Form:	Lung Reference Clinical for Case Set B v1.0

CDE ID	CDE Description
* 1063	Site Participant ID (Go To: 422)
* 422	EDRN Site ID (Go To: 423)
* 423	EDRN Protocol ID (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 2655)
* 2655	Proposed study group (Go To: 1292)
	Permissible Values (value): Set B Cases: Lung cancer (CT screening) (6)
1292	Height [in inches] (What is your total current height in inches?) (Go To: 1295)
1295	Weight [in pounds] (What is your current weight [in pounds]? (Go To: 1216)
* 1216	Date of diagnosis of lung cancer (histological or cytopathological report) (MM/DD/YYYY): (Go To: 3174)
3174	Date (YYYY) of diagnosis of lung cancer (histological or cytopathological report) (Go To: 1302)
1302	Age at diagnosis (Go To: 1220)
1338	Histologic confirmation? (Go To: 1257)
	Permissible Values (value): No (0)
	Yes (1)
1257	Histologic type (lung): (Go To: 1241)
	Permissible Values (value): Squamous cell carcinoma (1)
	Papillary squamous cell carcinoma (2)
	Clear cell squamous cell carcinoma (3)
	Small cell squamous cell carcinoma (4)
	Basaloid squamous cell carcinoma (5)
	Small cell carcinoma (6)
	Combined small cell carcinoma (7)
	Adenocarcinoma (8)
	Acinar adenocarcinoma (9)
	Papillary adenocarcinoma (10)
	Bronchioloalveolar carcinoma (11)
	Non-mucinous (12)
	Mucinous (13)
	Mixed mucinous and non-mucinous or indeterminate (14)
	Solid adenocarcinoma with mucin formation (15)
	Adenocarcinoma with mixed subtypes (16)
	Large cell carcinoma (17)
	Other (95)
	Unknown/refused (99)
1241	Histologic dimensions - height (cm): (Go To: 1242)
1242	Histologic dimensions - width (cm): (Go To: 1243)
1243	Histologic dimensions - depth (cm): (Go To: 1244)
1244	Histologic dimensions - volume (ml): (Go To: 1245)
1245	Distance/pleural margin (mm): (Go To: 1246)
1246	Distance/bronchial margin (mm): (Go To: 720)
720	Anatomical site (Go To: 1217)
	Permissible Values (value): Bladder (1)
	Bladder peritoneum (2)
	Bowel peritoneum/serosa (3)
	Corpus (4)
	Cervix (5)
	Cul-de-sac (6)
	Diaphram (7)
	Fallopian tube (8)
	Omentum (9)
	Paracolic gutter (10)
	Pelvic wall (11)
	Peritoneum/uterine serosa (12)
	Vagina (13)
	Ovary (14)
	Mainstem bronchus (15)
	Carina (16)
	Upper lobe (UL) (17)
	Lower lobe (LL) (18)
	Middle lobe (ML) (19)
	Ureter (20)
	Renal pelvis (21)
	Endometrium (22)
	Lymph node (25)
	Other (95)
	Other, specify: (97)
	Responses are organ-specific (999)
1217	Date of thoracotomy (MM/DD/YYYY): (Go To: 1234)
1234	Chest X-ray date (MM/DD/YYYY): (Go To: 1235)
1235	Chest X-ray nodule size (cm): (Go To: 1236)
1236	Chest X-ray nodule location: (Go To: 2656)
2656	Chest X-ray nodule shape: (Go To: 1237)
	Permissible Values (value): Smooth (0)
	Lobulated (2)
	Spiculated (5)
	Unknown (99)
1237	Chest CT date: (Go To: 1238)
1238	Chest CT nodule size (cm): (Go To: 1239)
1239	Chest CT nodule location: (Go To: 2657)
2657	CT nodule shape: (Go To: 1268)
	Permissible Values (value): Smooth (0)
	Lobulated (2)
	Spiculated (5)
	Unknown (99)
1268	PET scan date (MM/YYYY): (Go To: 1269)
