HL7 FHIR Implementation Guide: Breast Cancer Data, Release 1 - US Realm (Draft for Comment 2)
This page is part of the Breast Cancer Data Logical Models and FHIR Profiles (v0.2.0: STU 1 Draft) based on FHIR R3. . For a full list of available versions, see the Directory of published versions 
<StructureDefinition xmlns="http://hl7.org/fhir"> <id value="oncology-BreastCancerStageTopic-model"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <p><b>BC BreastCancerStageTopic Logical Model</b></p> <p>The topic class for describing a breast cancer staging observation.</p> </div> </text> <url value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerStageTopic-model"/> <identifier> <system value="http://hl7.org/fhir/us/breastcancer"/> <value value="oncology.BreastCancerStageTopic"/> </identifier> <version value="0.2.0"/> <name value="BreastCancerStageTopicModel"/> <title value="BC BreastCancerStageTopic Logical Model"/> <status value="draft"/> <date value="2018-08-17T00:00:00+10:00"/> <publisher value="The HL7 Cancer Interoperability Group sponsored by Clinical Interoperability Council Work Group (CIC)"/> <contact> <telecom> <system value="url"/> <value value="http://www.hl7.org/Special/committees/cic/index.cfm"/> </telecom> </contact> <description value="The topic class for describing a breast cancer staging observation."/> <kind value="logical"/> <abstract value="false"/> <type value="oncology-BreastCancerStageTopic-model"/> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Element"/> <derivation value="specialization"/> <snapshot> <element id="oncology-BreastCancerStageTopic-model"> <path value="oncology-BreastCancerStageTopic-model"/> <definition value="The topic class for describing a breast cancer staging observation."/> <min value="0"/> <max value="*"/> <base> <path value="oncology-BreastCancerStageTopic-model"/> <min value="0"/> <max value="*"/> </base> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode"> <path value="oncology-BreastCancerStageTopic-model.topicCode"/> <short value="The concept representing the finding or action that is the topic of the statement."/> <definition value="The concept representing the finding or action that is the topic of the statement. For action topics, the TopicCode represents the action being described. For findings, the TopicCode represents the 'question' or property being investigated. For evaluation result findings, the TopicCode contains a concept for an observable entity, such as systolic blood pressure. For assertion findings, the TopicCode contains a code representing the condition, allergy, or other item being asserted. In all cases, the TopicCode describes the topic independent of the context of the action or the finding."/> <min value="1"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.topicCode"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.id"> <path value="oncology-BreastCancerStageTopic-model.topicCode.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.extension"> <path value="oncology-BreastCancerStageTopic-model.topicCode.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.system"> <path value="oncology-BreastCancerStageTopic-model.topicCode.system"/> <short value="Identity of the terminology system"/> <definition value="The identification of the code system that defines the meaning of the symbol in the code."/> <comment value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously."/> <requirements value="Need to be unambiguous about the source of the definition of the symbol."/> <min value="1"/> <max value="1"/> <base> <path value="Coding.system"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <fixedUri value="http://ncimeta.nci.nih.gov"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.3"/> </mapping> <mapping> <identity value="rim"/> <map value="./codeSystem"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.version"> <path value="oncology-BreastCancerStageTopic-model.topicCode.version"/> <short value="Version of the system - if relevant"/> <definition value="The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged."/> <comment value="Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.version"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.7"/> </mapping> <mapping> <identity value="rim"/> <map value="./codeSystemVersion"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.code"> <path value="oncology-BreastCancerStageTopic-model.topicCode.code"/> <short value="Symbol in syntax defined by the system"/> <definition value="A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination)."/> <requirements value="Need to refer to a particular code in the system."/> <min value="1"/> <max value="1"/> <base> <path value="Coding.code"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <fixedCode value="C2216702"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.1"/> </mapping> <mapping> <identity value="rim"/> <map value="./code"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.display"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true"/> </extension> <path value="oncology-BreastCancerStageTopic-model.topicCode.display"/> <short value="Representation defined by the system"/> <definition value="A representation of the meaning of the code in the system, following the rules of the system."/> <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know the system."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.display"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.2 - but note this is not well followed"/> </mapping> <mapping> <identity value="rim"/> <map value="CV.displayName"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.userSelected"> <path value="oncology-BreastCancerStageTopic-model.topicCode.userSelected"/> <short value="If this coding was chosen directly by the user"/> <definition value="Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays)."/> <comment value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely."/> <requirements value="This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.userSelected"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="Sometimes implied by being first"/> </mapping> <mapping> <identity value="rim"/> <map value="CD.codingRationale"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.findingMethod"> <path value="oncology-BreastCancerStageTopic-model.findingMethod"/> <short value="The technique used to create the finding, for example, the specific imaging technical, lab test code, or assessment vehicle."/> <definition value="The technique used to create the finding, for example, the specific imaging technical, lab test code, or assessment vehicle."