ID

7609

Description

ANHL01P1: Institutional Pathology Form [reload] Rituximab, Rasburicase, and Combination Chemotherapy in Treating Young Patients With Newly Diagnosed Advanced B-Cell Leukemia or Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BA57175F-244D-0585-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BA57175F-244D-0585-E034-0003BA12F5E7

Keywords

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 6/27/15 6/27/15 -
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Drug/Agent Toxicity by Tissue/Organ NCT00057811 Pathology - ANHL01P1: Institutional Pathology Form [reload] - 2091881v3.0

No Instruction available.

  1. StudyEvent: ANHL01P1: Institutional Pathology Form [reload]
    1. No Instruction available.
Header
Description

Header

Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Study Number
Description

Protocol ID COG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516477
NCI Thesaurus Property
C25364
COG Number
Description

PatientCOGIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C39353
UMLS 2011AA Property-2
C1516477
Patient Name
Description

PatientName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Today's date
Description

Form Completion Date

Data type

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
Date worksheet entered into RDE
Description

DataEnteredDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C37949
UMLS 2011AA Property
C1521975
Unnamed2
Description

Unnamed2

Institutional Pathologist (Name)
Description

ReviewingPathologistName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C17723
UMLS 2011AA ObjectClass
C0334866
NCI Thesaurus ObjectClass-2
C25661
UMLS 2011AA ObjectClass-2
C1704362
Institutional surgical pathology number(s) (Must be able to accept numbers and letters)
Description

SpecimenAccessionNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C25402
UMLS 2011AA Property
C1510755
Date sample obtained from patient (mm/dd/yyyy)
Description

SpecimenLaboratoryProcedureCollectionDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Time sample obtained (One must be chosen)
Description

SpecimenCollectedPeriodType

Data type

text

Alias
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
please specify [time sample obtained] (Required if #4 is chosen for time sample obtained.)
Description

SpecimenCollectedPeriodSpecify

Data type

text

Alias
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Method for obtaining tissue samples (Required field)
Description

SpecimenCollectedMethodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property-2
C25452
Source of tissue samples (Required field)
Description

LeukemiaSpecimenCellSourceType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3161
UMLS 2011AA ObjectClass
C0023418
NCI Thesaurus Property
C12508
UMLS 2011AA Property
C0007634
NCI Thesaurus ObjectClass-2
C19157
UMLS 2011AA ObjectClass-2
C0370003
NCI Thesaurus Property-2
C25365
UMLS 2011AA Property-2
C0678257
please specify source [of tissue samples]
Description

SpecimenCellSourceSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C12508
UMLS 2011AA Property
C0007634
NCI Thesaurus Property-2
C25683
UMLS 2011AA Property-2
C0449416
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
and primary tumor site (Text field)
Description

DiseasePrimarySiteText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Unnamed3
Description

Unnamed3

Pathologic diagnosis (Required field)
Description

LymphomaPathologicDiagnosisType

Data type

text

Alias
NCI Thesaurus ObjectClass
C3208
UMLS 2011AA ObjectClass
C0024299
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
please fill in the ICD-O code of the pathologic diagnosis (If option #4 or #6 was chosen in the above question,)
Description

PrimaryCancerDiagnosisICD-OCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Immunophenotype (One must be chosen)
Description

ImmunophenotypeType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20072
UMLS 2011AA ObjectClass
C0079611
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Lymphoma Classification Diagnosis (See Appendix ? for explanation of Diagnosis Code to be entered - Melissa to assign appendix number)
Description

LymphomaHistologicCategoryCode

Data type

text

Alias
NCI Thesaurus ObjectClass
C3208
UMLS 2011AA ObjectClass
C0024299
NCI Thesaurus Property
C25161
UMLS 2011AA Property
C0008902
Results From Fresh Or Frozen Tissue
Description

Results From Fresh Or Frozen Tissue

Unnamed question [antigen]
Description

ImmunophenotypeAntigenType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20072
UMLS 2011AA ObjectClass
C0079611
NCI Metathesaurus Property
C0003320
Results from paraffin embedded tissue (One must be chosen)
Description

