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NSABP PROTOCOL B-35 PATHOLOGIST'S REPORT FORM Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01C3BB9-FE93-4CD3-E034-080020C9C0E0

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01C3BB9-FE93-4CD3-E034-080020C9C0E0

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versioni (2)
  1. 26/08/12 26/08/12 -
  2. 22/03/15 22/03/15 - Martin Dugas
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26 agosto 2012

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Creative Commons BY-NC 3.0 Legacy
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    Breast Cancer NCT00053898 Pathology - NSABP PROTOCOL B-35 PATHOLOGIST'S REPORT FORM - 2033891v3.0

    Inglese

    Form PRF (04-30-2002) This form is to be completed by the pathologist and submitted to the NSABP Biostatistical Center within 3 months of randomization. Please mail Form PRF separately from the slides and blocks.

    1 moduli  
    Unnamed1
    Descrizione

    Unnamed1

    First Three Letters of Patient's Last Name
    Descrizione

    FirstThreeLettersofPatient'sLastName

    Tipo di dati

    text

    Patient Study ID
    Descrizione

    PatientStudyID

    Tipo di dati

    text

    Institution Name
    Descrizione

    InstitutionName

    Tipo di dati

    text

    Affiliate Name
    Descrizione

    AffiliateName

    Tipo di dati

    text

    Are data amended? (If Yes, circle the amended items in red.)
    Descrizione

    AmendedDataInd

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C25416
    UMLS 2011AA Property
    C1691222
    Unnamed2
    Descrizione

    Unnamed2

    Accession Number (enter all that apply 123)
    Descrizione

    AccessionNumber

    Tipo di dati

    double

    Unnamed3
    Descrizione

    Unnamed3

    Pathologic Primary Tumor Size (cm leave blank if not directly measurable)
    Descrizione

    PathologicPrimaryTumorSize

    Tipo di dati

    double

    Alias
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    Is measurement gross or microscopic? (mark one)
    Descrizione

    DuctalBreastCarcinomainSituMicroscopicGrossSizeDocumentedStatus

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C2924
    UMLS 2011AA ObjectClass
    C0007124
    NCI Thesaurus Property
    C25252
    UMLS 2011AA Property
    C0205288
    NCI Thesaurus Property
    C43566
    UMLS 2011AA Property
    C0439806
    NCI Thesaurus Property
    C25681
    UMLS 2011AA Property
    C0456389
    NCI Thesaurus Property
    C25356
    UMLS 2011AA Property
    C1301725
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Estimated Size (cm best guess, if possible)
    Descrizione

    EstimatedSize

    Tipo di dati

    text

    Number of slides with DCIS present
    Descrizione

    NumberofslideswithDCISpresent

    Tipo di dati

    text

    Total slides examined for DCIS
    Descrizione

    TotalslidesexaminedforDCIS

    Tipo di dati

    text

    Unnamed4
    Descrizione

    Unnamed4

    Type DCIS (mark one)
    Descrizione

    TypeDCIS

    Tipo di dati

    text

    Growth Patterns (mark all that apply)
    Descrizione

    HistologicType

    Tipo di dati

    text

    Other, specify
    Descrizione

    HistologicType,OtherName

    Tipo di dati

    text

    Dominant Growth Pattern (mark only one)
    Descrizione

    HistologicType,Dominant

    Tipo di dati

    text

    Other, specify
    Descrizione

    HistologicType,Dominant,Other

    Tipo di dati

    text

    Percent Central Necrosis (% estimated necrotic surface area of DCIS associated with any growth pattern)
    Descrizione

    PercentCentralNecrosis

    Tipo di dati

    text

    Unnamed5
    Descrizione

    Unnamed5

    Nuclear Grade (by SBR criteria; mark highest grade)
    Descrizione

    NuclearGrade

    Tipo di dati

    text

    Unnamed6
    Descrizione

    Unnamed6

    Microcalcifications (mark one)
    Descrizione

    Microcalcifications

    Tipo di dati

    text

    Unnamed7
    Descrizione

    Unnamed7

    Margins of DCIS Resection (after re-excision, if done mark one)
    Descrizione

    DCIS,MarginResult

    Tipo di dati

    text

    Nearest Margin (mm if margins are negative)
    Descrizione

    SurgicalMarginDistance

    Tipo di dati

    double

    Unnamed8
    Descrizione

    Unnamed8

    Pathologist Completing Form (print name signature)
    Descrizione

    PathologistCompletingForm

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus Property
    C40988
    UMLS 2011AA Property
    C1516308
    NCI Thesaurus Property
    C25250
    UMLS 2011AA Property
    C0205197
    NCI Thesaurus ObjectClass
    C17723
    UMLS 2011AA ObjectClass
    C0334866
    Pathologist's Phone Number
    Descrizione

    PathologistTelephoneNumber

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ValueDomain
    C25395
    UMLS 2011AA ValueDomain
    C0039457
    NCI Thesaurus ObjectClass
    C17723
    UMLS 2011AA ObjectClass
    C0334866
    NCI Thesaurus Property
    C40978
    UMLS 2011AA Property
    C1515258
    Date Form Completed
    Descrizione

    FormCompletionDate,Original

    Tipo di dati

    date

    Ritorna all'inizio della pagina

    Similar models

    Form PRF (04-30-2002) This form is to be completed by the pathologist and submitted to the NSABP Biostatistical Center within 3 months of randomization. Please mail Form PRF separately from the slides and blocks.