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.findingMethod"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="preferred"/> <valueSetReference> <reference value="http://loinc.org/vs"/> </valueSetReference> </binding> </element> <element id="oncology-BreastCancerStageTopic-model.details"> <path value="oncology-BreastCancerStageTopic-model.details"/> <code> <system value="http://ncimeta.nci.nih.gov"/> <code value="C0947611"/> </code> <short value="A text note containing additional details, explanation, description, comment, or summarization. Details can discuss, support, explain changes to, or dispute information."/> <definition value="A text note containing additional details, explanation, description, comment, or summarization. Details can discuss, support, explain changes to, or dispute information."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.details"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.media"> <path value="oncology-BreastCancerStageTopic-model.media"/> <short value="A file that contains audio, video, image, or similar content."/> <definition value="A file that contains audio, video, image, or similar content."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.media"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-Media-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.category"> <path value="oncology-BreastCancerStageTopic-model.category"/> <short value="A class or division of people or things having particular shared characteristics"/> <definition value="A class or division of people or things having particular shared characteristics"/> <min value="1"/> <max value="*"/> <base> <path value="oncology-BreastCancerStageTopic-model.category"/> <min value="1"/> <max value="*"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="extensible"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/observation-category"/> </valueSetReference> </binding> </element> <element id="oncology-BreastCancerStageTopic-model.anatomicalLocation"> <path value="oncology-BreastCancerStageTopic-model.anatomicalLocation"/> <code> <system value="http://loinc.org"/> <code value="72369-2"/> </code> <short value="A location or structure in the body, including tissues, regions, cavities, and spaces; for example, right elbow, or left ventricle of the heart."/> <definition value="A location or structure in the body, including tissues, regions, cavities, and spaces; for example, right elbow, or left ventricle of the heart."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.anatomicalLocation"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-element-AnatomicalLocation-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.device"> <path value="oncology-BreastCancerStageTopic-model.device"/> <short value="A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients."/> <definition value="A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.device"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-entity-Device-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.specimen"> <path value="oncology-BreastCancerStageTopic-model.specimen"/> <short value="A specimen is a substance, physical object, or collection of objects, that the laboratory considers a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory workflow. A specimen may include multiple physical pieces as long as they are considered a single unit within the laboratory workflow. A specimen results from one to many specimen collection procedures, and may be contained in multiple specimen containers. Specimen may have one or more processing activities."/> <definition value="A specimen is a substance, physical object, or collection of objects, that the laboratory considers a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory workflow. A specimen may include multiple physical pieces as long as they are considered a single unit within the laboratory workflow. A specimen results from one to many specimen collection procedures, and may be contained in multiple specimen containers. Specimen may have one or more processing activities."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.specimen"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-entity-Specimen-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.precondition"> <path value="oncology-BreastCancerStageTopic-model.precondition"/> <short value="A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar."/> <definition value="A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.precondition"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Coding"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-statement-Observation-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.referenceRange"> <path value="oncology-BreastCancerStageTopic-model.referenceRange"/> <code> <system value="http://ncimeta.nci.nih.gov"/> <code value="C0883335"/> </code> <short value="The usual or acceptable range for a test result."/> <definition value="The usual or acceptable range for a test result."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.referenceRange"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-topic-ReferenceRange-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.evaluationComponent"> <path value="oncology-BreastCancerStageTopic-model.evaluationComponent"/> <short value="A simplified, non-separable evaluation consisting of a finding code (represented by the Concept), value (or exception value), reference range, and interpretation. The subject of the evaluation component is the same as in the parent evaluation."/> <definition value="A simplified, non-separable evaluation consisting of a finding code (represented by the Concept), value (or exception value), reference range, and interpretation. The subject of the evaluation component is the same as in the parent evaluation."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.evaluationComponent"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-topic-EvaluationComponent-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers"> <path value="oncology-BreastCancerStageTopic-model.panelMembers"/> <short value="PanelMembers represent the elements of a group of a related but independent evaluations."/> <definition value="PanelMembers represent the elements of a group of a related but independent evaluations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent evaluation, but the grouping reflects a composite lab order, shared specimen, or a single report author. Typically the Category and Reason are not given for individual findings that are part of the panel, but rather given at the level of the panel itself."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation"/> <short value="Represents the result of evaluations (measurements, tests, or questions) that have been performed."