1269	PET scan standardized uptake value (SUV) for the lesion: (Go To: 1273)
	Permissible Values (value): Less than 2.5 (1)
	Greater than or equal to 2.5 (2)
1273	PET scan standardized uptake value (SUV) for the liver: (Go To: 1274)
1274	PET scan other hotspots: (Go To: 786)
	Permissible Values (value): Mediastinum (1)
	Bone (2)
	Brain (3)
	Adrenal (5)
	Liver (10)
	Lung (12)
	None (44)
786	Lung T-Stage, Pathologic (Go To: 789)
	Permissible Values (value): pTX (1)
	pT0 (2)
	pTis (4)
	pT1 (8)
	pT2 (13)
	pT3 (16)
	pT4 (19)
789	Lung N-Stage, Pathologic (Go To: 790)
	Permissible Values (value): pNX (1)
	pN0 (2)
	pN1 (7)
	pN2 (12)
	pN3 (15)
790	Lung M-Stage, Pathologic (Go To: 785)
	Permissible Values (value): pMX (1)
	pM0 (2)
	pM1 (3)
785	Lung T-Stage, Clinical (Go To: 787)
	Permissible Values (value): TX (1)
	T0 (2)
	Tis (3)
	T1 (4)
	T2 (5)
	T3 (6)
	T4 (7)
787	Lung N-Stage, Clinical (Go To: 788)
	Permissible Values (value): NX (1)
	N0 (2)
	N1 (3)
	N2 (4)
	N3 (5)
788	Lung M-Stage, Clinical (Go To: 1240)
	Permissible Values (value): MX (1)
	M0 (2)
	M1 (3)
1240	Reported adenopathy > 1 cm in the mediastinum at time of diagnosis? (Go To: 1268)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
1266	Other lung diseases participant has: (Go To: 1249)
	Permissible Values (value): COPD (1)
	Asthma (2)
	Pulmonary fibrosis (3)
	Sarcoidosis (4)
	Granulomatosis (5)
	Cavitary lesion (6)
	Bronchiectasis (7)
1249	Pulmonary function test date (MM/DD/YYYY): (Go To: 1250)
1250	FVC liters (Go To: 1251)
1251	FVC % predicted: (Go To: 1252)
1252	FEV1 liters: (Go To: 1253)
1253	FEV1 % predicted: (Go To: 1254)
1254	FEV1/FVC (Go To: 1255)
1255	DLCO liters/minute/mmhg (Go To: 1256)
1256	DLCO % predicted: (Go To: 2148)
2148	Primary cancer treatment(s) received: (Go To: 1258)
	Permissible Values (value): Chemotherapy (1)
	Radiation therapy (2)
	Surgery (3)
	Hormone therapy (4)
	Cryotherapy (5)
	LHRH agonists or anti-androgens hormone therapy (6)
	Other hormone therapy (e.g. testosterone patch) (7)
	Unknown/refused (9)
	None (44)
	Other (95)
1258	Chemotherapy treatment(s) received: [specify drug(s)] (Go To: 1259)
1259	Chemotherapy start date (MM/YYYY): (Go To: 1260)
1260	Chemotherapy end date (MM/YYYY): (Go To: 1261)
1261	Radiation therapy received: (specify site) (Go To: 1262)
1262	Radiation therapy start date: (MM/YYYY): (Go To: 1263)
1263	Radiation therapy end date: (MM/YYYY): (Go To: 1264)
1264	Total dose to chest: (cGy) (Go To: 1265)
1265	Total dose to other organ(s): (cGy) (Go To: 1282)
1282	Radiation therapy (RT) volume [cubic mm]: (Go To: 1281)
1281	Radiation therapy (RT) complications: (Go To: 1279)
	Permissible Values (value): Pneumonitis requiring steroids (1)
	Esophagitis requiring IVF (2)
	Feeding tube (3)
	Hospitalization (4)
	Other (95)
1279	Response to treatment (imaging criteria) (Go To: 1278)
	Permissible Values (value): No (0)
	Yes (1)
1278	Date of response (MM/DD/YYYY): (Go To: 1221)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)