ID

43303

Descripción

E5103 On-Study Form NCT00433511 Doxorubicin, Cyclophosphamide, and Paclitaxel With or Without Bevacizumab in Treating Patients With Lymph Node-Positive or High-Risk, Lymph Node-Negative Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=22AFBF9F-D69B-53CC-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=22AFBF9F-D69B-53CC-E044-0003BA3F9857

Palabras clave

Versiones (4)
  1. 26/8/12 26/8/12 -
  2. 9/1/15 9/1/15 - Martin Dugas
  3. 16/6/15 16/6/15 -
  4. 20/9/21 20/9/21 -
Subido en

20 de septiembre de 2021

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy
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    E5103 On-Study Form NCT00433511

    Inglés

    Instructions: Complete this form and submit original to the ECOG Coordinating Center within one week of registrations. Keep a copy for your files.

    1 formularios  
    ECOG clinical trial administrative data
    Descripción

    ECOG clinical trial administrative data

    ECOG Protocol Number
    Descripción

    Protocol Number ECOG

    Tipo de datos

    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
    Descripción

    Patient ID ECOG

    Tipo de datos

    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
    DCI Name
    Descripción

    Generic drug form

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C3242750
    NCI Thesaurus Property
    C19464
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus ObjectClass-2
    C25452
    Registration Step
    Descripción

    Registration Number

    Tipo de datos

    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
    Reporting Period
    Descripción

    Clinical Trial Period

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2347804
    NCI Thesaurus ObjectClass
    C25214
    NCI Thesaurus Property
    C25616
    NCI Thesaurus ObjectClass-2
    C25651
    Please mark an 'X' if data have been amended (Please circle amended items in red)
    Descripción

    Data amended

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Date data amended (M D Y)
    Descripción

    Data amended date

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property
    C25416
    NCI Thesaurus ValueDomain-2
    C25367
    Patient demographics
    Descripción

    Patient demographics

    Patient Initials (Last,First)
    Descripción

    Patient Initials

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Participating Group Protocol Number
    Descripción

    Study Number Participating Group

    Tipo de datos

    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
    Descripción

    Trial subject ID Participating Group

    Tipo de datos

    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
    Descripción

    Institution Name

    Tipo de datos

    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
    Performance status
    Descripción

    Performance status

    ECOG Performance Status (Day 1 of this cycle)
    Descripción

    ECOG Performance Status

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1520224
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ValueDomain-2
    C25491
    NCI Thesaurus ObjectClass
    C20641
    Menopausal status (Definitions of Menopausal Status: Postmenopausal: Defined as at least one of the following: 1 age >55 with no spontaneous menses for at least 12 months; or 2 age </=55 with no spontaneous menses within the past 12 months e.g., spontaneously or...)
    Descripción

    PatientMenopauseStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C3231
    UMLS 2011AA Property
    C0025320
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Pre-registration Evaluation
    Descripción

    Pre-registration Evaluation

    Height
    Descripción

    Patient Height

    Tipo de datos

    float

    Unidades de medida
    • cm
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0489786
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25347
    cm
    Weight (kg)
    Descripción

    Patient Weight

    Tipo de datos

    float

    Unidades de medida
    • Kg
    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS CUI-1
    C0005910
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25208
    Kg
    Prior tamoxifen therapy
    Descripción

    PriorTamoxifenAdministeredInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C855
    UMLS 2011AA ObjectClass
    C0039286
    NCI Thesaurus ObjectClass-2
    C25629
    UMLS 2011AA ObjectClass-2
    C0332152
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Prior raloxifene therapy? (for chemoprevention)
    Descripción

    HormoneTherapyPriorRaloxifeneReceivedInd-3

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C15445
    UMLS 2011AA ObjectClass
    C0279025
    NCI Thesaurus Property
    C1518
    UMLS 2011AA Property
    C0244404
    NCI Thesaurus Property-2
    C25629
    UMLS 2011AA Property-2
    C0332152
    NCI Thesaurus Property-3
    C25639
    UMLS 2011AA Property-3
    C1514756
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Urine Protein/Creatinine Ratio
    Descripción

    UrinaryCreatinineProteinAssessmentValue

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25711
    UMLS 2011AA ObjectClass
    C1524119
    NCI Thesaurus ObjectClass-2
    C17021
    UMLS 2011AA ObjectClass-2
    C0033684
    NCI Metathesaurus ObjectClass
    C0010294
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Date lab assessment performed
    Descripción

