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T1 Age 2 13 52-year-old T2 Sex 14 17 man T3 History 25 51 30-year history of smoking T4 Sign_symptom 79 85 nodule E1 Sign_symptom:T4 T5 Detailed_description 70 78 abnormal R1 MODIFY Arg1:T5 Arg2:E1 T6 Area 96 108 0.8 × 1.5 cm R2 MODIFY Arg1:T6 Arg2:E1 T7 Biological_structure 116 136 left upper lung lobe R3 MODIFY Arg1:T7 Arg2:E1 T8 Diagnostic_procedure 158 177 computed tomography E2 Diagnostic_procedure:T8 T9 Biological_structure 152 157 chest R4 MODIFY Arg1:T9 Arg2:E2 T10 Diagnostic_procedure 179 181 CT E3 Diagnostic_procedure:T10 R5 IDENTICAL Arg1:E3 Arg2:E2 T11 Date 195 205 March 2012 E4 Date:T11 T12 Nonbiological_location 211 229 community hospital T13 Clinical_event 52 61 presented E5 Clinical_event:T13 R6 MODIFY Arg1:T12 Arg2:E5 T14 History 238 311 previously been well without any additional relevant or abnormal symptoms T15 Diagnostic_procedure 313 333 Physical examination E6 Diagnostic_procedure:T15 T16 Sign_symptom 359 372 abnormalities E7 Sign_symptom:T16 A1 POLARITY E7 NEG T17 Diagnostic_procedure 374 393 Laboratory findings E8 Diagnostic_procedure:T17 T18 Lab_value 399 418 within normal range R7 MODIFY Arg1:T18 Arg2:E8 T19 Diagnostic_procedure 433 457 carcinoembryonic antigen E9 Diagnostic_procedure:T19 T20 Diagnostic_procedure 459 462 CEA E10 Diagnostic_procedure:T20 R8 IDENTICAL Arg1:E10 Arg2:E9 R9 SUB_PROCEDURE Arg1:E9 Arg2:E8 T21 Lab_value 473 484 30.25 ng/mL R10 MODIFY Arg1:T21 Arg2:E9 T22 Biological_structure 524 529 serum R11 MODIFY Arg1:T22 Arg2:T21 T23 Diagnostic_procedure 547 575 positron emission tomography E11 Diagnostic_procedure:T23 T24 Diagnostic_procedure 577 580 PET E12 Diagnostic_procedure:T24 R12 IDENTICAL Arg1:E12 Arg2:E11 T25 Diagnostic_procedure 582 584 CT E13 Diagnostic_procedure:T25 T26 Sign_symptom 604 610 lesion E14 Sign_symptom:T26 T27 Biological_structure 599 603 lung R13 MODIFY Arg1:T27 Arg2:E14 T28 Diagnostic_procedure 618 643 standardized uptake value E15 Diagnostic_procedure:T28 T29 Lab_value 647 651 7.94 R14 MODIFY Arg1:T29 Arg2:E15 R15 MODIFY Arg1:E14 Arg2:E15 T30 Disease_disorder 688 703 malignant tumor E16 Disease_disorder:T30 T31 Therapeutic_procedure 756 765 lobectomy E17 Therapeutic_procedure:T31 T32 Biological_structure 740 755 left upper lung R16 MODIFY Arg1:T32 Arg2:E17 T33 Therapeutic_procedure 770 791 lymph node dissection E18 Therapeutic_procedure:T33 T34 Diagnostic_procedure 807 831 pathological examination E19 Diagnostic_procedure:T34 T35 Disease_disorder 844 858 adenocarcinoma E20 Disease_disorder:T35 T36 Disease_disorder 860 863 ADC E21 Disease_disorder:T36 R17 IDENTICAL Arg1:E21 