)
C20200 (NCI Thesaurus ValueDomain)
C1274040 (UMLS 2011AA ValueDomain)
Code List
Results
CL Item
Equivocal (Equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
CL Item
Not Applicable (N/A)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
LesionAssessmentDate
Item
Date of Evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain-2)
SentinelLymphNodeBiopsyBlueDyeUseInd-2
Item
Was blue dye used
boolean
C15667 (NCI Thesaurus ObjectClass)
C0796693 (UMLS 2011AA ObjectClass)
C461 (NCI Thesaurus Property)
C0013343 (UMLS 2011AA Property)
C25340 (NCI Thesaurus Property-2)
C0457083 (UMLS 2011AA Property-2)
C48333 (NCI Thesaurus Property-3)
C1260957 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
SentinelLymphNodeBiopsyTechnetium99mDextranUseInd-2
Item
Was technetium used
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15667 (NCI Thesaurus ObjectClass)
C0796693 (UMLS 2011AA ObjectClass)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
C1243 (NCI Thesaurus Property-2)
C0076028 (UMLS 2011AA Property-2)
Item Group
Footer Module
Person Completing Form
Item
Completed by (Last name, First name)
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Date Form Completed
Item
Date Form Completed (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

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