ID

11298

Description

E2905 Leukemia Cytogenetics Report Form NCT00843882 Lenalidomide With or Without Epoetin Alfa in Treating Patients With Myelodysplastic Syndrome and Anemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EAAE2F5-F92E-0A7F-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EAAE2F5-F92E-0A7F-E044-0003BA3F9857

Mots-clés

Versions (4)
  1. 18/12/2014 18/12/2014 - Martin Dugas
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 09/01/2015 09/01/2015 - Martin Dugas
  4. 27/06/2015 27/06/2015 -
Téléchargé le

27 juin 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy
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E2905 Leukemia Cytogenetics Report Form NCT00843882

Anglais

INSTITUTION INSTRUCTIONS: Complete patient identifier section. Submit this form with the required specimen(s) and appropriate Material Submission Form to your cytogenetic lab. Keep a copy for your files. LOCAL CYTOGENETICS LAB INSTRUCTIONS...

1 Formulaires  
ECOG clinical trial administrative data
Description

ECOG clinical trial administrative data

Registration Step
Description

Registration Number

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1514821
NCI Thesaurus ObjectClass
C25646
UMLS CUI-2
C0237753
NCI Thesaurus Property
C16154
NCI Thesaurus ValueDomain-2
C16154
Patient's Name (Place ID Label Here)
Description

Patient Name

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1299487
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25364
ECOG Protocol Number
Description

Protocol Number ECOG

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
ECOG Protocol Number
Description

Protocol Number ECOG

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
ECOG Patient ID
Description

Patient ID ECOG

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
ECOG Patient ID
Description

Patient ID ECOG

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
Participating Group Protocol Number
Description

Study Number Participating Group

Type de données

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
Description

Trial subject ID Participating Group

Type de données

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

Type de données

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
Leukemia Cytogenetics Evaluation
Description

Leukemia Cytogenetics Evaluation

Name of Cytogeneticist
Description

CytogeneticsIdentifier

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C16487
UMLS 2011AA ObjectClass
C0010802
Phone Number
Description

PhoneNumber

Type de données

text

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25395
UMLS 2011AA ObjectClass
C0039457
Date specimens collected (MM/DD/YYYY)
Description

SpecimenCollectedDate

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25452
NCI Thesaurus Property-2
C25275
UMLS 2011AA Property
C2745955
Is extra material stored?
Description

SpecimenRemainingStorageInd-3

Type de données

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25649
UMLS 2011AA Property
C1527428
NCI Thesaurus Property-2
C60824
UMLS 2011AA Property-2
C1698986
Extra material type
Description

SpecimenRemainingStorageName

Type de données

text

Alias
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C25649
UMLS 2011AA Property
C1527428
NCI Thesaurus Property-2
C60824
UMLS 2011AA Property-2
C1698986
Unstimulated short-term culture (24 - 72 hours)
Description

BoneMarrowMetaphasePresentNumber

Type de données

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass-2
C16846
UMLS 2011AA ObjectClass-2
C0025564
Direct preparation (metaphases)
Description

BoneMarrowDirectMetaphasePresentNumber

Type de données

float

Alias
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass-2
C16846
UMLS 2011AA ObjectClass-2
C0025564
NCI Metathesaurus ObjectClass
C0439851
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Stimulated Culture (metaphases)
Description

BoneMarrowCultureMetaphasePresentNumber

Type de données

float

Alias
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass-2
C16478
UMLS 2011AA ObjectClass-2
C0010453
NCI Thesaurus ObjectClass-3
C16846
UMLS 2011AA ObjectClass-3
C0025564
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Mitogen type
Description

BoneMarrowCultureMitogenDescriptionText

Type de données

text

Alias
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass-2
C16478
UMLS 2011AA ObjectClass-2
C0010453
NCI Thesaurus ObjectClass-3
C660
UMLS 2011AA ObjectClass-3
C0026249
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Other culture method
Description

CytogeneticsCultureProcedureSpecify

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25300
UMLS 2011AA Property
C0430400
NCI Thesaurus ObjectClass
C16487
UMLS 2011AA ObjectClass
C0010802
Other culture method
Description

CytogeneticsCultureProcedureSpecify

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25300
UMLS 2011AA Property
C0430400
NCI Thesaurus ObjectClass
C16487
UMLS 2011AA ObjectClass
C0010802
Culture method and duration
Description

BoneMarrowCultureMethodText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus ObjectClass-2
C16478
UMLS 2011AA ObjectClass-2
C0010453
Unstimulated short-term culture (24 - 72 hours)
Description

PeripheralBloodMetaphasePresentNumber

Type de données

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Metathesaurus ObjectClass
C0229664
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
Stimulated culture
Description