ImmunophenotypeAntigenInd

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C20072
UMLS 2011AA ObjectClass
C0079611
NCI Metathesaurus Property
C0003320
TDT Method (One must be chosen)
Description

ImmunophenotypeMethodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C20072
UMLS 2011AA ObjectClass
C0079611
Results From Paraffin Embedded Tissue
Description

Results From Paraffin Embedded Tissue

Unnamed question [antigen]
Description

ImmunophenotypeAntigenType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20072
UMLS 2011AA ObjectClass
C0079611
NCI Metathesaurus Property
C0003320
Results from paraffin embedded tissue (One must be chosen)
Description

ImmunophenotypeAntigenInd

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C20072
UMLS 2011AA ObjectClass
C0079611
NCI Metathesaurus Property
C0003320
SLIDE/TISSUE SUBMISSION: For Central Review? (One must be chosen)
Description

PathologySpecimenCentralReviewerSubmissionInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus ObjectClass-2
C18189
UMLS 2011AA ObjectClass-2
C0030664
NCI Thesaurus Property
C25694
UMLS 2011AA Property
C1515022
NCI Thesaurus Property-2
C51807
UMLS 2011AA Property-2
C1707338
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Is any frozen tissue available? (One must be chosen)
Description

SpecimenFrozenInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Metathesaurus Property
CL267638
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Fixative used (BIOPSY TISSUE PROCESSING DETAILS)
Description

SpecimenFixativeType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C498
UMLS 2011AA Property
C0016184
please specify [biopsy tissue processing details, fixative used] (Probably should accept numbers and letters)
Description

SpecimenFixativeSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C498
UMLS 2011AA Property
C0016184
Number of hours in fixative before processing
Description

SpecimenFixativeHoursType

Data type

text

Alias
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
NCI Thesaurus Property
C498
UMLS 2011AA Property
C0016184
Is there evidence of clonality by gene rearrangement? (Required field)
Description

SpecimenCloneExaminedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25500
UMLS 2011AA Property
C0332128
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Ccrr Module For Anhl01p1: Institutional Pathology Form [reload]
Description

Ccrr Module For Anhl01p1: Institutional Pathology Form [reload]

Similar models

No Instruction available.

