ID
9056
Description
Pathology Form (Form 24-P) Brain Function in Premenopausal Women Receiving Tamoxifen With or Without Ovarian Function Suppression for Early-Stage Breast Cancer on Clinical Trial IBCSG-2402 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B126C787-1E49-54D3-E034-0003BA12F5E7
Link
Keywords
Versions (2)
- 8/27/12 8/27/12 -
- 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00659373 Pathology - Pathology Form (Form 24-P) - 2074955v3.0
PATHOLOGY FORM (Form 24-P) Instructions: This form is to be completed by participating pathologist or investigator. Submit this form within 1 month of randomization, with the pathology report(s) and required pathology materials. Mark your selection with an ?X? in the appropriate box(es). Use minus one (-1) to indicate that an answer is unknown, unobtainable or not done.
Description
Header
Description
SpecimenIdentifierNumber
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
Description
Adjacentnormaltissueblockspecimennumber
Data type
text
Description
Primarytumorslidespecimennumber
Data type
text
Description
Adjacentnormalbreasttissueslidespecimennumber
Data type
text
Description
BreastSideAssessmentSite
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ObjectClass
- C12971
- UMLS 2011AA ObjectClass
- C0006141
- NCI Thesaurus Property-2
- C25306
- UMLS 2011AA Property-2
- C0441987
Description
Primary Tumor
Description
PathologicPrimaryTumorSize
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS 2011AA ValueDomain
- C0242485
Description
HistologicType
Data type
text
Description
HistologicType,OtherName
Data type
text
Description
Grade
Description
Totalpoints-Bloom,Richardson,Elston(Grade)
Data type
text
Description
TubuleFormation
Data type
text
Description
Nuclearpleomorphism
Data type
text
Description
Mitoses
Data type
text
Description
HistologicGrade
Data type
text
Description
Excision Margins
Description
InvasiveNeoplasmExcisionMarginType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C14159
- UMLS 2011AA ObjectClass-2
- C0205281
- NCI Thesaurus Property
- C15232
- UMLS 2011AA Property
- C0728940
- NCI Thesaurus Property-2
- C25563
- UMLS 2011AA Property-2
- C0205284
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
DCISExcisionMarginType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C15232
- UMLS 2011AA Property
- C0728940
- NCI Thesaurus ObjectClass
- C2924
- UMLS 2011AA ObjectClass
- C0007124
- NCI Thesaurus Property-2
- C25563
- UMLS 2011AA Property-2
- C0205284
Description
Vessel Invasion
Description
Her2/neu
Description
Her2/Neuexpressionstatusbyimmunohistochemistry
Data type
text
Description
StainingAntibody
Data type
text
Description
Other,specify(assay)
Data type
text
Description
FISHCytologyResultProcedure
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16491
- UMLS 2011AA ObjectClass
- C0010819
- NCI Thesaurus ObjectClass-2
- C17563
- UMLS 2011AA ObjectClass-2
- C0162789
- NCI Thesaurus ValueDomain
- C25218
- UMLS 2011AA ValueDomain
- C1948041
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
Description
FISHKitorTestType
Data type
text
Description
FISHKitorTestType,Other
Data type
float
Description
Byothertechnique,(Her2/neu)
Data type
text
Description
Her2/neustatus,(byothertechnique)
Data type
text
Description
Nodal Involvement
Description
AxillaryNodeExaminedTotalCount
Data type
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
Description
Numberofpositiveaxillarylymphnodes
Data type
float
Description
ExtracapsularExtensionInd
Data type
boolean
Description
IsolatedNeoplasticCellPresentInd-2
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C25626
- UMLS 2011AA Property
- C0150312
- NCI Thesaurus ObjectClass
- C25549
- UMLS 2011AA ObjectClass
- C0205409
- NCI Thesaurus ObjectClass-2
- C12922
- UMLS 2011AA ObjectClass-2
- C0597032
Description
AxillarySentinelLymphNodeExaminedTotalCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C13351
- UMLS 2011AA ObjectClass
- C0004454
- NCI Thesaurus ObjectClass-2
- C12947
- UMLS 2011AA ObjectClass-2
- C1522495
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ValueDomain
- C25304
- UMLS 2011AA ValueDomain
- C0439810
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
MetastaticAxillarySentinelLymphNodeExaminedCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C14174