PeripheralBoodCultureMetaphasePresentNumber

Type de données

float

Alias
NCI Metathesaurus ObjectClass
C0229664
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
NCI Thesaurus ObjectClass-2
C16846
UMLS 2011AA ObjectClass-2
C0025564
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Mitogen type
Description

PeripheralBoodCultureMitogenDescriptionText

Type de données

text

Alias
NCI Metathesaurus ObjectClass
C0229664
NCI Thesaurus ObjectClass
C16478
UMLS 2011AA ObjectClass
C0010453
NCI Thesaurus ObjectClass-2
C660
UMLS 2011AA ObjectClass-2
C0026249
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Culture method and duration
Description

CytogeneticsCultureMethodDuration

Type de données

text

Alias
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C16487
UMLS 2011AA ObjectClass
C0010802
NCI Thesaurus ObjectClass-2
C16478
UMLS 2011AA ObjectClass-2
C0010453
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
Number of karyotype preparations
Description

LaboratoryProcedureKaryotypeOutcomeCount

Type de données

float

Alias
NCI Thesaurus Property
C25215
UMLS 2011AA Property
C1261273
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Are results adequate for banded analysis?
Description

MetaphaseAnalysisInd-3

Type de données

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25391
UMLS 2011AA Property
C0936012
NCI Thesaurus ObjectClass
C16846
UMLS 2011AA ObjectClass
C0025564
Were FISH studies performed?
Description

FISHEvaluationPerformedInd-3

Type de données

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25214
UMLS 2011AA ObjectClass
C0220825
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
FISH probe(s), specify
Description

FISHAssessmentDNAProbeNameText

Type de données

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C451
UMLS 2011AA Property-2
C0012893
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Total number of interphase nuclei
Description

Interphases,TotalNuclei

Type de données

float

Total Number of Abnormal Interphases
Description

Interphases,Abnormal

Type de données

float

Total Number of Metaphases
Description

FISHAssessmentTotalResultMetaphaseNumber

Type de données

float

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Total Number of Metaphases
Description

FISHAssessmentTotalResultMetaphaseNumber

Type de données

float

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Total Number of Abnormal Metaphases
Description

FISHAssessmentAbnormalResultMetaphaseNumber

Type de données

float

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C25401
UMLS 2011AA Property
C0205161
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Total Number of Abnormal Metaphases
Description

FISHAssessmentAbnormalResultMetaphaseNumber

Type de données

float

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus ObjectClass-2
C17563
UMLS 2011AA ObjectClass-2
C0162789
NCI Thesaurus Property
C25401
UMLS 2011AA Property
C0205161
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Footer module
Description

Footer module

Complete ISCN (1995) Karyotype Description
Description

KaryotypeDescription

Type de données

text

Physician of record
Description

Investigator Name

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2826892
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass
C17089
NCI Thesaurus ObjectClass-2
C25644
Date form originally completed
Description

Form Completion Date

Type de données

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C1549507
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25604
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
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Similar models

INSTITUTION INSTRUCTIONS: Complete patient identifier section. Submit this form with the required specimen(s) and appropriate Material Submission Form to your cytogenetic lab. Keep a copy for your files. LOCAL CYTOGENETICS LAB INSTRUCTIONS...