  1. StudyEvent: ANHL01P1: Institutional Pathology Form [reload]
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Institution Name
Item
Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Institution Name
Item
Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Protocol ID COG
Item
Study Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516477 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
PatientCOGIdentifierNumber
Item
COG Number
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C39353 (NCI Thesaurus Property-2)
C1516477 (UMLS 2011AA Property-2)
PatientName
Item
Patient Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Form Completion Date
Item
Today's date
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)
DataEnteredDate
Item
Date worksheet entered into RDE
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C37949 (NCI Thesaurus Property)
C1521975 (UMLS 2011AA Property)
Item Group
Unnamed2
ReviewingPathologistName
Item
Institutional Pathologist (Name)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C17723 (NCI Thesaurus ObjectClass)
C0334866 (UMLS 2011AA ObjectClass)
C25661 (NCI Thesaurus ObjectClass-2)
C1704362 (UMLS 2011AA ObjectClass-2)
SpecimenAccessionNumber
Item
Institutional surgical pathology number(s) (Must be able to accept numbers and letters)
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25402 (NCI Thesaurus Property)
C1510755 (UMLS 2011AA Property)
SpecimenLaboratoryProcedureCollectionDate
Item
Date sample obtained from patient (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Item
Time sample obtained (One must be chosen)
text
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Code List
Time sample obtained (One must be chosen)
CL Item
Sample Or Specimen Collected Before Patient Received Treatment For Cancer (Pre-treatment (at study entry))
CL Item
Any other time after study entry (Any other time after study entry)
CL Item
Death (Death)
CL Item
Other Specify (Other)
CL Item
Sample Or Specimen Collected Before Patient Was Diagnosed With Cancer (Pre-diagnosis)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Sample Or Specimen Collected After Patient Received Treatment For Cancer (Post-treatment)
SpecimenCollectedPeriodSpecify
Item
please specify [time sample obtained] (Required if #4 is chosen for time sample obtained.)
text
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Item
Method for obtaining tissue samples (Required field)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C25452 (NCI Thesaurus Property-2)
Code List
Method for obtaining tissue samples (Required field)
CL Item
Sample Or Specimen Collected Via Biopsy (Surgical biopsy)
CL Item
Sample Or Specimen Collected Via Biopsy (Needle core biopsy)
CL Item
Sample Or Specimen Collected Via Fine Needle Aspiration (Fine needle aspiration)
CL Item
Cytology (Cytology)
CL Item
Sample Or Specimen Collected Via Pleural Effusion (Body fluid cytology)
CL Item
(pleural effusion or ascites fluid ((pleural effusion or ascites fluid)
CL Item
Bone marrow aspirate (Bone marrow aspirate)
CL Item
Bone marrow biopsy (Bone marrow biopsy)
CL Item
Sample Or Specimen Collected Via Abdominal Effusion Or Ascites (Abdominal/ascites effusion)
CL Item
Sample Or Specimen Collected Via Bronchial Alveolar Lavage (Bronchial alveolar lavage (BAL))
CL Item
Sample Or Specimen Collected Via Bronchial Brushing Or Washing (Bronchial brushing/washing)
CL Item
Sample Or Specimen Collected Via Mediastinoscopy (Mediastinoscopy)
CL Item
Other Specify (Other, specify)
CL Item
Sample Or Specimen Collected Via Pericardial Effusion (Pericardial effusion)
CL Item
Sample Or Specimen Collected Via Pleural Lavage (Pleural lavage)
CL Item
Sample Or Specimen Collected Via Induced Sputum (Sputum, induced)
CL Item
Sample Or Specimen Collected Via Spontaneous Sputum (Sputum, spontaneous)
