ID

2716

Description

Histopathologic Evaluation (HE) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122BFC7-B32C-4DBD-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122BFC7-B32C-4DBD-E034-0003BA12F5E7

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

September 19, 2012

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License

Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Registration - Histopathologic Evaluation (HE) - 2073503v3.0

English

No Instruction available.

1 forms  
  1. StudyEvent: Histopathologic Evaluation (HE)
    1. No Instruction available.
Histopathologic Stage:
Description

Histopathologic Stage:

Tumor:
Description

TStage,Pathologic

Data type

text

Nodes
Description

NStage,Pathologic

Data type

text

Alias
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
Metastisis
Description

MStage,Pathologic

Data type

text

Alias
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
Completed by:
Description

CompletedBy

Data type

text

Date: (Year Month Day)
Description

FormCompletionDate,Original

Data type

date

Ccrr Module For Histopathologic Evaluation (he)
Description

Ccrr Module For Histopathologic Evaluation (he)

Patient ID (Pt. ID issued during registration or previously issued patient ID)
Description

Pt.ID

Data type

text

Institution ID:
Description

InstitutionNo.

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient Initials: (F ML)
Description

PatientInitialsName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Institution:
Description

InstitutionName

Data type

text

Date of Histopathologic Evaluation (Year Month Day)
Description

AssessmentDate

Data type

date

Source of Specimen (Mark all that apply)
Description

AssessmentType,Diagnostic

Data type

text

If residual tumor present, indicate tumor thickness: (mm)
Description

Ifresidualtumorpresent,indicatetumorthickness:

Data type

text

Total # of tumor-positive sentinel nodes (SNs) identified by pathologist (total for all basins):
Description

SentinelNode(s)PositiveNumber

Data type

double

Basin location(s) of tumor-positive Sentinel Nodes:
Description

DiseaseSite,LymphNodes

Data type

text

Total # of tumor-positive lymph nodes (LNs) identified by pathologist (total for all basins):
Description

LymphNode(s)PositiveNumber

Data type

double

Alias
NCI Thesaurus Property
C25246
UMLS 2011AA Property
C1446409
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
Final margin after re-excision:
Description

SurgicalMarginStatus

Data type

text

Final margin after re-excision:
Description

SurgicalMarginStatus

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: Histopathologic Evaluation (HE)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Histopathologic Stage:
Item
Tumor:
text
CL.1
Code List
Tumor:
CL Item
Tumor Invades Subepithelial Connective Tissue (T1)
CL Item
T2 (T2)
CL Item
T3 (T3)
CL Item
Inflammatory Carcinoma (T4)
C0334385 (NCI Metathesaurus)
Item
Nodes
text
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.2
Code List
Nodes
CL Item
N0 (N0)
CL Item
Metastasis In A Single Lymph Node, 2 Cm Or Less In Greatest Dimension (N1)
CL Item
Metastasis In A Single Lymph Node, More Than 2 Cm But Not More Than 5 Cm In Greatest Dimension; Or Multiple Lymph Nodes, None More Than 5 Cm In Greatest Dimension (N2)
CL Item
Metastasis In A Lymph Node More Than 5 Cm In Greatest Dimension (N3)
Item
Metastisis
text
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.3
Code List
Metastisis
CL Item
M0, According To Ajcc Staging Definitions (M0)
CL Item
M1, According To Ajcc Staging Definitions (M1)
CompletedBy
Item
Completed by:
text
FormCompletionDate,Original
Item
Date: (Year Month Day)
date
Item Group
Ccrr Module For Histopathologic Evaluation (he)
Pt.ID
Item
Patient ID (Pt. ID issued during registration or previously issued patient ID)
text
InstitutionNo.
Item
Institution ID:
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientInitialsName
Item
Patient Initials: (F ML)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
InstitutionName
Item
Institution:
text
AssessmentDate
Item
Date of Histopathologic Evaluation (Year Month Day)
date
Item
Source of Specimen (Mark all that apply)
text
CL.4
Code List
Source of Specimen (Mark all that apply)
CL Item
Excision/Sentinel Node Biopsy (Excision/Sentinel Node Biopsy)
CL Item
Completion Lymphadenectomy (Completion Lymphadenectomy)
CL Item
Re-excision (Re-excision)
Ifresidualtumorpresent,indicatetumorthickness:
Item
If residual tumor present, indicate tumor thickness: (mm)
text
SentinelNode(s)PositiveNumber
Item
Total # of tumor-positive sentinel nodes (SNs) identified by pathologist (total for all basins):
double
DiseaseSite,LymphNodes
Item
Basin location(s) of tumor-positive Sentinel Nodes:
text
LymphNode(s)PositiveNumber
Item
Total # of tumor-positive lymph nodes (LNs) identified by pathologist (total for all basins):
double
C25246 (NCI Thesaurus Property)
C1446409 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
Item
Final margin after re-excision:
text
CL.6
Code List
Final margin after re-excision:
CL Item
Positive (Positive)
CL Item
Negative (Negative)
Item
Final margin after re-excision:
text
CL.6
Code List
Final margin after re-excision:
CL Item
Positive (Positive)
CL Item
Negative (Negative)
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