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
ECOG clinical trial administrative data
Registration Number
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Patient Name
Item
Patient's Name (Place ID Label Here)
text
C25191 (NCI Thesaurus ValueDomain)
C1299487 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Protocol Number ECOG
Item
ECOG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Protocol Number ECOG
Item
ECOG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Patient ID ECOG
Item
ECOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Patient ID ECOG
Item
ECOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Study Number Participating Group
Item
Participating Group Protocol Number
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)
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)
Item Group
Leukemia Cytogenetics Evaluation
CytogeneticsIdentifier
Item
Name of Cytogeneticist
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C16487 (NCI Thesaurus ObjectClass)
C0010802 (UMLS 2011AA ObjectClass)
PhoneNumber
Item
Phone Number
text
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ObjectClass)
C0039457 (UMLS 2011AA ObjectClass)
SpecimenCollectedDate
Item
Date specimens collected (MM/DD/YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property)
Item
Is extra material stored?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
C60824 (NCI Thesaurus Property-2)
C1698986 (UMLS 2011AA Property-2)
CL.1
Code List
Is extra material stored?
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
SpecimenRemainingStorageName
Item
Extra material type
text
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25649 (NCI Thesaurus Property)
C1527428 (UMLS 2011AA Property)
C60824 (NCI Thesaurus Property-2)
C1698986 (UMLS 2011AA Property-2)
BoneMarrowMetaphasePresentNumber
Item
Unstimulated short-term culture (24 - 72 hours)
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16846 (NCI Thesaurus ObjectClass-2)
C0025564 (UMLS 2011AA ObjectClass-2)
BoneMarrowDirectMetaphasePresentNumber
Item
Direct preparation (metaphases)
float
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16846 (NCI Thesaurus ObjectClass-2)
C0025564 (UMLS 2011AA ObjectClass-2)
C0439851 (NCI Metathesaurus ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
BoneMarrowCultureMetaphasePresentNumber
Item
Stimulated Culture (metaphases)
float
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass-2)
C0010453 (UMLS 2011AA ObjectClass-2)
C16846 (NCI Thesaurus ObjectClass-3)
C0025564 (UMLS 2011AA ObjectClass-3)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
BoneMarrowCultureMitogenDescriptionText
Item
Mitogen type
text
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass-2)
C0010453 (UMLS 2011AA ObjectClass-2)
C660 (NCI Thesaurus ObjectClass-3)
C0026249 (UMLS 2011AA ObjectClass-3)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
CytogeneticsCultureProcedureSpecify
Item
Other culture method
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25300 (NCI Thesaurus Property)
C0430400 (UMLS 2011AA Property)
C16487 (NCI Thesaurus ObjectClass)
C0010802 (UMLS 2011AA ObjectClass)
CytogeneticsCultureProcedureSpecify
Item
Other culture method
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25300 (NCI Thesaurus Property)
C0430400 (UMLS 2011AA Property)
C16487 (NCI Thesaurus ObjectClass)
C0010802 (UMLS 2011AA ObjectClass)
BoneMarrowCultureMethodText
Item
Culture method and duration
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass-2)
C0010453 (UMLS 2011AA ObjectClass-2)
PeripheralBloodMetaphasePresentNumber
Item
Unstimulated short-term culture (24 - 72 hours)
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C0229664 (NCI Metathesaurus ObjectClass)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
PeripheralBoodCultureMetaphasePresentNumber
Item
Stimulated culture
float
C0229664 (NCI Metathesaurus ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
C16846 (NCI Thesaurus ObjectClass-2)
C0025564 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PeripheralBoodCultureMitogenDescriptionText
Item
Mitogen type
text
C0229664 (NCI Metathesaurus ObjectClass)
C16478 (NCI Thesaurus ObjectClass)
C0010453 (UMLS 2011AA ObjectClass)
C660 (NCI Thesaurus ObjectClass-2)
C0026249 (UMLS 2011AA ObjectClass-2)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
CytogeneticsCultureMethodDuration
Item
Culture method and duration
text
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C16487 (NCI Thesaurus ObjectClass)
C0010802 (UMLS 2011AA ObjectClass)
C16478 (NCI Thesaurus ObjectClass-2)
C0010453 (UMLS 2011AA ObjectClass-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
LaboratoryProcedureKaryotypeOutcomeCount
Item
Number of karyotype preparations
float
C25215 (NCI Thesaurus Property)
C1261273 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
Item
Are results adequate for banded analysis?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25391 (NCI Thesaurus Property)
C0936012 (UMLS 2011AA Property)
C16846 (NCI Thesaurus ObjectClass)
C0025564 (UMLS 2011AA ObjectClass)
CL.2
Code List
Are results adequate for banded analysis?
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Were FISH studies performed?
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
CL.3
Code List
Were FISH studies performed?
CL Item
No (no)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
FISHAssessmentDNAProbeNameText
Item
FISH probe(s), specify
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C451 (NCI Thesaurus Property-2)
C0012893 (UMLS 2011AA Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Interphases,TotalNuclei
Item
Total number of interphase nuclei
float
Interphases,Abnormal
Item
Total Number of Abnormal Interphases
float
FISHAssessmentTotalResultMetaphaseNumber
Item
Total Number of Metaphases
float
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
FISHAssessmentTotalResultMetaphaseNumber
Item
Total Number of Metaphases
float
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
FISHAssessmentAbnormalResultMetaphaseNumber
Item
Total Number of Abnormal Metaphases
float
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25401 (NCI Thesaurus Property)
C0205161 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
FISHAssessmentAbnormalResultMetaphaseNumber
Item
Total Number of Abnormal Metaphases
float
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25401 (NCI Thesaurus Property)
C0205161 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Item Group
Footer module
KaryotypeDescription
Item
Complete ISCN (1995) Karyotype Description
text
Investigator Name
Item
Physician of record
text
C25191 (NCI Thesaurus ValueDomain)
C2826892 (UMLS CUI-1)
C25364 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C25644 (NCI Thesaurus ObjectClass-2)
Form Completion Date
Item
Date form originally completed
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
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