Item
Source of tissue samples (Required field)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3161 (NCI Thesaurus ObjectClass)
C0023418 (UMLS 2011AA ObjectClass)
C12508 (NCI Thesaurus Property)
C0007634 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass-2)
C0370003 (UMLS 2011AA ObjectClass-2)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
Code List
Source of tissue samples (Required field)
CL Item
Primary tumor (Primary tumor)
CL Item
Pleural Fluid (Pleural effusion or ascites)
C0225778 (NCI Metathesaurus)
CL Item
Other Specify (Other site of tumor, specify below)
CL Item
Bone Biopsy (Bone biopsy)
CL Item
Bone Marrow (Bone marrow)
C12431 (NCI Thesaurus)
C0005953 (UMLS 2011AA)
CL Item
Cerebrospinal Fluid (Cerebrospinal fluid)
C12692 (NCI Thesaurus)
C0007806 (UMLS 2011AA)
CL Item
Lymph Node (Lymph node)
C12745 (NCI Thesaurus)
C0024204 (UMLS 2011AA)
CL Item
Peripheral Blood (Peripheral blood)
C0229664 (NCI Metathesaurus)
CL Item
Peritoneal Fluid (Peritoneal fluid)
CL Item
Soft Tissue Mass (Soft tissue mass)
C0457193 (NCI Metathesaurus)
SpecimenCellSourceSpecify
Item
please specify source [of tissue samples]
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C12508 (NCI Thesaurus Property)
C0007634 (UMLS 2011AA Property)
C25683 (NCI Thesaurus Property-2)
C0449416 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
DiseasePrimarySiteText
Item
and primary tumor site (Text field)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
Item Group
Unnamed3
Item
Pathologic diagnosis (Required field)
text
C3208 (NCI Thesaurus ObjectClass)
C0024299 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Code List
Pathologic diagnosis (Required field)
CL Item
Lymphoblastic Lymphoma (Lymphoblastic Lymphoma)
CL Item
Large Cell Lymphoma (Large cell lymphoma)
CL Item
Small, Non-cleaved Cell Lymphoma (Small, non-cleaved cell lymphoma)
CL Item
Other Non-hodgkin's Lymphoma (Other non-Hodgkin's lymphoma)
CL Item
Other Non-hodgkin's Lymphoma Subtype, Unknown (Other non-Hodgkin's lymphoma subtype, unknown)
CL Item
Other Malignancy, Specify (Other malignancy, specify ICD-O code below))
CL Item
Unknown/not Evaluated (Unknown/Not evaluated)
PrimaryCancerDiagnosisICD-OCode
Item
please fill in the ICD-O code of the pathologic diagnosis (If option #4 or #6 was chosen in the above question,)
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Item
Immunophenotype (One must be chosen)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20072 (NCI Thesaurus ObjectClass)
C0079611 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Code List
Immunophenotype (One must be chosen)
CL Item
B-cell Immunophenotype (B-cell)
CL Item
T-cell Immunophenotype (T-cell)
CL Item
Mixed Cells Immunophenotype (B & T cell/Bi-phenotype)
CL Item
Non-t/non-b Cell Immunophenotype (Non-T/Non-B)
CL Item
Not Done (Not Done)
CL Item
Indeterminate Immunophenotype (Unknown)
CL Item
Other Specified Immunophenotype (Other, specify)
LymphomaHistologicCategoryCode
Item
Lymphoma Classification Diagnosis (See Appendix ? for explanation of Diagnosis Code to be entered - Melissa to assign appendix number)
text
C3208 (NCI Thesaurus ObjectClass)
C0024299 (UMLS 2011AA ObjectClass)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
Item Group
Results From Fresh Or Frozen Tissue
Item
Unnamed question [antigen]
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20072 (NCI Thesaurus ObjectClass)
C0079611 (UMLS 2011AA ObjectClass)
C0003320 (NCI Metathesaurus Property)
Code List
Unnamed question [antigen]
CL Item
Cd2 (CD1)
CL Item
Cd2 (CD2)
CL Item
CD3 (CD3)
CL Item
Cd4 (CD4)
CL Item
Cd5 (CD5)
CL Item
Cd7 (CD7)
CL Item
Cd8 (CD8)
CL Item
Cd43 (CD43)
CL Item
Cd45 (CD45RO)
CL Item
Cd20 (CD20)
CL Item
CD22 (CD22)
CL Item
Cd24 (CD24)
CL Item
Cd45 (CD45RA)
CL Item
CD79a (CD79a)
CL Item
CD80 (CD80)
CL Item
Kappa (Kappa)
