ID

11100

Descrição

CALGB: 40601 PRE-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=3A963C4E-69F2-4844-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A963C4E-69F2-4844-E044-0003BA3F9857

Palavras-chave

Versões (3)
  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 18/06/2015 18/06/2015 -
Transferido a

18 de junho de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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CALGB: 40601 PRE-NEOADJUVANT CHEMOTHERAPY SURGICAL EVALUATION FORM NCT00770809

Inglês

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

1 Formulários  
Header
Descrição

Header

CALGB Form
Descrição

Form ID CALGB

Tipo de dados

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
Descrição

Protocol ID CALGB

Tipo de dados

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
Descrição

Trial subject ID CALGB

Tipo de dados

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
Descrição

Assessment Date

Tipo de dados

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
Descrição

Data amended

Tipo de dados

boolean

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

Patient demographics

Patient Initials (Last, First Middle)
Descrição

Patient Initials

Tipo de dados

text

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

Medical Record Number

Tipo de dados

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
Descrição

Institution Name

Tipo de dados

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
Descrição

Participating Group

Tipo de dados

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.
Descrição

Study Number Participating Group

Tipo de dados

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
Descrição

Trial subject ID Participating Group

Tipo de dados

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
Descrição

Breast Conserving Therapy

Was the patient's clinical breast exam normal?
Descrição

ClinicalBreastExaminationNormalEvaluationInd-2

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C14165
UMLS 2011AA Property-2
C0205307
NCI Thesaurus ObjectClass
C70552
UMLS 2011AA ObjectClass
C2347781
Describe abnormality (If no,)
Descrição

ClinicalBreastExaminationAbnormalEvaluationText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C25401
UMLS 2011AA Property-2
C0205161
NCI Thesaurus ObjectClass
C70552
UMLS 2011AA ObjectClass
C2347781
Is the patient currently(before receiving neoadjuvant chemotherapy) a candidate for breast conserving treatment
Descrição

BreastConservationTreatmentPriorNeoadjuvantTherapyQualificationInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
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,)
Descrição

BreastConservationTreatmentPriorNeoadjuvantTherapyNotQualificationReason

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C15665
UMLS 2011AA Property-2
C0600558
NCI Metathesaurus Property
CL052458
NCI Thesaurus Property-3
C43608
UMLS 2011AA Property-3
C1709790
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other, specify
Descrição

BreastConservationTreatmentPriorNeoadjuvantTherapyNotQualificationSpecify

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C15280
UMLS 2011AA ObjectClass
C0917927
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C15665
UMLS 2011AA Property-2
C0600558
NCI Metathesaurus Property
CL052458
NCI Thesaurus Property-3
C43608
UMLS 2011AA Property-3
C1709790
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Absolute contraindication to radiation therapy
Descrição

BreastConservationTreatmentRadiationTherapyMedicalContraindicationReason

Tipo de dados

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
Descrição

BreastConservationTreatmentRadiationTherapyConnectiveTissueDisorderMedicalContraindicationSpecify

Tipo de dados

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
Axillary Node
Descrição

Axillary Node

Was the patient's pre-neoadjuvent chemotherapy treatment axillary nodal status evaluated?
Descrição

AxillaryLymphNodePriorNeoadjuvantTherapyEvaluationInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ObjectClass
C12904
UMLS 2011AA ObjectClass
C0729594
NCI Thesaurus Property
C25214
UMLS 2011AA Property
C0220825
NCI Thesaurus Property-2
C25629
UMLS 2011AA Property-2
C0332152
NCI Thesaurus Property-3
C15665
UMLS 2011AA Property-3
C0600558
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Method of Evaluation
Descrição

Evaluation method

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
Clinical N Stage
Descrição

BreastTumorClinicalNStage

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12971
UMLS 2011AA ObjectClass-2
C0006141
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus Property-2
C25580
UMLS 2011AA Property-2
C0456532
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
Results
Descrição

AxillaryLymphNodePostNeoadjuvantTherapyEvaluationResult

Tipo de dados

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
If positive, specify why ultrasound criteria made it positive
Descrição

UltrasoundImagingPositiveFindingResultText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C38758
UMLS 2011AA Property
C1514241
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ObjectClass
C17230
UMLS 2011AA ObjectClass
C0041618
Date of Evaluation
Descrição

LesionAssessmentDate

Tipo de dados

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
Other Specify
Descrição

Evaluation method, specify

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C2911685
NCI Thesaurus ObjectClass
C20989
UMLS CUI-2
C1521902
NCI Thesaurus Property
C16847
Sentinel Node Biopsy Date
Descrição

SentinelNodeBiopsyDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C15189
UMLS 2011AA Property
C0005558
NCI Thesaurus ObjectClass
C12947
UMLS 2011AA ObjectClass
C1522495
Was blue dye used
Descrição

SentinelLymphNodeBiopsyBlueDyeUseInd-2

Tipo de dados

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
Descrição

SentinelLymphNodeBiopsyTechnetium99mDextranUseInd-2

Tipo de dados

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
Date of dissection
Descrição

LymphNodeDissectionDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus Property
C15227
UMLS 2011AA Property
C0012737
Footer Module
Descrição

Footer Module

Comments
Descrição

Research Comments

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Completed by (Last name, First name)
Descrição

Person Completing Form

Tipo de dados

text

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

Date Form Completed

Tipo de dados

date

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

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

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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
Item
Was the patient's clinical breast exam normal?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C14165 (NCI Thesaurus Property-2)
C0205307 (UMLS 2011AA Property-2)
C70552 (NCI Thesaurus ObjectClass)
C2347781 (UMLS 2011AA ObjectClass)
CL.2
Code List
Was the patient's clinical breast exam normal?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
ClinicalBreastExaminationAbnormalEvaluationText
Item
Describe abnormality (If no,)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25401 (NCI Thesaurus Property-2)
C0205161 (UMLS 2011AA Property-2)
C70552 (NCI Thesaurus ObjectClass)
C2347781 (UMLS 2011AA ObjectClass)
BreastConservationTreatmentPriorNeoadjuvantTherapyQualificationInd-2
Item
Is the patient currently(before receiving neoadjuvant chemotherapy) a candidate for breast conserving treatment
boolean
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (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)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15665 (NCI Thesaurus Property-2)
C0600558 (UMLS 2011AA Property-2)
CL052458 (NCI Metathesaurus Property)
C43608 (NCI Thesaurus Property-3)
C1709790 (UMLS 2011AA Property-3)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.4
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)
BreastConservationTreatmentPriorNeoadjuvantTherapyNotQualificationSpecify
Item
Other, specify
text
C15280 (NCI Thesaurus ObjectClass)
C0917927 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15665 (NCI Thesaurus Property-2)
C0600558 (UMLS 2011AA Property-2)
CL052458 (NCI Metathesaurus Property)
C43608 (NCI Thesaurus Property-3)
C1709790 (UMLS 2011AA Property-3)
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)
CL.5
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)
Item Group
Axillary Node
AxillaryLymphNodePriorNeoadjuvantTherapyEvaluationInd-2
Item
Was the patient's pre-neoadjuvent chemotherapy treatment axillary nodal status evaluated?
boolean
C12904 (NCI Thesaurus ObjectClass)
C0729594 (UMLS 2011AA ObjectClass)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (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)
CL.10
Code List
Method of Evaluation
CL Item
Axillary Dissection (Axillary dissection)
CL Item
Excisional Biopsy Or Lumpectomy (Excisional biopsy or lumpectomy)
CL Item
Fine Needle Aspiration Biopsy (Fine needle aspiration biopsy)
CL Item
Mri Scan (MRI scan)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Pet Scan (PET scan)
CL Item
Sentinel Node Biopsy (Sentinel node biopsy)
Item
Clinical N Stage
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus ObjectClass-2)
C0006141 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property-2)
C0456532 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.8
Code List
Clinical N Stage
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Metastasis To Movable Ipsilateral Axillary Lymph Node(s) (N1)
CL Item
Metastasis To Ipsilateral Axillary Lymph Node(s) Fixed Or Matted, Or In Clinically Apparent* Ipsilateral Internal Mammary Nodes In The Absence Of Clinically Evident Lymph Node Metastasis (N2)
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)
CL.11
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)
UltrasoundImagingPositiveFindingResultText
Item
If positive, specify why ultrasound criteria made it positive
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C38758 (NCI Thesaurus Property)
C1514241 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C17230 (NCI Thesaurus ObjectClass)
C0041618 (UMLS 2011AA ObjectClass)
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)
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)
SentinelNodeBiopsyDate
Item
Sentinel Node Biopsy Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C15189 (NCI Thesaurus Property)
C0005558 (UMLS 2011AA Property)
C12947 (NCI Thesaurus ObjectClass)
C1522495 (UMLS 2011AA ObjectClass)
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)
LymphNodeDissectionDate
Item
Date of dissection
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C15227 (NCI Thesaurus Property)
C0012737 (UMLS 2011AA Property)
Item Group
Footer Module
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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)
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