    1 moduli
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Unnamed1
    FirstThreeLettersofPatient'sLastName
    Item
    First Three Letters of Patient's Last Name
    text
    PatientStudyID
    Item
    Patient Study ID
    text
    InstitutionName
    Item
    Institution Name
    text
    AffiliateName
    Item
    Affiliate Name
    text
    Item
    Are data amended? (If Yes, circle the amended items in red.)
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    CL.1
    Code List
    Are data amended? (If Yes, circle the amended items in red.)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    Item Group
    Unnamed2
    AccessionNumber
    Item
    Accession Number (enter all that apply 123)
    double
    Item Group
    Unnamed3
    PathologicPrimaryTumorSize
    Item
    Pathologic Primary Tumor Size (cm leave blank if not directly measurable)
    double
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    Item
    Is measurement gross or microscopic? (mark one)
    text
    C2924 (NCI Thesaurus ObjectClass)
    C0007124 (UMLS 2011AA ObjectClass)
    C25252 (NCI Thesaurus Property)
    C0205288 (UMLS 2011AA Property)
    C43566 (NCI Thesaurus Property)
    C0439806 (UMLS 2011AA Property)
    C25681 (NCI Thesaurus Property)
    C0456389 (UMLS 2011AA Property)
    C25356 (NCI Thesaurus Property)
    C1301725 (UMLS 2011AA Property)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Is measurement gross or microscopic? (mark one)
    CL Item
    Gross (Gross)
    CL Item
    Microscopic (Microscopic)
    C25252 (NCI Thesaurus)
    C0205288 (UMLS 2011AA)
    CL Item
    Not Directly Measurable (Not directly measurable)
    EstimatedSize
    Item
    Estimated Size (cm best guess, if possible)
    text
    NumberofslideswithDCISpresent
    Item
    Number of slides with DCIS present
    text
    TotalslidesexaminedforDCIS
    Item
    Total slides examined for DCIS
    text
    Item Group
    Unnamed4
    Item
    Type DCIS (mark one)
    text
    CL.3
    Code List
    Type DCIS (mark one)
    CL Item
    Comedo (Comedo)
    C26453 (NCI Thesaurus)
    C0221228 (UMLS 2011AA)
    CL Item
    Non-comedo (Non-comedo)
    Item
    Growth Patterns (mark all that apply)
    text
    CL.4
    Code List
    Growth Patterns (mark all that apply)
    CL Item
    Solid (Solid)
    CL Item
    Cribriform (Cribriform)
    CL Item
    Micropapillary (Micropapillary)
    CL Item
    Papillary (Papillary)
    CL Item
    Other, specify (Other, specify)
    HistologicType,OtherName
    Item
    Other, specify
    text
    Item
    Dominant Growth Pattern (mark only one)
    text
    CL.5
    Code List
    Dominant Growth Pattern (mark only one)
    CL Item
    Solid (Solid)
    C0205208 (NCI Metathesaurus)
    CL Item
    Cribriform (Cribriform)
    C25731 (NCI Thesaurus)
    C1621425 (UMLS 2011AA)
    CL Item
    Micropapillary (Micropapillary)
    CL Item
    Papillary (Papillary)
    CL Item
    Other, Specify (Other, specify)
    HistologicType,Dominant,Other
    Item
    Other, specify
    text
    PercentCentralNecrosis
    Item
    Percent Central Necrosis (% estimated necrotic surface area of DCIS associated with any growth pattern)
    text
    Item Group
    Unnamed5
    Item
    Nuclear Grade (by SBR criteria; mark highest grade)
    text
    CL.6
    Code List
    Nuclear Grade (by SBR criteria; mark highest grade)
    CL Item
    Grade 1 (Grade 1)
    CL Item
    Grade 2 (Grade 2)
    CL Item
    Grade 3 (Grade 3)
    Item Group
    Unnamed6
    Item
    Microcalcifications (mark one)
    text
    CL.7
    Code List
    Microcalcifications (mark one)
    CL Item
    Present, Involving Benign Ducts (Present, involving benign tissue elements)
    CL Item
    Present, Involving Dcis (Present, involving DCIS)
    CL Item
    Present, Involving Both Benign Ducts And Dcis (Present, involving both benign tissue elements and DCIS)
    CL Item
    None (None)
    C41132 (NCI Thesaurus)
    C0549184 (UMLS 2011AA)
    Item Group
    Unnamed7
    Item
    Margins of DCIS Resection (after re-excision, if done mark one)
    text
    CL.8
    Code List
    Margins of DCIS Resection (after re-excision, if done mark one)
    CL Item
    Positive (Positive)
    CL Item
    Indefinite (Indefinite)
    CL Item
    Negative (Negative)
    CL Item
    Unable to evaluate margins (Unable to evaluate margins)
    SurgicalMarginDistance
    Item
    Nearest Margin (mm if margins are negative)
    double
    Item Group
    Unnamed8
    PathologistCompletingForm
    Item
    Pathologist Completing Form (print name signature)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C40988 (NCI Thesaurus Property)
    C1516308 (UMLS 2011AA Property)
    C25250 (NCI Thesaurus Property)
    C0205197 (UMLS 2011AA Property)
    C17723 (NCI Thesaurus ObjectClass)
    C0334866 (UMLS 2011AA ObjectClass)
    PathologistTelephoneNumber
    Item
    Pathologist's Phone Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25395 (NCI Thesaurus ValueDomain)
    C0039457 (UMLS 2011AA ValueDomain)
    C17723 (NCI Thesaurus ObjectClass)
    C0334866 (UMLS 2011AA ObjectClass)
    C40978 (NCI Thesaurus Property)
    C1515258 (UMLS 2011AA Property)
    FormCompletionDate,Original
    Item
    Date Form Completed
    date
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