CL Item
Lambda (Lambda)
CL Item
Myeloperoxidase (Myeloperoxidase)
C0027021 (NCI Metathesaurus)
CL Item
Lysozyme (Muramidase) (Lysozyme (Muramidase))
CL Item
Cd15 (CD15)
CL Item
CD68 (CD68)
CL Item
Cd10 (CD10)
CL Item
Cd25 (CD25)
CL Item
Cd30 (CD30)
CL Item
Cd34 (CD34)
CL Item
Cd45 (CD45 (LCA))
CL Item
ALK-1 (ALK-1)
CL Item
Terminal Transferase (tdt) (TDT)
CL Item
EBV LMP (EBV LMP)
CL Item
EBER (EBER)
CL Item
Cd22 Intracytoplasmic (CD22 intracytoplasmic)
CL Item
Cd22 Surface (CD22 surface)
CL Item
Cd3 Intracytoplasmic (CD3 intracytoplasmic)
CL Item
Cd3 Surface (CD3 surface)
CL Item
Cd79a Intracytoplasmic (CD79a intracytoplasmic)
CL Item
Cd79a Surface (CD79a surface)
CL Item
Cd79b Intracytoplasmic (CD79b intracytoplasmic)
CL Item
Cd79b Surface (CD79b surface)
CL Item
Glycophorin (Glycophorin)
C0017954 (NCI Metathesaurus)
CL Item
Ig-kappa Intracytoplasmic (Ig-kappa intracytoplasmic)
CL Item
Ig-kappa Surface (Ig-kappa surface)
CL Item
Ig-lambda Intracytoplasmic (Ig-lambda intracytoplasmic)
CL Item
Ig-lambda Surface (Ig-lambda surface)
CL Item
Iga Surface (IgA surface)
CL Item
Igd Surface (IgD surface)
CL Item
Igg Surface (IgG surface)
CL Item
Igm Intracytoplasmic (IgM intracytoplasmic)
CL Item
Igm Surface (IgM surface)
CL Item
Ki67 (Ki67)
CL Item
Lactoferrin (Lactoferrin)
C0022942 (NCI Metathesaurus)
CL Item
Lung-resistance-related Or Major Vault Protein (lrp/mvp) (Lung-resistance-related or major vault protein (LRP/MVP))
CL Item
Multidrug Resistance-associated Protein (mrp) (Multidrug resistance-associated protein (MRP))
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
P-glycoprotein (pgp/mdr1) (P-glycoprotein (Pgp/MDR1))
Item
Results from paraffin embedded tissue (One must be chosen)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C20072 (NCI Thesaurus ObjectClass)
C0079611 (UMLS 2011AA ObjectClass)
C0003320 (NCI Metathesaurus Property)
Code List
Results from paraffin embedded tissue (One must be chosen)
CL Item
Yes (Positive)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (Negative)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Indeterminate (Equivocal)
C48658 (NCI Thesaurus)
C0205258 (UMLS 2011AA)
CL Item
Not Done (Not done/Not evaluable)
CL281691 (NCI Metathesaurus)
Item
TDT Method (One must be chosen)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C20072 (NCI Thesaurus ObjectClass)
C0079611 (UMLS 2011AA ObjectClass)
Code List
TDT Method (One must be chosen)
CL Item
Flow Cytometry, Not Otherwise Specified (Flow cytometry)
CL Item
Immunofluorescence (Immunofluorescence)
CL Item
Both (Both)
CL Item
Unknown (Unknown)
CL Item
Flow Cytometry, 2 Color (Flow cytometry, 2 color)
CL Item
Flow Cytometry, 3 Color (Flow cytometry, 3 color)
CL Item
Flow Cytometry, 4 Or More Color (Flow cytometry, 4 or more color)
CL Item
Immunohistochemistry (Immunohistochemistry)
C16722 (NCI Thesaurus)
CL Item
Other Specify (Other, specify)
Item Group
Results From Paraffin Embedded Tissue
Item
Unnamed question [antigen]
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20072 (NCI Thesaurus ObjectClass)
C0079611 (UMLS 2011AA ObjectClass)
C0003320 (NCI Metathesaurus Property)
Code List
Unnamed question [antigen]
CL Item
Cd2 (CD1)
CL Item
Cd2 (CD2)
CL Item
CD3 (CD3)
CL Item
Cd4 (CD4)
CL Item
Cd5 (CD5)
CL Item
Cd7 (CD7)
CL Item
Cd8 (CD8)
CL Item
Cd43 (CD43)
CL Item
Cd45 (CD45RO)
CL Item
Cd20 (CD20)
CL Item
CD22 (CD22)
CL Item
Cd24 (CD24)
CL Item
Cd45 (CD45RA)
CL Item
CD79a (CD79a)
CL Item
CD80 (CD80)
CL Item
Kappa (Kappa)
CL Item
Lambda (Lambda)
CL Item
Myeloperoxidase (Myeloperoxidase)
C0027021 (NCI Metathesaurus)
CL Item
Lysozyme (Muramidase) (Lysozyme (Muramidase))
CL Item
Cd15 (CD15)
CL Item
CD68 (CD68)
CL Item
Cd10 (CD10)
CL Item
Cd25 (CD25)
CL Item
Cd30 (CD30)
CL Item
Cd34 (CD34)
CL Item
Cd45 (CD45 (LCA))
CL Item
ALK-1 (ALK-1)
CL Item
Terminal Transferase (tdt) (TDT)
