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)
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)
AccessionNumber
Item
Accession Number (enter all that apply 123)
double
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)
Code List
Is measurement gross or microscopic? (mark one)
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
Type DCIS (mark one)
text
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
Code List
Growth Patterns (mark all that apply)
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
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
Nuclear Grade (by SBR criteria; mark highest grade)
text
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
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
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
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