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 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
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
AmendedDataInd
Item
Are data amended? (If Yes, circle the amended items in red.)
boolean
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
AccessionNumber
Item
Accession Number (enter all that apply 123)
float
Item Group
Pathology report
C0807321 (UMLS CUI-1)
Tumor size
Item
Pathologic Primary Tumor Size (cm leave blank if not directly measurable)
float
C25209 (NCI Thesaurus ValueDomain)
C0475440 (UMLS CUI-1)
Item
Is measurement gross or microscopic? (mark one)
text
C2924 (NCI Thesaurus ObjectClass)
C25252 (NCI Thesaurus Property)
C43566 (NCI Thesaurus Property-2)
C25681 (NCI Thesaurus Property-3)
C25356 (NCI Thesaurus Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0205288 (UMLS CUI-1)
C0439806 (UMLS CUI-2)
CL.2
Code List
Is measurement gross or microscopic? (mark one)
CL Item
Gross (Gross)
C0439806 (UMLS CUI-1)
CL Item
Microscopic (Microscopic)
C25252 (NCI Thesaurus)
C0205288 (UMLS CUI-1)
CL Item
Not Directly Measurable (Not directly measurable)
C1518373 (UMLS CUI-1)
EstimatedSize
Item
Estimated Size (cm best guess, if possible)
text
Number of slides with DCIS
Item
Number of slides with DCIS present
integer
Total slides examined for DCIS
Item
Total slides examined for DCIS
integer
Item
Type DCIS (mark one)
text
C0007124 (UMLS CUI-1)
C0008902 (UMLS CUI-2)
CL.3
Code List
Type DCIS (mark one)
CL Item
Comedo (Comedo)
C26453 (NCI Thesaurus)
C0279559 (UMLS CUI-1)
CL Item
Non-comedo (Non-comedo)
C1334250 (UMLS CUI-1)
Item
Growth Patterns (mark all that apply)
text
C0449574 (UMLS CUI-1)
CL.4
Code List
Growth Patterns (mark all that apply)
CL Item
Solid (Solid)
C0205208 (UMLS CUI-1)
CL Item
Cribriform (Cribriform)
C1621425 (UMLS CUI-1)
CL Item
Micropapillary (Micropapillary)
C1334756 (UMLS CUI-1)
CL Item
Papillary (Papillary)
C0205312 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
HistologicType,OtherName
Item
Other, specify
text
Item
Dominant Growth Pattern (mark only one)
text
CL.4
Code List
Dominant Growth Pattern (mark only one)
CL Item
Solid (Solid)
C0205208 (UMLS CUI-1)
CL Item
Cribriform (Cribriform)
C1621425 (UMLS CUI-1)
CL Item
Micropapillary (Micropapillary)
C1334756 (UMLS CUI-1)
CL Item
Papillary (Papillary)
C0205312 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
HistologicType,Dominant,Other
Item
Other, specify
text
Percent Central Necrosis
Item
Percent Central Necrosis (% estimated necrotic surface area of DCIS associated with any growth pattern)
integer
C1265871 (UMLS CUI-1)
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
Microcalcifications (mark one)
text
C0520594 (UMLS CUI-1)
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
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)
float
Pathologist
Item
Pathologist Completing Form (print name signature)
text
C25191 (NCI Thesaurus ValueDomain)
C40988 (NCI Thesaurus Property)
C25250 (NCI Thesaurus Property-2)
C17723 (NCI Thesaurus ObjectClass)
C0334866 (UMLS CUI-1)
Pathologist Telephone Number
Item
Pathologist's Phone Number
text
C25337 (NCI Thesaurus ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C17723 (NCI Thesaurus ObjectClass)
C40978 (NCI Thesaurus Property)
C0334866 (UMLS CUI-1)
C1515258 (UMLS CUI-2)
FormCompletionDate,Original
Item
Date Form Completed
date
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