CL Item
EBV LMP (EBV LMP)
CL Item
EBER (EBER)
CL Item
Cd22 Intracytoplasmic (CD22 intracytoplasmic)
CL Item
Cd22 Surface (CD22 surface)
CL Item
Cd3 Intracytoplasmic (CD3 intracytoplasmic)
CL Item
Cd3 Surface (CD3 surface)
CL Item
Cd79a Intracytoplasmic (CD79a intracytoplasmic)
CL Item
Cd79a Surface (CD79a surface)
CL Item
Cd79b Intracytoplasmic (CD79b intracytoplasmic)
CL Item
Cd79b Surface (CD79b surface)
CL Item
Glycophorin (Glycophorin)
C0017954 (NCI Metathesaurus)
CL Item
Ig-kappa Intracytoplasmic (Ig-kappa intracytoplasmic)
CL Item
Ig-kappa Surface (Ig-kappa surface)
CL Item
Ig-lambda Intracytoplasmic (Ig-lambda intracytoplasmic)
CL Item
Ig-lambda Surface (Ig-lambda surface)
CL Item
Iga Surface (IgA surface)
CL Item
Igd Surface (IgD surface)
CL Item
Igg Surface (IgG surface)
CL Item
Igm Intracytoplasmic (IgM intracytoplasmic)
CL Item
Igm Surface (IgM surface)
CL Item
Ki67 (Ki67)
CL Item
Lactoferrin (Lactoferrin)
C0022942 (NCI Metathesaurus)
CL Item
Lung-resistance-related Or Major Vault Protein (lrp/mvp) (Lung-resistance-related or major vault protein (LRP/MVP))
CL Item
Multidrug Resistance-associated Protein (mrp) (Multidrug resistance-associated protein (MRP))
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
P-glycoprotein (pgp/mdr1) (P-glycoprotein (Pgp/MDR1))
Item
Results from paraffin embedded tissue (One must be chosen)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C20072 (NCI Thesaurus ObjectClass)
C0079611 (UMLS 2011AA ObjectClass)
C0003320 (NCI Metathesaurus Property)
Code List
Results from paraffin embedded tissue (One must be chosen)
CL Item
Yes (Positive)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (Negative)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Indeterminate (Equivocal)
C48658 (NCI Thesaurus)
C0205258 (UMLS 2011AA)
CL Item
Not Done (Not done/Not evaluable)
CL281691 (NCI Metathesaurus)
PathologySpecimenCentralReviewerSubmissionInd-2
Item
SLIDE/TISSUE SUBMISSION: For Central Review? (One must be chosen)
boolean
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C18189 (NCI Thesaurus ObjectClass-2)
C0030664 (UMLS 2011AA ObjectClass-2)
C25694 (NCI Thesaurus Property)
C1515022 (UMLS 2011AA Property)
C51807 (NCI Thesaurus Property-2)
C1707338 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
SpecimenFrozenInd-2
Item
Is any frozen tissue available? (One must be chosen)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL267638 (NCI Metathesaurus Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Item
Fixative used (BIOPSY TISSUE PROCESSING DETAILS)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C498 (NCI Thesaurus Property)
C0016184 (UMLS 2011AA Property)
Code List
Fixative used (BIOPSY TISSUE PROCESSING DETAILS)
CL Item
Formalin (Formalin)
C0949307 (NCI Metathesaurus)
CL Item
Zinc Formalin (Zinc Formalin)
CL Item
B5 (B5)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
SpecimenFixativeSpecify
Item
please specify [biopsy tissue processing details, fixative used] (Probably should accept numbers and letters)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C498 (NCI Thesaurus Property)
C0016184 (UMLS 2011AA Property)
Item
Number of hours in fixative before processing
text
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C498 (NCI Thesaurus Property)
C0016184 (UMLS 2011AA Property)
Code List
Number of hours in fixative before processing
CL Item
24 Hours Or Less (24 hours or less)
CL Item
25-48 Hours (25-48 hours)
CL Item
Greater Than 48 Hours (>48 hours)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
SpecimenCloneExaminedInd-2
Item
Is there evidence of clonality by gene rearrangement? (Required field)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Item Group
Ccrr Module For Anhl01p1: Institutional Pathology Form [reload]

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