- UMLS 2011AA ObjectClass
- C0036525
- NCI Thesaurus ObjectClass-2
- C13351
- UMLS 2011AA ObjectClass-2
- C0004454
- NCI Thesaurus ObjectClass-3
- C12947
- UMLS 2011AA ObjectClass-3
- C1522495
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ValueDomain
- C25304
- UMLS 2011AA ValueDomain
- C0439810
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
Ifpositive,largesttumordeposit:
Data type
text
Description
Ifpositive,largesttumordeposit:
Data type
text
Description
InternalMammarySentinelNodeExaminedTotalNumber
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C12947
- UMLS 2011AA ObjectClass
- C1522495
- NCI Thesaurus ObjectClass-2
- C25234
- UMLS 2011AA ObjectClass-2
- C0205102
- NCI Thesaurus ObjectClass-3
- C43595
- UMLS 2011AA ObjectClass-3
- C0006141
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
- NCI Thesaurus ValueDomain-2
- C25304
- UMLS 2011AA ValueDomain-2
- C0439810
Description
MetastaticInternalMammarySentinelNodeExaminedCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C14174
- UMLS 2011AA ObjectClass
- C0036525
- NCI Thesaurus ObjectClass-2
- C12947
- UMLS 2011AA ObjectClass-2
- C1522495
- NCI Thesaurus ObjectClass-3
- C25234
- UMLS 2011AA ObjectClass-3
- C0205102
- NCI Thesaurus ObjectClass-4
- C43595
- UMLS 2011AA ObjectClass-4
- C0006141
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
PersonCompletingForm,ProjectRole
Data type
text
Description
Comments
Data type
text
Description
PathologistorInvestigator'sSignature
Data type
text
Description
Investigator Signature Date
Data type
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
Similar models
PATHOLOGY FORM (Form 24-P) Instructions: This form is to be completed by participating pathologist or investigator. Submit this form within 1 month of randomization, with the pathology report(s) and required pathology materials. Mark your selection with an ?X? in the appropriate box(es). Use minus one (-1) to indicate that an answer is unknown, unobtainable or not done.
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C0030705 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C0805701 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
C1515974 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25306 (NCI Thesaurus Property-2)
C0441987 (UMLS 2011AA Property-2)
C0242485 (UMLS 2011AA ValueDomain)
C0027651 (UMLS 2011AA ObjectClass)
C14159 (NCI Thesaurus ObjectClass-2)
C0205281 (UMLS 2011AA ObjectClass-2)
C15232 (NCI Thesaurus Property)
C0728940 (UMLS 2011AA Property)
C25563 (NCI Thesaurus Property-2)
C0205284 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15232 (NCI Thesaurus Property)
C0728940 (UMLS 2011AA Property)
C2924 (NCI Thesaurus ObjectClass)
C0007124 (UMLS 2011AA ObjectClass)
C25563 (NCI Thesaurus Property-2)
C0205284 (UMLS 2011AA Property-2)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0010819 (UMLS 2011AA ObjectClass)
C17563 (NCI Thesaurus ObjectClass-2)
C0162789 (UMLS 2011AA ObjectClass-2)
C25218 (NCI Thesaurus ValueDomain)
C1948041 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
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)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25549 (NCI Thesaurus ObjectClass)
C0205409 (UMLS 2011AA ObjectClass)
C12922 (NCI Thesaurus ObjectClass-2)
C0597032 (UMLS 2011AA ObjectClass-2)
C0004454 (UMLS 2011AA ObjectClass)
C12947 (NCI Thesaurus ObjectClass-2)
C1522495 (UMLS 2011AA ObjectClass-2)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0036525 (UMLS 2011AA ObjectClass)
C13351 (NCI Thesaurus ObjectClass-2)
C0004454 (UMLS 2011AA ObjectClass-2)
C12947 (NCI Thesaurus ObjectClass-3)
C1522495 (UMLS 2011AA ObjectClass-3)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C1522495 (UMLS 2011AA ObjectClass)
C25234 (NCI Thesaurus ObjectClass-2)
C0205102 (UMLS 2011AA ObjectClass-2)
C43595 (NCI Thesaurus ObjectClass-3)
C0006141 (UMLS 2011AA ObjectClass-3)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25304 (NCI Thesaurus ValueDomain-2)
C0439810 (UMLS 2011AA ValueDomain-2)
C0036525 (UMLS 2011AA ObjectClass)
C12947 (NCI Thesaurus ObjectClass-2)
C1522495 (UMLS 2011AA ObjectClass-2)
C25234 (NCI Thesaurus ObjectClass-3)
C0205102 (UMLS 2011AA ObjectClass-3)
C43595 (NCI Thesaurus ObjectClass-4)
C0006141 (UMLS 2011AA ObjectClass-4)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)