Arg2:E20 T37 Diagnostic_procedure 875 895 Immunohistochemistry E22 Diagnostic_procedure:T37 T38 Diagnostic_procedure 897 900 IHC E23 Diagnostic_procedure:T38 R18 IDENTICAL Arg1:E23 Arg2:E22 T39 Diagnostic_procedure 937 940 CK7 E24 Diagnostic_procedure:T39 T40 Diagnostic_procedure 942 947 TTF-1 E25 Diagnostic_procedure:T40 T41 Diagnostic_procedure 949 952 p63 E26 Diagnostic_procedure:T41 T42 Diagnostic_procedure 958 965 NapsinA E27 Diagnostic_procedure:T42 T43 Diagnostic_procedure 983 989 CK 5/6 E28 Diagnostic_procedure:T43 T44 Diagnostic_procedure 991 994 Syn E29 Diagnostic_procedure:T44 T45 Diagnostic_procedure 996 999 cgA E30 Diagnostic_procedure:T45 T46 Diagnostic_procedure 1005 1010 Ki-67 E31 Diagnostic_procedure:T46 T47 Lab_value 970 978 negative R19 MODIFY Arg1:T47 Arg2:E28 R20 MODIFY Arg1:T47 Arg2:E29 R21 MODIFY Arg1:T47 Arg2:E30 R22 MODIFY Arg1:T47 Arg2:E31 T48 Lab_value 924 932 positive R23 MODIFY Arg1:T48 Arg2:E24 R24 MODIFY Arg1:T48 Arg2:E25 R25 MODIFY Arg1:T48 Arg2:E26 R26 SUB_PROCEDURE Arg1:E24 Arg2:E22 R27 SUB_PROCEDURE Arg1:E25 Arg2:E22 R28 SUB_PROCEDURE Arg1:E26 Arg2:E22 R29 SUB_PROCEDURE Arg1:E27 Arg2:E22 R30 SUB_PROCEDURE Arg1:E28 Arg2:E22 R31 SUB_PROCEDURE Arg1:E29 Arg2:E22 R32 SUB_PROCEDURE Arg1:E30 Arg2:E22 R33 SUB_PROCEDURE Arg1:E31 Arg2:E22 T49 Diagnostic_procedure 1026 1040 clinical stage E32 Diagnostic_procedure:T49 T50 Lab_value 1059 1062 IA2 R34 MODIFY Arg1:T50 Arg2:E32 T51 Lab_value 1064 1072 pT1bN0M0 R35 MODIFY Arg1:T51 Arg2:E32 T52 Coreference 1087 1092 tumor E33 Coreference:T52 R36 IDENTICAL Arg1:E33 Arg2:E14 T53 Medication 1150 1168 adjuvant treatment E34 Medication:T53 A2 POLARITY E34 NEG T54 Detailed_description 1109 1120 early stage R37 MODIFY Arg1:T54 Arg2:E33 T55 Therapeutic_procedure 1189 1198 monitored E35 Therapeutic_procedure:T55 T56 Clinical_event 1224 1230 visits E36 Clinical_event:T56 T57 Frequency 1231 1245 every 3 months R38 MODIFY Arg1:T57 Arg2:E36 T58 Nonbiological_location 1215 1223 hospital R39 MODIFY Arg1:T58 Arg2:E36 T59 Diagnostic_procedure 1261 1270 condition E37 Diagnostic_procedure:T59 T60 Lab_value 1280 1286 stable R40 MODIFY Arg1:T60 Arg2:E37 T61 Sign_symptom 1317 1321 pain E38 Sign_symptom:T61 T62 Biological_structure 1306 1316 left chest R41 MODIFY Arg1:T62 Arg2:E38 T63 Date 1325 1335 April 2015 E39 Date:T63 T64 Clinical_event 1353 1364 transferred E40 Clinical_event:T64 T65 Nonbiological_location 1372 1380 hospital T66 Nonbiological_location 1384 1406 tertiary care hospital R42 MODIFY Arg1:T65 Arg2:E40 R43 MODIFY Arg1:T66 Arg2:E40 T67 Diagnostic_procedure 1431 1451 Physical examination E41 Diagnostic_procedure:T67 T68 Sign_symptom 1476 1488 