    Laboratory Procedure Date

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0022885
    NCI Thesaurus Property
    C25214
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property-2
    C38000
    NCI Thesaurus ObjectClass
    C25294
    Pre-registration Scans/imaging
    Descripción

    Pre-registration Scans/imaging

    Method of Evaluation
    Descripción

    Evaluation method

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2911685
    NCI Thesaurus ObjectClass
    C20989
    NCI Thesaurus Property
    C16847
    Date of Assessment
    Descripción

    Assessment Date

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985720
    NCI Thesaurus ObjectClass
    C25367
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C38000
    Result
    Descripción

    AssessmentImageReportingType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus ValueDomain-2
    C25651
    UMLS 2011AA ValueDomain-2
    C0700287
    NCI Thesaurus Property
    C19477
    UMLS 2011AA Property
    C1704254
    Disease Description
    Descripción

    Disease Description

    Tumor Laterality (NOTE: Submit copies of pathology reports for all diagnostic and therapeutic surgical procedures with E5103 Source Document Tracking Coversheet)
    Descripción

    PrimaryTumorLateralityType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25251
    UMLS 2011AA ObjectClass-2
    C0205225
    NCI Thesaurus Property
    C25185
    UMLS 2011AA Property
    C0332304
    Breast: Surgical Procedures
    Descripción

    Breast: Surgical Procedures

    Most Extensive Primary Surgery
    Descripción

    BreastPrimarySurgicalProcedurePerformedType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C25251
    UMLS 2011AA ObjectClass
    C0205225
    NCI Thesaurus ObjectClass-2
    C12971
    UMLS 2011AA ObjectClass-2
    C0006141
    NCI Thesaurus ObjectClass-3
    C15329
    UMLS 2011AA ObjectClass-3
    C0543467
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    Date of Most Extensive Primary Surgery (m/d/y)
    Descripción

    PrimarySurgeryDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C25251
    UMLS 2011AA ObjectClass
    C0205225
    NCI Thesaurus ObjectClass-2
    C15329
    UMLS 2011AA ObjectClass-2
    C0543467
    NCI Thesaurus Property
    C25275
    UMLS 2011AA Property
    C2745955
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    Was sentinel node sampling performed
    Descripción

    SentinelNodeBiopsyInd-3

    Tipo de datos

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C15189
    UMLS 2011AA Property
    C0005558
    NCI Thesaurus ObjectClass
    C12947
    UMLS 2011AA ObjectClass
    C1522495
    Sentinel Node Biopsy Date (If yes: - m/d/y)
    Descripción

    SentinelNodeBiopsyDate

    Tipo de datos

    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
    Number of Sentinel Nodes Examined
    Descripción

    SentinelNodeExaminedCount

    Tipo de datos

    float

    Alias
    NCI Thesaurus Property
    C25500
    UMLS 2011AA Property
    C0332128
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus ObjectClass
    C12947
    UMLS 2011AA ObjectClass
    C1522495
    Number of Positive Sentinel Nodes by H&E (enter '0' if no positive nodes)
    Descripción

    SentinelNodePositiveHematoxylinandEosinStainingAssessmentCount

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C12947
    UMLS 2011AA ObjectClass
    C1522495
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0205159
    NCI Thesaurus Property-2
    C23011
    UMLS 2011AA Property-2
    C0523207
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    Number of Positive Sentinel Nodes by Immunohistochemistry (IHC) only (enter '0' if no positive nodes)
    Descripción

    SentinelNodePositiveImmunohistochemistryAssessmentCount

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C12947
    UMLS 2011AA ObjectClass
    C1522495
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Metathesaurus Property
    C0205159
    NCI Thesaurus Property-2
    C16722
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    Mark an 'X' if not done
    Descripción

    DataUnknownText

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C17998
    UMLS 2011AA Property
    C0439673
    Was axillary dissection performed?
    Descripción

    AxillaryNodeDissectionInd-3

    Tipo de datos

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C15227
    UMLS 2011AA Property
    C0012737
    NCI Thesaurus ObjectClass
    C12904
    UMLS 2011AA ObjectClass
    C0729594
    Date of Axillary Dissection (If yes: - m/d/y)
    Descripción

    AxillarySurgeryDissectionDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C13351
    UMLS 2011AA ObjectClass
    C0004454
    NCI Thesaurus ObjectClass-2
    C15329
    UMLS 2011AA ObjectClass-2
    C0543467
    NCI Thesaurus Property
    C15227
    UMLS 2011AA Property
    C0012737
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    Total number of axillary lymph nodes examined
    Descripción

    AxillaryNodeExaminedTotalCount

    Tipo de datos

    float

    Alias
    NCI Thesaurus ValueDomain
    C25304
    UMLS 2011AA ValueDomain
    C0439810
    NCI Thesaurus Property
    C25500
    UMLS 2011AA Property
    C0332128
    NCI Thesaurus ValueDomain-2
    C25463
    UMLS 2011AA ValueDomain-2
    C0750480
    NCI Thesaurus ObjectClass
    C12904
    UMLS 2011AA ObjectClass
    C0729594
    Number of positive axillary nodes by H&E (enter '0' if no positive nodes)
    Descripción

    PositiveAxillaryNodeHematoxylinAndEosinStainingAssessmentCount

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25246
    UMLS 2011AA ObjectClass
    C1446409
    NCI Thesaurus ObjectClass-2
    C12904
    UMLS 2011AA ObjectClass-2
    C0729594
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C23011
    UMLS 2011AA Property-2
    C0523207
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    Number of positive axillary nodes by IHC only (enter '0' if no positive nodes)
    Descripción

    PositiveAxillaryNodeImmunohistochemistryAssessmentCount

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C25246
    UMLS 2011AA ObjectClass
    C1446409
    NCI Thesaurus ObjectClass-2
    C12904
    UMLS 2011AA ObjectClass-2
    C0729594
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C16722
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    Breast: Disease Description
    Descripción

    Breast: Disease Description

    Date of Initial Diagnosis of Primary Tumor (Date of first positive biopsy)
    Descripción

    FirstBiopsyPositiveDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C15189
    UMLS 2011AA ObjectClass
    C0005558
    NCI Thesaurus ObjectClass-2
    C25509
    UMLS 2011AA ObjectClass-2
    C1279901
    NCI Thesaurus Property
    C25246
    UMLS 2011AA Property
    C1446409
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property-2
    C2745955
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    Pathologic Primary Tumor Size (cm Maximum diameter of the invasive component; if multiple lesions, use longest lesion)
    Descripción

    PathologicTumorPrimarySizeMeasurement

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25610
    UMLS 2011AA ObjectClass-2
    C1521733
    NCI Thesaurus Property
    C25251
    UMLS 2011AA Property
    C0205225
    NCI Thesaurus Property-2
    C25681
    UMLS 2011AA Property-2
    C0456389
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    Histologic Grade (For breast cancer, a combined histologic grade is used according to SBR/Elston classification)
    Descripción

    BreastTumorHistologicGrade

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C12971
    UMLS 2011AA ObjectClass-2
    C0006141
    NCI Thesaurus Property
    C25526
    UMLS 2011AA Property
    C0205462
    NCI Thesaurus Property-2
    C25365
    UMLS 2011AA Property-2
    C0678257
    NCI Thesaurus ValueDomain
    C25526
    UMLS 2011AA ValueDomain
    C0205462
    NCI Thesaurus ValueDomain-2
    C18000
    UMLS 2011AA ValueDomain-2
    C0919553
    Nuclear Grade
    Descripción

    BreastNeoplasmNuclearGradeCategory

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C12971
    UMLS 2011AA ObjectClass-2
    C0006141
    NCI Thesaurus Property
    C13361
    UMLS 2011AA Property
    C0521447
    NCI Thesaurus Property-2
    C48309
    UMLS 2011AA Property-2
    C0441800
    NCI Thesaurus ValueDomain
    C25372
    UMLS 2011AA ValueDomain
    C0683312
    Receptor Status, ER (as defined by local laboratory; borderline results should be reported as positive)
    Descripción

    ERLevelTumorStatus

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C3262
    UMLS 2011AA ValueDomain
    C0027651
    NCI Thesaurus ObjectClass
    C17069
    UMLS 2011AA ObjectClass
    C0034804
    NCI Thesaurus ValueDomain-2
    C25688
    UMLS 2011AA ValueDomain-2
    C0449438
    NCI Thesaurus Property
    C25554
    UMLS 2011AA Property
    C0441889
    Receptor Status, PgR
    Descripción

