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

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B126C787-1E49-54D3-E034-0003BA12F5E7

Keywords

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

January 9, 2015

DOI

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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.

Ccrr Module For Pathology Form (form 24-p)
Description

Ccrr Module For Pathology Form (form 24-p)

Patient ID No. (Study No.)
Description

PatientStudyID,CoordinatingGroup

Data type

text

Patient Initials (f m fl sl)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient's Date of Birth (day)
Description

PatientBirthDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Participating Center/Affiliate
Description

ParticipatingCenter/Affiliate

Data type

text

Center Code
Description

ParticipatingGroupCode

Data type

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Header
Description

Header

Specimen ID Number
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
Adjacent normal tissue block specimen number
Description

Adjacentnormaltissueblockspecimennumber

Data type

text

Primary tumor slide specimen number
Description

Primarytumorslidespecimennumber

Data type

text

Adjacent normal breast tissue slide specimen number
Description

Adjacentnormalbreasttissueslidespecimennumber

Data type

text

This form is being completed for
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
Primary Tumor
Description

Primary Tumor

Pathologic primary tumor size. Maximum diameter of invasive component. (cm )
Description

PathologicPrimaryTumorSize

Data type

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Histological type (Dominant)
Description

HistologicType

Data type

text

other, (specify)
Description

HistologicType,OtherName

Data type

text

Grade
Description

Grade

Total points - Bloom, Richardson, Elston (Grade) (If not available, complete Q4.)
Description

Totalpoints-Bloom,Richardson,Elston(Grade)

Data type

text

Tubule formation
Description

TubuleFormation

Data type

text

Nuclear pleomorphism
Description

Nuclearpleomorphism

Data type

text

Mitoses
Description

Mitoses

Data type

text

Differentiation (select one)
Description

HistologicGrade

Data type

text

Excision Margins
Description

Excision Margins

Invasive cancer
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
DCIS
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
Vessel Invasion
Description

Vessel Invasion

Was there invasion of vessels around primary tumor? (select one)
Description

Wasthereinvasionofvesselsaroundprimarytumor?

Data type

text

Her2/neu
Description

Her2/neu

Score by immunohistochemistry
Description

Her2/Neuexpressionstatusbyimmunohistochemistry

Data type

text

Immunohistochemistry Kit or Test Type
Description

StainingAntibody

Data type

text

Other, specify (assay)
Description

Other,specify(assay)

Data type

text

By FISH
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
Type of Assay
Description

FISHKitorTestType

Data type

text

Other, specify (assay)
Description

FISHKitorTestType,Other

Data type

float

By other technique, (Her2/neu)
Description

Byothertechnique,(Her2/neu)

Data type

text

Her2/neu status, (by other technique)
Description

Her2/neustatus,(byothertechnique)

Data type

text

Nodal Involvement
Description

Nodal Involvement

Total number examined
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
Number of metastatic axillary lymph nodes
Description

Numberofpositiveaxillarylymphnodes

Data type

float

Extracapsular Extension
Description

ExtracapsularExtensionInd

Data type

boolean

Isolated tumor cells only
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
Total number examined
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
Number of metastatic axillary sentinel lymph nodes
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
Largest tumor deposit
Description

Ifpositive,largesttumordeposit:

Data type

text

Largest tumor deposit
Description

Ifpositive,largesttumordeposit:

Data type

text

Total number examined
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
Number of metastatic internal mammary sentinel nodes
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
Form completed by (select one)
Description

PersonCompletingForm,ProjectRole

Data type

text

Comments
Description

Comments

Data type

text

Investigator/Pathologist Signature
Description

PathologistorInvestigator'sSignature

Data type

text

Date
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.