tender point E42 Sign_symptom:T68 T69 Biological_structure 1496 1511 left chest wall R44 MODIFY Arg1:T69 Arg2:E42 T70 Severity 1464 1475 significant R45 MODIFY Arg1:T70 Arg2:E42 T71 Diagnostic_procedure 1513 1532 Laboratory findings E43 Diagnostic_procedure:T71 T72 Diagnostic_procedure 1594 1629 cytokeratin19 fragment antigen 21–1 E44 Diagnostic_procedure:T72 T73 Diagnostic_procedure 1631 1640 CYFRA21–1 E45 Diagnostic_procedure:T73 R46 IDENTICAL Arg1:E45 Arg2:E44 T74 Lab_value 1652 1663 17.45 ng/mL T75 Biological_structure 1671 1676 serum R47 MODIFY Arg1:T75 Arg2:T74 R48 MODIFY Arg1:T74 Arg2:E44 R49 SUB_PROCEDURE Arg1:E44 Arg2:E43 T76 Diagnostic_procedure 1707 1709 CT E46 Diagnostic_procedure:T76 T77 Diagnostic_procedure 1714 1717 PET E47 Diagnostic_procedure:T77 T78 Diagnostic_procedure 1718 1720 CT E48 Diagnostic_procedure:T78 T79 Sign_symptom 1751 1762 involvement E49 Sign_symptom:T79 T80 Severity 1743 1750 serious R50 MODIFY Arg1:T80 Arg2:E49 T81 Biological_structure 1766 1777 left pleura R51 MODIFY Arg1:T81 Arg2:E49 T82 Sign_symptom 1802 1809 lesions E50 Sign_symptom:T82 T83 Biological_structure 1797 1801 lung T84 Detailed_description 1787 1796 bilateral R52 MODIFY Arg1:T84 Arg2:E50 R53 MODIFY Arg1:T83 Arg2:E50 T85 Diagnostic_procedure 1845 1859 clinical stage E51 Diagnostic_procedure:T85 T86 Lab_value 1864 1872 upgraded T87 Lab_value 1876 1879 IVB R54 MODIFY Arg1:T86 Arg2:E51 R55 MODIFY Arg1:T87 Arg2:E51 T88 Therapeutic_procedure 1913 1921 puncture E52 Therapeutic_procedure:T88 T89 Biological_structure 1901 1912 left pleura T90 Detailed_description 1891 1900 CT-guided R56 MODIFY Arg1:T89 Arg2:E52 R57 MODIFY Arg1:T90 Arg2:E52 T91 Diagnostic_procedure 1936 1948 IHC analysis E53 Diagnostic_procedure:T91 T92 Diagnostic_procedure 1978 1981 p63 E54 Diagnostic_procedure:T92 T93 Diagnostic_procedure 1983 1986 p40 E55 Diagnostic_procedure:T93 T94 Diagnostic_procedure 1988 1992 CK 7 E56 Diagnostic_procedure:T94 T95 Diagnostic_procedure 1998 2004 CK 5/6 E57 Diagnostic_procedure:T95 T96 Diagnostic_procedure 2012 2017 TTF-1 E58 Diagnostic_procedure:T96 T97 Diagnostic_procedure 2022 2029 NapsinA E59 Diagnostic_procedure:T97 T98 Disease_disorder 2078 2101 squamous cell carcinoma E60 Disease_disorder:T98 T99 Disease_disorder 2103 2106 SCC E61 Disease_disorder:T99 R58 IDENTICAL Arg1:E61 Arg2:E60 T100 Lab_value 1956 1964 positive R59 MODIFY Arg1:T100 Arg2:E54 R60 MODIFY Arg1:T100 Arg2:E55 R61 MODIFY Arg1:T100 Arg2:E56 R62 MODIFY Arg1:T100 Arg2:E57 T101 Lab_value 2044 2050 absent R63 MODIFY Arg1:T101 Arg2:E59 R64 MODIFY Arg1:T101 Arg2:E58 R65 SUB_PROCEDURE Arg1:E54 Arg2:E53 R66 SUB_PROCEDURE Arg1:E55 Arg2:E53 