    PgRStatusType

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C17075
    UMLS 2011AA ObjectClass
    C0034833
    NCI Metathesaurus Property
    C0678257
    Oncotype DX Recurrence Score (If ER+:)
    Descripción

    LaboratoryProcedureOncotypeDXBreastCancerAssayResultScore

    Tipo de datos

    float

    Alias
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property-2
    C52159
    UMLS 2011AA Property-2
    C1709318
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Her2/neu expression status by immunohistochemistry (DAKO HercepTest)
    Descripción

    BreastCytogeneticsHER2/neuPolyclonalAntibodyTestScore

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C12971
    UMLS 2011AA ObjectClass
    C0006141
    NCI Thesaurus ObjectClass-2
    C16487
    UMLS 2011AA ObjectClass-2
    C0010802
    NCI Thesaurus Property
    C25294
    UMLS 2011AA Property
    C0022885
    NCI Thesaurus Property-2
    C17756
    UMLS 2011AA Property-2
    C0242957
    NCI Thesaurus Property-3
    C61381
    UMLS 2011AA Property-3
    C0312586
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    FISH HER2/neu chromosome 17 Ratio
    Descripción

    FISHAssessmentChromosome17ResultHER2NeuNumber

    Tipo de datos

    float

    Alias
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus ObjectClass-2
    C17563
    UMLS 2011AA ObjectClass-2
    C0162789
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C13212
    UMLS 2011AA Property-2
    C0008659
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ValueDomain-2
    C17756
    UMLS 2011AA ValueDomain-2
    C0242957
    Mark an 'X' if not done
    Descripción

    Laboratory Procedure Not Performed

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0022885
    NCI Thesaurus Property
    C25594
    UMLS CUI-2
    C0445106
    NCI Thesaurus Property-2
    C38000
    NCI Thesaurus ObjectClass
    C25294
    Breast: Surgical Procedures
    Descripción

    Breast: Surgical Procedures

    Breast: Disease Description
    Descripción

    Breast: Disease Description

    Footer Module
    Descripción

    Footer Module

    Investigator Signature
    Descripción

    Investigator Signature

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    NCI Thesaurus ObjectClass
    C17089
    Investigator Signature Date
    Descripción

    Investigator Signature Date

    Tipo de datos

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    UMLS CUI-2
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C17089
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    Similar models

    Instructions: Complete this form and submit original to the ECOG Coordinating Center within one week of registrations. Keep a copy for your files.