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Ccrr Module For Pathology Form (form 24-p)
PatientStudyID,CoordinatingGroup
Item
Patient ID No. (Study No.)
text
Patient Initials
Item
Patient Initials (f m fl sl)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
PatientBirthDate
Item
Patient's Date of Birth (day)
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
ParticipatingCenter/Affiliate
Item
Participating Center/Affiliate
text
ParticipatingGroupCode
Item
Center Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Item Group
Header
SpecimenIdentifierNumber
Item
Specimen ID Number
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Adjacentnormaltissueblockspecimennumber
Item
Adjacent normal tissue block specimen number
text
Primarytumorslidespecimennumber
Item
Primary tumor slide specimen number
text
Adjacentnormalbreasttissueslidespecimennumber
Item
Adjacent normal breast tissue slide specimen number
text
Item
This form is being completed for
text
C13717 (NCI Thesaurus ValueDomain)
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)
Code List
This form is being completed for
CL Item
Left Breast/side (Left breast/side)
CL Item
Right Breast/side (Right breast/side)
Item Group
Primary Tumor
PathologicPrimaryTumorSize
Item
Pathologic primary tumor size. Maximum diameter of invasive component. (cm )
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item
Histological type (Dominant)
text
Code List
Histological type (Dominant)
CL Item
invasive ductal (NOS) (invasive ductal (NOS))
CL Item
medullary (medullary)
CL Item
medullary-atypical (medullary-atypical)
CL Item
invasive lobular - classic type (invasive lobular - classic type)
CL Item
invasive lobular - variant type (invasive lobular - variant type)
CL Item
mucinous (colloid) (mucinous (colloid))
CL Item
mucinous (colloid) - variant (mucinous (colloid) - variant)
CL Item
tubular (tubular)
CL Item
tubular-variant (tubular-variant)
CL Item
invasive ductal with predominant intraductal component (invasive ductal with predominant intraductal component)
CL Item
intraductal (in situ) carcinoma, high grade (intraductal (in situ) carcinoma, high grade)
CL Item
intraductal (in situ) carcinoma, moderate grade (intraductal (in situ) carcinoma, moderate grade)
CL Item
intraductal (in situ) carcinoma, low grade (intraductal (in situ) carcinoma, low grade)
CL Item
invasive cribriform, pure (invasive cribriform, pure)
CL Item
invasive cribriform, mixed (invasive cribriform, mixed)
CL Item
in situ lobular carcinoma (in situ lobular carcinoma)
CL Item
no cancer on slide (no cancer on slide)
CL Item
other, specify (other, specify)
HistologicType,OtherName
Item
other, (specify)
text
Item Group
Grade
Totalpoints-Bloom,Richardson,Elston(Grade)
Item
Total points - Bloom, Richardson, Elston (Grade) (If not available, complete Q4.)
text
TubuleFormation
Item
Tubule formation
text
Nuclearpleomorphism
Item
Nuclear pleomorphism
text
Mitoses
Item
Mitoses
text
Item
Differentiation (select one)
text
Code List
Differentiation (select one)
CL Item
Tumor Is Well Differentiated According To Who Grading System (Well differentiated)
CL Item
Tumor Is Moderately Differentiated According To Who Grading System (Moderately differentiated)
CL Item
Tumor Is Poorly Differentiated According To Who Grading System (Poorly differentiated)
Item Group
Excision Margins
Item
Invasive cancer
text
C3262 (NCI Thesaurus ObjectClass)
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)
Code List
Invasive cancer
CL Item
<= 1 Mm, But Not Involved (<= 1 mm, but not involved)
CL Item
> 1 And <= 10 Mm (> 1 and <= 10 mm)
CL Item
> 10 Mm (> 10 mm)
CL Item
Not Involved, But Distance Not Assessable (Not involved, but distance not assessable)
Item
DCIS
text
C25284 (NCI Thesaurus 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)
Code List
DCIS
CL Item
<= 1 Mm, But Not Involved (<= 1 mm, but not involved)
CL Item
> 1 And <= 10 Mm (> 1 and <= 10 mm)
CL Item
> 10 Mm (> 10 mm)
CL Item
Not Involved, But Distance Not Assessable (Not involved, but distance not assessable)
Item Group
Vessel Invasion
Item
Was there invasion of vessels around primary tumor? (select one)
text
Code List
Was there invasion of vessels around primary tumor? (select one)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Not Able To Assess (Not able to assess)
Item Group
Her2/neu
Item
Score by immunohistochemistry
text
Code List
Score by immunohistochemistry
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1+ (1+)
CL Item
2+ (2+)
CL Item
3+ (3+)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
Item
Immunohistochemistry Kit or Test Type
text
Code List
Immunohistochemistry Kit or Test Type
CL Item
Dako Herceptest [tm] (DAKO Herceptest [TM])
CL Item
Other, Specify (Other, specify)
Other,specify(assay)
Item
Other, specify (assay)
text
Item
By FISH
text
C16491 (NCI Thesaurus ObjectClass)
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)
Code List
By FISH
CL Item
Amplified (Amplified)
CL Item
Normal Copy Number (Normal copy number)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Polysomic (Polysomic)
Item
Type of Assay
text
Code List
Type of Assay
CL Item
Dako (DAKO)
CL Item
Oncor (Oncor)
CL Item
Other, Specify (Other, specify)
CL Item
Vysis (Vysis)
FISHKitorTestType,Other
Item
Other, specify (assay)
float
Byothertechnique,(Her2/neu)
Item
By other technique, (Her2/neu)
text
Item
Her2/neu status, (by other technique)
text
Code List
Her2/neu status, (by other technique)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Not Done (Not done)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
Item Group
Nodal Involvement
AxillaryNodeExaminedTotalCount
Item
Total number 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)
Numberofpositiveaxillarylymphnodes
Item
Number of metastatic axillary lymph nodes
float
ExtracapsularExtensionInd
Item
Extracapsular Extension
boolean
IsolatedNeoplasticCellPresentInd-2
Item
Isolated tumor cells only
boolean
C38147 (NCI Thesaurus ValueDomain)
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)
AxillarySentinelLymphNodeExaminedTotalCount
Item
Total number examined
float
C13351 (NCI Thesaurus ObjectClass)
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)
MetastaticAxillarySentinelLymphNodeExaminedCount
Item
Number of metastatic axillary sentinel lymph nodes
float
C14174 (NCI Thesaurus ObjectClass)
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)
Item
Largest tumor deposit
text
Code List
Largest tumor deposit
CL Item
Isolated Tumor Cells Alone (Isolated tumor cells alone)
CL Item
Macrometastases (Macrometastases)
CL Item
Micrometastases (Micrometastases)
CL Item
None Detected (None detected)
Item
Largest tumor deposit
text
Code List
Largest tumor deposit
CL Item
Isolated Tumor Cells Alone (Isolated tumor cells alone)
CL Item
Macrometastases (Macrometastases)
CL Item
Micrometastases (Micrometastases)
CL Item
None Detected (None detected)
InternalMammarySentinelNodeExaminedTotalNumber
Item
Total number examined
float
C12947 (NCI Thesaurus ObjectClass)
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)
MetastaticInternalMammarySentinelNodeExaminedCount
Item
Number of metastatic internal mammary sentinel nodes
float
C14174 (NCI Thesaurus ObjectClass)
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)
Item
Form completed by (select one)
text
Code List
Form completed by (select one)
CL Item
Pathologist (Pathologist)
CL Item
Investigator (Investigator)
Comments
Item
Comments
text
PathologistorInvestigator'sSignature
Item
Investigator/Pathologist Signature
text
Investigator Signature Date
Item
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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