ID

758

Descrizione

CALGB: HER-2/NEU Status Form Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D12AD-990B-4739-E034-0003BA0B1A09

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D12AD-990B-4739-E034-0003BA0B1A09

Keywords

  1. 26/08/12 26/08/12 -
  2. 22/05/15 22/05/15 -
  3. 03/06/15 03/06/15 -
Caricato su

26 agosto 2012

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy

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Breast Cancer NCT00053339 Pathology - CALGB: HER-2/NEU Status Form - 2029244v3.0

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. Do not leave any entries blank. Enter -1 to indicate that an answer in unknown, unobtainable, not applicable, or not done. Retain a copy for your records and submit ORIGINAL to the CALGB Data Management Center.

Unnamed1
Descrizione

Unnamed1

CALGB Form
Descrizione

CALGBForm

Tipo di dati

text

CALGB Study No
Descrizione

CALGBStudyNo

Tipo di dati

text

CALGB Patient ID
Descrizione

CALGBPatientID

Tipo di dati

text

Amended data?
Descrizione

AmendedDataInd

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Unnamed2
Descrizione

Unnamed2

Patient's Name
Descrizione

Patient'sName

Tipo di dati

text

Participating Group
Descrizione

ParticipatingGroup

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital Number
Descrizione

PatientHospitalNumber

Tipo di dati

text

Participating Group Protocol No.
Descrizione

ParticipatingGroupProtocolNo.

Tipo di dati

text

Main Member Institution/Adjunct
Descrizione

AffiliateName

Tipo di dati

text

Participating Group Patient No.
Descrizione

ParticipatingGroupPatientID

Tipo di dati

text

Sample Data
Descrizione

Sample Data

Could the tissue sample be evaluated?
Descrizione

SpecimenCondition

Tipo di dati

text

If no, specify reason (sample could not be evaluated)
Descrizione

Ifno,specifyreason(samplecouldnotbeevaluated)

Tipo di dati

text

Testing Data
Descrizione

Testing Data

Tumor site tested
Descrizione

Tumorsitetested

Tipo di dati

text

Staining antibody used for IHC
Descrizione

StainingAntibody

Tipo di dati

text

Other, specify (staining antibody)
Descrizione

StainingAntibody,Other

Tipo di dati

text

Serum ECD test
Descrizione

SerumECDtest

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other, specify (serum ECD test)
Descrizione

Other,specify(serumECDtest)

Tipo di dati

text

Method of testing
Descrizione

TumorMarkerTestMethod

Tipo di dati

text

Kit used for FISH
Descrizione

FISHKitorTestType

Tipo di dati

text

Other, specify (FISH Kit)
Descrizione

FISHKitorTestType,Other

Tipo di dati

double

Testing Results
Descrizione

Testing Results

Her-2/neu Status
Descrizione

HER2/neuFinalDiagnosis

Tipo di dati

text

IHC Lab value
Descrizione

HerceptestScore

Tipo di dati

text

Completed by
Descrizione

PersonCompletingForm,FirstName

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Date completed
Descrizione

FormCompletionDate,Original

Tipo di dati

date

Ccrr Module For Calgb: Her-2/neu Status Form
Descrizione

Ccrr Module For Calgb: Her-2/neu Status Form

Similar models

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. Do not leave any entries blank. Enter -1 to indicate that an answer in unknown, unobtainable, not applicable, or not done. Retain a copy for your records and submit ORIGINAL to the CALGB Data Management Center.

Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Unnamed1
CALGBForm
Item
CALGB Form
text
CALGBStudyNo
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
Item
Amended data?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
Code List
Amended data?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Unnamed2
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital Number
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
AffiliateName
Item
Main Member Institution/Adjunct
text
ParticipatingGroupPatientID
Item
Participating Group Patient No.
text
Item Group
Sample Data
Item
Could the tissue sample be evaluated?
text
Code List
Could the tissue sample be evaluated?
CL Item
Damaged Or Unusable (no)
CL Item
Useable (yes)
Ifno,specifyreason(samplecouldnotbeevaluated)
Item
If no, specify reason (sample could not be evaluated)
text
Item Group
Testing Data
Item
Tumor site tested
text
Code List
Tumor site tested
CL Item
Primary (primary)
C25251 (NCI Thesaurus)
C0205225 (UMLS 2011AA)
CL Item
Metastatic (metastatic)
C14174 (NCI Thesaurus)
C0036525 (UMLS 2011AA)
Item
Staining antibody used for IHC
text
Code List
Staining antibody used for IHC
CL Item
Cb-11/ventana Kit (CB11)
CL Item
Dako Herceptest [tm] (DAKO A0485 [Herceptest])
CL Item
Other, Specify (Other, specify)
StainingAntibody,Other
Item
Other, specify (staining antibody)
text
Item
Serum ECD test
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Serum ECD test
CL Item
Other, Specify (Other, specify)
Other,specify(serumECDtest)
Item
Other, specify (serum ECD test)
text
Item
Method of testing
text
Code List
Method of testing
CL Item
Immunohistochemistry (ihc) (Immunohistochemistry (IHC))
CL Item
Fluorescence In Situ Hybridization (fish) (Fluorescent in-situ hybridization (FISH))
Item
Kit used for FISH
text
Code List
Kit used for FISH
CL Item
Vysis/path Vysion[tm] (Vysis)
CL Item
Ventana/oncorprobe[tm] (Ventana)
CL Item
Other, Specify (Other, specify)
FISHKitorTestType,Other
Item
Other, specify (FISH Kit)
double
Item Group
Testing Results
Item
Her-2/neu Status
text
Code List
Her-2/neu Status
CL Item
Negative (negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
Item
IHC Lab value
text
Code List
IHC Lab value
CL Item
0 (0 or 0% cells staining)
C0919414 (NCI Metathesaurus)
CL Item
1+ (1 or 1-10% cells staining)
CL Item
2+ (2 or 11-49% cells staining)
CL Item
3+ (3 or 50-100% cells staining)
PersonCompletingForm,FirstName
Item
Completed by
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
FormCompletionDate,Original
Item
Date completed
date
Item Group
Ccrr Module For Calgb: Her-2/neu Status Form

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