    1 formularios
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    ECOG clinical trial administrative data
    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)
    Generic drug form
    Item
    DCI Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C3242750 (UMLS CUI-1)
    C19464 (NCI Thesaurus Property)
    C25474 (NCI Thesaurus ObjectClass)
    C25452 (NCI Thesaurus ObjectClass-2)
    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)
    Item
    Reporting Period
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2347804 (UMLS CUI-1)
    C25214 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C25651 (NCI Thesaurus ObjectClass-2)
    CL.1
    Code List
    Reporting Period
    CL Item
    Baseline Step 1 (Baseline step 1)
    Data amended
    Item
    Please mark an 'X' if data have been amended (Please circle amended items in red)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Data amended date
    Item
    Date data amended (M D Y)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C0011008 (UMLS CUI-2)
    C25416 (NCI Thesaurus Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Patient demographics
    Patient Initials
    Item
    Patient Initials (Last,First)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    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
    Performance status
    Item
    ECOG Performance Status (Day 1 of this cycle)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1520224 (UMLS CUI-1)
    C25367 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus ValueDomain-2)
    C20641 (NCI Thesaurus ObjectClass)
    CL.2
    Code List
    ECOG Performance Status (Day 1 of this cycle)
    CL Item
    Fully Active, Able To Carry On All Pre-disease Performance Without Restriction. (0)
    CL Item
    Restricted In Physically Strenuous Activity But Ambulatory And Able To Carry Out Work Of A Light Or Sedentary Nature, E.g., Light Housework, Office Work. (1)
    CL Item
    Ambulatory And Capable Of All Selfcare But Unable To Carry Out Any Work Activities. Up And About More Than 50% Of Waking Hours. (2)
    CL Item
    Capable Of Only Limited Selfcare, Confined To Bed Or Chair More Than 50% Of Waking Hours. (3)
    CL Item
    Completely Disabled. Cannot Carry On Any Selfcare. Totally Confined To Bed Or Chair. (4)
    Item
    Menopausal status (Definitions of Menopausal Status: Postmenopausal: Defined as at least one of the following: 1 age >55 with no spontaneous menses for at least 12 months; or 2 age </=55 with no spontaneous menses within the past 12 months e.g., spontaneously or...)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C3231 (NCI Thesaurus Property)
    C0025320 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.3
    Code List
    Menopausal status (Definitions of Menopausal Status: Postmenopausal: Defined as at least one of the following: 1 age >55 with no spontaneous menses for at least 12 months; or 2 age </=55 with no spontaneous menses within the past 12 months e.g., spontaneously or...)
    CL Item
    Postmenopausal (Postmenopausal)
    C15421 (NCI Thesaurus)
    C0232970 (UMLS 2011AA)
    C15421 (NCI Thesaurus-3)
    C0232970 (UMLS 2011AA-4)
    C15421 (NCI Thesaurus-5)
    C0232970 (UMLS 2011AA-6)
    CL Item
    Premenopausal (Premenopausal)
    C15491 (NCI Thesaurus)
    C0279752 (UMLS 2011AA)
    CL Item
    Perimenopausal (Perimenopausal)
    C15692 (NCI Thesaurus)
    C3839366 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item Group
    Pre-registration Evaluation
    Patient Height
    Item
    Height
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0489786 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25347 (NCI Thesaurus Property)
    Patient Weight
    Item
    Weight (kg)
    float
    C25209 (NCI Thesaurus ValueDomain)
    C0005910 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25208 (NCI Thesaurus Property)
    Item
    Prior tamoxifen therapy
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C855 (NCI Thesaurus ObjectClass)
    C0039286 (UMLS 2011AA ObjectClass)
    C25629 (NCI Thesaurus ObjectClass-2)
    C0332152 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    CL.4
    Code List
    Prior tamoxifen therapy
    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
    Prior raloxifene therapy? (for chemoprevention)
    text
    C15445 (NCI Thesaurus ObjectClass)
    C0279025 (UMLS 2011AA ObjectClass)
    C1518 (NCI Thesaurus Property)
    C0244404 (UMLS 2011AA Property)
    C25629 (NCI Thesaurus Property-2)
    C0332152 (UMLS 2011AA Property-2)
    C25639 (NCI Thesaurus Property-3)
