Form:	MSA Follow-up Cystoscopy Procedure and Results v1.2

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 876)
* 876	Date of cystoscopy (MM/DD/YYYY): (Go To: 422)
* 422	EDRN Site ID (Go To: 423)
* 423	EDRN Protocol ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 773)
* 773	Visit code (Go To: 914)
	Permissible Values (value): F03 (5)
	F06 (6)
	F09 (7)
	F12 (8)
	F15 (9)
	F18 (10)
	F21 (11)
	F24 (12)
914	Date cystoscopy report completed (MM/DD/YYYY): (Go To: 835)
* 835	Presence of bladder cancer based on cystoscopy report: (Go To: 838)
	Permissible Values (value): Bladder cancer absent (1)
	Bladder cancer present (2) (Go To: 837)
	Indeterminate (7)
837	Number of primary tumors visualized during cystoscopy: (Go To: 842)
	Permissible Values (value): Solitary (1)
	Multiple (2)
	Not reported (3)
	Indeterminate (7)
842	Bladder T-Stage, Clinical (Go To: 836)
	Permissible Values (value): TX (1)
	T0 (2)
	Ta (3)
	Tis (4)
	T1 (5)
	T2 (6)
	T3 (7)
	T4 (8)
	T4a (9)
	T4b (10)
836	Was carcinoma in situ (CIS) visualized during cystoscopy? (Go To: 838)
	Permissible Values (value): No (0)
	Yes (1)
	Indeterminate (7)
* 838	Did cystoscopy generate a pathology report? (Go To: End of Form)
	Permissible Values (value): No (0)
	Yes (1)
* 1075	Presence of bladder malignancy based on pathology report (Go To: 844)
	Permissible Values (value): Malignancy absent (1)
	Malignancy present (2) (Go To: 1203)
	Inconclusive (3)
* 1203	How many primary bladder tumors were pathologically confirmed? (Go To: 1209)
* 1209	Pathology information for tumor number: (Go To: 711)
* 711	Histologic classification (WHO) (Go To: 911)
	Permissible Values (value): Urothelial carcinoma (Transitional carcinoma) (1)
	Sarcomatoid carcinoma (3)
	Adenocarcinoma (4)
	Small cell carcinoma (5)
	Squamous cell carcinoma (6)
	Other, specify: (97) (Go To: 718)
718	Histologic classification (WHO) (Other, specify) (Go To: 911)
* 911	Is the tumor invasive? (Go To: 1082)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 910)
* 1082	Histologic type (non-invasive): (Go To: 909)
	Permissible Values (value): Papilloma (1)
	Papillary neoplasm of low malignant potential (2)
	Non-invasive low grade papillary carcinoma (3)
	Non-invasive high grade papillary carcinoma (4)
	Flat carcinoma in situ (5)
	Other, specify: (97) (Go To: 1083)
1083	Histologic type (non-invasive) [other, specify]: (Go To: 909)
* 910	Histologic type (invasive): (Go To: 909)
	Permissible Values (value): Lamina propria (1)
	Muscularis propria (2)
909	Histologic grade (WHO/ISUP): (Go To: 844)
	Permissible Values (value): Low grade (1)
	High grade (2)
844	Date pathology report completed (MM/DD/YYYY): (Go To: 839)
839	ID number of local pathology report: (Go To: End of Form)