R67 SUB_PROCEDURE Arg1:E56 Arg2:E53 R68 SUB_PROCEDURE Arg1:E57 Arg2:E53 R69 SUB_PROCEDURE Arg1:E58 Arg2:E53 R70 SUB_PROCEDURE Arg1:E59 Arg2:E53 T102 Diagnostic_procedure 2129 2149 molecular evaluation E62 Diagnostic_procedure:T102 T103 Sign_symptom 2163 2177 L858R mutation E63 Sign_symptom:T103 T104 Sign_symptom 2195 2209 T790M mutation E64 Sign_symptom:T104 T105 Detailed_description 2213 2220 exon 20 T106 Detailed_description 2181 2188 exon 21 R71 MODIFY Arg1:T106 Arg2:E63 R72 MODIFY Arg1:T105 Arg2:E64 T107 Other_entity 2237 2437 Considering the pathology of the SCC was quite distinct compared with that of the originally resected NSCLC specimen, we retrospectively reassessed the surgery specimen to verify our primary diagnosis #1 AnnotatorNotes T107 Discussion T108 Other_entity 2439 2605 The morphologic and IHC results were in complete agreement with the initial diagnoses, but an L858R mutation was identified using the newly added molecular evaluation #2 AnnotatorNotes T108 Discussion T109 Therapeutic_procedure 2696 2736 three-dimensional conformal radiotherapy E65 Therapeutic_procedure:T109 T110 Therapeutic_procedure 2738 2744 3D-CRT E66 Therapeutic_procedure:T110 R73 IDENTICAL Arg1:E66 Arg2:E65 T111 Detailed_description 2685 2695 palliative R74 MODIFY Arg1:T111 Arg2:E65 T112 Dosage 2800 2818 42 Gy/14 fractions R75 MODIFY Arg1:T112 Arg2:E65 T113 Frequency 2824 2834 once daily T114 Dosage 2839 2846 5f/week R76 MODIFY Arg1:T113 Arg2:T112 R77 MODIFY Arg1:T114 Arg2:E65 T115 Sign_symptom 2760 2766 lesion E67 Sign_symptom:T115 T116 Biological_structure 2754 2759 chest R78 MODIFY Arg1:T116 Arg2:E67 T117 Medication 3510 3519 gefitinib E68 Medication:T117 T118 Dosage 3521 3530 150 mg qd R79 MODIFY Arg1:T118 Arg2:E68 T119 Date 3566 3584 from November 2015 E69 Date:T119 T120 Medication 3615 3633 Ibandronate sodium E70 Medication:T120 T121 Frequency 3644 3651 monthly R80 MODIFY Arg1:T121 Arg2:E70 T122 Sign_symptom 3656 3679 skeletal-related events E71 Sign_symptom:T122 T123 Diagnostic_procedure 3730 3732 SD E72 Diagnostic_procedure:T123 T124 Diagnostic_procedure 3757 3759 PS E73 Diagnostic_procedure:T124 T125 Lab_value 3770 3771 0 R81 MODIFY Arg1:T125 Arg2:E73 R82 MODIFY Arg1:T125 Arg2:E72 T126 Clinical_event 3706 3724 under surveillance E74 Clinical_event:T126 T127 Diagnostic_procedure 2860 2891 volume over radiation dose 5 Gy E75 Diagnostic_procedure:T127 T128 Lab_value 2945 2948 20% T129 Lab_value 2950 2952 0% T130 Lab_value 2958 2962 7.8% T131 Biological_structure 2911 2915 left T132 Biological_structure 2917 2922 right T133 Biological_structure 2928 2939 total lungs R83 MODIFY Arg1:T131 Arg2:T128 