    C1514756 (UMLS 2011AA Property-3)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    CL.5
    Code List
    Prior raloxifene therapy? (for chemoprevention)
    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)
    UrinaryCreatinineProteinAssessmentValue
    Item
    Urine Protein/Creatinine Ratio
    float
    C25711 (NCI Thesaurus ObjectClass)
    C1524119 (UMLS 2011AA ObjectClass)
    C17021 (NCI Thesaurus ObjectClass-2)
    C0033684 (UMLS 2011AA ObjectClass-2)
    C0010294 (NCI Metathesaurus ObjectClass)
    C25367 (NCI Thesaurus Property)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    Laboratory Procedure Date
    Item
    Date lab assessment performed
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0022885 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C38000 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    Item Group
    Pre-registration Scans/imaging
    Item
    Method of Evaluation
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2911685 (UMLS CUI-1)
    C20989 (NCI Thesaurus ObjectClass)
    C16847 (NCI Thesaurus Property)
    CL.6
    Code List
    Method of Evaluation
    CL Item
    Bone Scan (Bone scan)
    C17646 (NCI Thesaurus)
    C0203668 (UMLS 2011AA)
    CL Item
    Chest Radiography (Chest CT)
    C38103 (NCI Thesaurus)
    C0039985 (UMLS 2011AA)
    CL Item
    Chest X-ray (Chest x-ray)
    Assessment Date
    Item
    Date of Assessment
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985720 (UMLS CUI-1)
    C25367 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus ValueDomain-2)
    C38000 (NCI Thesaurus Property)
    Item
    Result
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C25651 (NCI Thesaurus ValueDomain-2)
    C0700287 (UMLS 2011AA ValueDomain-2)
    C19477 (NCI Thesaurus Property)
    C1704254 (UMLS 2011AA Property)
    CL.7
    Code List
    Result
    CL Item
    Positive (Positive)
    C25246 (NCI Thesaurus)
    C1446409 (UMLS 2011AA)
    CL Item
    Negative (negative)
    C25247 (NCI Thesaurus)
    C0205160 (UMLS 2011AA)
    CL Item
    Not Done (not done)
    CL281691 (NCI Metathesaurus)
    Item Group
    Disease Description
    Item
    Tumor Laterality (NOTE: Submit copies of pathology reports for all diagnostic and therapeutic surgical procedures with E5103 Source Document Tracking Coversheet)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25251 (NCI Thesaurus ObjectClass-2)
    C0205225 (UMLS 2011AA ObjectClass-2)
    C25185 (NCI Thesaurus Property)
    C0332304 (UMLS 2011AA Property)
    CL.8
    Code List
    Tumor Laterality (NOTE: Submit copies of pathology reports for all diagnostic and therapeutic surgical procedures with E5103 Source Document Tracking Coversheet)
    CL Item
    Bilateral (Bilateral)
    C13332 (NCI Thesaurus)
    C0238767 (UMLS 2011AA)
    CL Item
    Left (Left)
    C25229 (NCI Thesaurus)
    C0205091 (UMLS 2011AA)
    CL Item
    Right (Right)
    C25228 (NCI Thesaurus)
    C0205090 (UMLS 2011AA)
    Item Group
    Breast: Surgical Procedures
    Item
    Most Extensive Primary Surgery
    text
    C25251 (NCI Thesaurus ObjectClass)
    C0205225 (UMLS 2011AA ObjectClass)
    C12971 (NCI Thesaurus ObjectClass-2)
    C0006141 (UMLS 2011AA ObjectClass-2)
    C15329 (NCI Thesaurus ObjectClass-3)
    C0543467 (UMLS 2011AA ObjectClass-3)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    CL.17
    Code List
    Most Extensive Primary Surgery
    CL Item
    Partial Mastectomy, Lumpectomy Or Excisional Biopsy (Partial mastectomy/lumpectomy/excisional biopsy)
    CL Item
    Mastectomy, Nos (Mastectomy NOS)
    PrimarySurgeryDate
    Item
    Date of Most Extensive Primary Surgery (m/d/y)
    date
    C25251 (NCI Thesaurus ObjectClass)
    C0205225 (UMLS 2011AA ObjectClass)
    C15329 (NCI Thesaurus ObjectClass-2)
    C0543467 (UMLS 2011AA ObjectClass-2)
    C25275 (NCI Thesaurus Property)
    C2745955 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    SentinelNodeBiopsyInd-3
    Item
    Was sentinel node sampling performed
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15189 (NCI Thesaurus Property)
    C0005558 (UMLS 2011AA Property)
    C12947 (NCI Thesaurus ObjectClass)
    C1522495 (UMLS 2011AA ObjectClass)
    SentinelNodeBiopsyDate
    Item
    Sentinel Node Biopsy Date (If yes: - m/d/y)
    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)
    SentinelNodeExaminedCount
    Item
    Number of Sentinel Nodes Examined
    float
    C25500 (NCI Thesaurus Property)
    C0332128 (UMLS 2011AA Property)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C12947 (NCI Thesaurus ObjectClass)
    C1522495 (UMLS 2011AA ObjectClass)
    SentinelNodePositiveHematoxylinandEosinStainingAssessmentCount
    Item
    Number of Positive Sentinel Nodes by H&E (enter '0' if no positive nodes)
    float
    C12947 (NCI Thesaurus ObjectClass)
    C1522495 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0205159 (NCI Metathesaurus Property)
    C23011 (NCI Thesaurus Property-2)
    C0523207 (UMLS 2011AA Property-2)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    SentinelNodePositiveImmunohistochemistryAssessmentCount
    Item
    Number of Positive Sentinel Nodes by Immunohistochemistry (IHC) only (enter '0' if no positive nodes)
    float
    C12947 (NCI Thesaurus ObjectClass)
    C1522495 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C0205159 (NCI Metathesaurus Property)
    C16722 (NCI Thesaurus Property-2)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    DataUnknownText
    Item
    Mark an 'X' if not done
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C17998 (NCI Thesaurus Property)
    C0439673 (UMLS 2011AA Property)
    AxillaryNodeDissectionInd-3
    Item
    Was axillary dissection performed?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15227 (NCI Thesaurus Property)
    C0012737 (UMLS 2011AA Property)
    C12904 (NCI Thesaurus ObjectClass)
    C0729594 (UMLS 2011AA ObjectClass)
    AxillarySurgeryDissectionDate
    Item
    Date of Axillary Dissection (If yes: - m/d/y)
    date
    C13351 (NCI Thesaurus ObjectClass)
    C0004454 (UMLS 2011AA ObjectClass)
    C15329 (NCI Thesaurus ObjectClass-2)
    C0543467 (UMLS 2011AA ObjectClass-2)
    C15227 (NCI Thesaurus Property)
    C0012737 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    AxillaryNodeExaminedTotalCount
    Item
    Total number of axillary lymph nodes examined
    float
    C25304 (NCI Thesaurus ValueDomain)
    C0439810 (UMLS 2011AA ValueDomain)
    C25500 (NCI Thesaurus Property)
    C0332128 (UMLS 2011AA Property)
    C25463 (NCI Thesaurus ValueDomain-2)
    C0750480 (UMLS 2011AA ValueDomain-2)
    C12904 (NCI Thesaurus ObjectClass)
    C0729594 (UMLS 2011AA ObjectClass)
    PositiveAxillaryNodeHematoxylinAndEosinStainingAssessmentCount
    Item
    Number of positive axillary nodes by H&E (enter '0' if no positive nodes)
    float
    C25246 (NCI Thesaurus ObjectClass)
    C1446409 (UMLS 2011AA ObjectClass)
    C12904 (NCI Thesaurus ObjectClass-2)
    C0729594 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C23011 (NCI Thesaurus Property-2)
    C0523207 (UMLS 2011AA Property-2)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    PositiveAxillaryNodeImmunohistochemistryAssessmentCount
    Item
    Number of positive axillary nodes by IHC only (enter '0' if no positive nodes)
    float
    C25246 (NCI Thesaurus ObjectClass)
    C1446409 (UMLS 2011AA ObjectClass)
    C12904 (NCI Thesaurus ObjectClass-2)
    C0729594 (UMLS 2011AA ObjectClass-2)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C16722 (NCI Thesaurus Property-2)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    Item Group
    Breast: Disease Description
    FirstBiopsyPositiveDate
    Item
    Date of Initial Diagnosis of Primary Tumor (Date of first positive biopsy)
    date
    C15189 (NCI Thesaurus ObjectClass)
    C0005558 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus ObjectClass-2)
    C1279901 (UMLS 2011AA ObjectClass-2)
    C25246 (NCI Thesaurus Property)
    C1446409 (UMLS 2011AA Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    PathologicTumorPrimarySizeMeasurement
    Item
    Pathologic Primary Tumor Size (cm Maximum diameter of the invasive component; if multiple lesions, use longest lesion)
    float
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25610 (NCI Thesaurus ObjectClass-2)
    C1521733 (UMLS 2011AA ObjectClass-2)
    C25251 (NCI Thesaurus Property)
    C0205225 (UMLS 2011AA Property)
    C25681 (NCI Thesaurus Property-2)
    C0456389 (UMLS 2011AA Property-2)
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    Item
    Histologic Grade (For breast cancer, a combined histologic grade is used according to SBR/Elston classification)
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12971 (NCI Thesaurus ObjectClass-2)
    C0006141 (UMLS 2011AA ObjectClass-2)
    C25526 (NCI Thesaurus Property)
    C0205462 (UMLS 2011AA Property)
    C25365 (NCI Thesaurus Property-2)
    C0678257 (UMLS 2011AA Property-2)
    C25526 (NCI Thesaurus ValueDomain)
    C0205462 (UMLS 2011AA ValueDomain)
    C18000 (NCI Thesaurus ValueDomain-2)
    C0919553 (UMLS 2011AA ValueDomain-2)
    CL.20
    Code List
    Histologic Grade (For breast cancer, a combined histologic grade is used according to SBR/Elston classification)