R84 MODIFY Arg1:T132 Arg2:T129 R85 MODIFY Arg1:T133 Arg2:T130 R86 MODIFY Arg1:T128 Arg2:E75 R87 MODIFY Arg1:T129 Arg2:E75 R88 MODIFY Arg1:T130 Arg2:E75 T134 Diagnostic_procedure 2982 3014 volume over radiation dose 20 Gy E76 Diagnostic_procedure:T134 T135 Lab_value 3033 3036 10% T136 Lab_value 3038 3040 0% T137 Lab_value 3046 3048 5% R89 MODIFY Arg1:T135 Arg2:E76 R90 MODIFY Arg1:T136 Arg2:E76 R91 MODIFY Arg1:T137 Arg2:E76 T138 Diagnostic_procedure 3068 3082 mean lung dose E77 Diagnostic_procedure:T138 T139 Lab_value 3093 3097 5 Gy R92 MODIFY Arg1:T139 Arg2:E77 T140 Diagnostic_procedure 3084 3087 MLD E78 Diagnostic_procedure:T140 R93 IDENTICAL Arg1:E78 Arg2:E77 T141 Medication 3178 3193 GP chemotherapy E79 Medication:T141 T142 Medication 3195 3204 cisplatin E80 Medication:T142 T143 Medication 3218 3229 gemcitabine E81 Medication:T143 T144 Dosage 3205 3216 75 mg/m2 d1 T145 Dosage 3230 3247 1250 mg/m2 d1, d8 R94 MODIFY Arg1:T144 Arg2:E80 R95 MODIFY Arg1:T145 Arg2:E81 T146 Lab_value 3277 3285 4 cycles R96 MODIFY Arg1:T146 Arg2:E79 R97 SUB_PROCEDURE Arg1:E80 Arg2:E79 R98 SUB_PROCEDURE Arg1:E81 Arg2:E79 T147 Detailed_description 3253 3271 21 days as a cycle R99 MODIFY Arg1:T147 Arg2:T146 T148 Sign_symptom 3320 3329 remission E82 Sign_symptom:T148 A3 POLARITY E82 MAYBE_POS T149 Detailed_description 3312 3319 partial R100 MODIFY Arg1:T149 Arg2:E82 T150 Date 3335 3349 after 2 cycles E83 Date:T150 T151 Disease_disorder 3363 3377 stable disease E84 Disease_disorder:T151 T152 Disease_disorder 3379 3381 SD E85 Disease_disorder:T152 R101 IDENTICAL Arg1:E85 Arg2:E84 T153 Date 3383 3397 after 4 cycles E86 Date:T153 T154 Diagnostic_procedure 3445 3489 response evaluation criteria in solid tumors E87 Diagnostic_procedure:T154 T155 Diagnostic_procedure 3491 3497 RECIST E88 Diagnostic_procedure:T155 R102 IDENTICAL Arg1:E88 Arg2:E87 T156 Detailed_description 3499 3502 1.1 R103 MODIFY Arg1:T156 Arg2:E87 * OVERLAP E5 E1 E2 E4 E6 E8 E11 E13 E14 E15 E16 R104 BEFORE Arg1:E16 Arg2:E17 * OVERLAP E17 E18 R105 BEFORE Arg1:E18 Arg2:E19 * OVERLAP E19 E20 E22 E32 R106 BEFORE Arg1:E32 Arg2:E33 * OVERLAP E33 E34 E35 E36 R107 BEFORE Arg1:E36 Arg2:E37 R108 BEFORE Arg1:E37 Arg2:E38 * OVERLAP E38 E39 R109 BEFORE Arg1:E39 Arg2:E40 * OVERLAP E40 E41 E42 E43 E46 E47 E48 E49 E50 E51 R110 BEFORE Arg1:E51 Arg2:E52 R111 BEFORE Arg1:E52 Arg2:E53 * OVERLAP E53 E60 E62 E63 E64 R112 BEFORE Arg1:E64 Arg2:E65 * OVERLAP E65 E67 E75 E76 E77 E79 R113 BEFORE Arg1:E79 Arg2:E82 * OVERLAP E82 E83 R114 BEFORE Arg1:E83 Arg2:E84 * OVERLAP E84 E86 E87 R115 BEFORE Arg1:E87 Arg2:E68 * OVERLAP E68 E69 E70 E71 R116 BEFORE Arg1:E71 Arg2:E74 * OVERLAP E74 E72 E73