    CL Item
    Well Differentiated (Grade I (low))
    CL Item
    Moderately Differentiated (Grade II (intermediate))
    CL Item
    Poorly Differentiated (Grade III (high))
    CL Item
    Unknown (UNKNOWN)
    Item
    Nuclear Grade
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12971 (NCI Thesaurus ObjectClass-2)
    C0006141 (UMLS 2011AA ObjectClass-2)
    C13361 (NCI Thesaurus Property)
    C0521447 (UMLS 2011AA Property)
    C48309 (NCI Thesaurus Property-2)
    C0441800 (UMLS 2011AA Property-2)
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    CL.21
    Code List
    Nuclear Grade
    CL Item
    Low (Low)
    CL124342 (NCI Metathesaurus)
    CL Item
    Intermediate (Intermediate)
    C0205103 (NCI Metathesaurus)
    CL Item
    High (High)
    C25227 (NCI Thesaurus)
    C0205250 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item
    Receptor Status, ER (as defined by local laboratory; borderline results should be reported as positive)
    text
    C3262 (NCI Thesaurus ValueDomain)
    C0027651 (UMLS 2011AA ValueDomain)
    C17069 (NCI Thesaurus ObjectClass)
    C0034804 (UMLS 2011AA ObjectClass)
    C25688 (NCI Thesaurus ValueDomain-2)
    C0449438 (UMLS 2011AA ValueDomain-2)
    C25554 (NCI Thesaurus Property)
    C0441889 (UMLS 2011AA Property)
    CL.22
    Code List
    Receptor Status, ER (as defined by local laboratory; borderline results should be reported as positive)
    CL Item
    Negative (Negative)
    C25247 (NCI Thesaurus)
    C0205160 (UMLS 2011AA)
    CL Item
    Positive (Positive)
    C25246 (NCI Thesaurus)
    C1446409 (UMLS 2011AA)
    CL Item
    Not Done (NOT DONE)
    CL281691 (NCI Metathesaurus)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item
    Receptor Status, PgR
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C17075 (NCI Thesaurus ObjectClass)
    C0034833 (UMLS 2011AA ObjectClass)
    C0678257 (NCI Metathesaurus Property)
    CL.23
    Code List
    Receptor Status, PgR
    CL Item
    Negative (Negative)
    C25247 (NCI Thesaurus)
    C0205160 (UMLS 2011AA)
    CL Item
    Positive (Positive)
    C25246 (NCI Thesaurus)
    C1446409 (UMLS 2011AA)
    CL Item
    Not Done (NOT DONE)
    CL281691 (NCI Metathesaurus)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    LaboratoryProcedureOncotypeDXBreastCancerAssayResultScore
    Item
    Oncotype DX Recurrence Score (If ER+:)
    float
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C52159 (NCI Thesaurus Property-2)
    C1709318 (UMLS 2011AA Property-2)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Item
    Her2/neu expression status by immunohistochemistry (DAKO HercepTest)
    text
    C12971 (NCI Thesaurus ObjectClass)
    C0006141 (UMLS 2011AA ObjectClass)
    C16487 (NCI Thesaurus ObjectClass-2)
    C0010802 (UMLS 2011AA ObjectClass-2)
    C25294 (NCI Thesaurus Property)
    C0022885 (UMLS 2011AA Property)
    C17756 (NCI Thesaurus Property-2)
    C0242957 (UMLS 2011AA Property-2)
    C61381 (NCI Thesaurus Property-3)
    C0312586 (UMLS 2011AA Property-3)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    CL.24
    Code List
    Her2/neu expression status by immunohistochemistry (DAKO HercepTest)
    CL Item
    0 (0)
    C0919414 (NCI Metathesaurus)
    CL Item
    1+ (1+)
    CL Item
    2+ (2+)
    CL Item
    3+ (3+)
    CL Item
    Not Done: C49484 (not done)
    C49484 (NCI Thesaurus)
    C1272696 (UMLS 2011AA)
    FISHAssessmentChromosome17ResultHER2NeuNumber
    Item
    FISH HER2/neu chromosome 17 Ratio
    float
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C17563 (NCI Thesaurus ObjectClass-2)
    C0162789 (UMLS 2011AA ObjectClass-2)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C13212 (NCI Thesaurus Property-2)
    C0008659 (UMLS 2011AA Property-2)
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C17756 (NCI Thesaurus ValueDomain-2)
    C0242957 (UMLS 2011AA ValueDomain-2)
    Laboratory Procedure Not Performed
    Item
    Mark an 'X' if not done
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0022885 (UMLS CUI-1)
    C25594 (NCI Thesaurus Property)
    C0445106 (UMLS CUI-2)
    C38000 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    Item Group
    Footer Module
    Investigator Signature
    Item
    Investigator Signature
    text
    C25704 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    Investigator Signature Date
    Item
    Investigator Signature Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C25367 (NCI Thesaurus ValueDomain-2)
    C17089 (NCI Thesaurus ObjectClass)
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