/> <definition value="Represents the result of evaluations (measurements, tests, or questions) that have been performed. Observation has a value representing the result (answer), or an ExceptionValue indicating why the value is not present. The subject of a finding can be the entire patient, or an entity such as a location body structure, intervention, or condition. Things observed about the subject can include social and behavioral factors, subjective and objective observations, and assessments."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation"/> <min value="0"/> <max value="1"/> </base> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerPrimaryTumorClassification"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerPrimaryTumorClassification"/> <code> <system value="http://snomed.info/sct"/> <code value="78873005"/> <display value="T category"/> </code> <short value="The size and extent of the primary tumor, based on criteria defined by the staging system being used."/> <definition value="The size and extent of the primary tumor, based on criteria defined by the staging system being used."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerPrimaryTumorClassification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerPrimaryTumorClassification-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerRegionalNodesClassification"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerRegionalNodesClassification"/> <code> <system value="http://snomed.info/sct"/> <code value="277206009"/> <display value="N category"/> </code> <short value="The presence of metastases in regional lymph nodes, based on criteria defined by the staging system being used."/> <definition value="The presence of metastases in regional lymph nodes, based on criteria defined by the staging system being used."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerRegionalNodesClassification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerRegionalNodesClassification-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerDistantMetastasesClassification"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerDistantMetastasesClassification"/> <code> <system value="http://snomed.info/sct"/> <code value="277208005"/> <display value="M category (observable entity)"/> </code> <short value="The presence of distant metastases, based on criteria defined by the staging system being used."/> <definition value="The presence of distant metastases, based on criteria defined by the staging system being used."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerDistantMetastasesClassification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerDistantMetastasesClassification-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.hER2ReceptorStatus"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.hER2ReceptorStatus"/> <code> <system value="http://loinc.org"/> <code value="48676-1"/> <display value="HER2 [Interpretation] in Tissue"/> </code> <short value="HER2 receptor status. HER2 is a member of the human epidermal growth factor receptor family of proteins and is encoded by the ERBB2 oncogene. HER2 is overexpressed in 20-30% of breast tumors, and is associated with an aggressive clinical course and poor prognosis. HER2 status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options."/> <definition value="HER2 receptor status. HER2 is a member of the human epidermal growth factor receptor family of proteins and is encoded by the ERBB2 oncogene. HER2 is overexpressed in 20-30% of breast tumors, and is associated with an aggressive clinical course and poor prognosis. HER2 status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.hER2ReceptorStatus"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-HER2ReceptorStatus-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.estrogenReceptorStatus"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.estrogenReceptorStatus"/> <code> <system value="http://loinc.org"/> <code value="16112-5"/> <display value="Estrogen receptor [Interpretation] in Tissue"/> </code> <short value="Estrogen receptor alpha is the predominant estrogen receptor expressed in breast tissue and is overexpressed in around 50% of breast carcinomas. ER status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options."/> <definition value="Estrogen receptor alpha is the predominant estrogen receptor expressed in breast tissue and is overexpressed in around 50% of breast carcinomas. ER status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options. The current approach is that positive/negative designation is a value, even though that value is (in fact) an interpretation of evidence (NuclearPositivity and AverageStainingIntensity)."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.estrogenReceptorStatus"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-EstrogenReceptorStatus-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.progesteroneReceptorStatus"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.progesteroneReceptorStatus"/> <code> <system value="http://loinc.org"/> <code value="16113-3"/> <display value="Progesterone receptor [Interpretation] in Tissue"/> </code> <short value="Progesterone receptor status is a factor in determining prognosis and treatment options. The value is the percentage of cells that test (stain) positive for the presence of a receptor. The interpretation of positive or negative (found in the interpretation property) is based on the staining percentage, and may take into account the staining intensity."/> <definition value="Progesterone receptor status is a factor in determining prognosis and treatment options. The value is the percentage of cells that test (stain) positive for the presence of a receptor. The interpretation of positive or negative (found in the interpretation property) is based on the staining percentage, and may take into account the staining intensity. Based on discussion with Cancer Interoperability Group subject matter experts, there was insufficient rationale to include the following components in the data model: StainingControl, PrimaryAntibody, Allred Score (both total and component scores). We are seeking feedback on whether or not those components should be included in this model."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.progesteroneReceptorStatus"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-ProgesteroneReceptorStatus-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.dCISNuclearGrade"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.dCISNuclearGrade"/> <code> <system value="urn:tbd"/> <code value="TBD"/> <display value="Nuclear Grade"/> </code> <short value="An evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade. In breast cancer, nuclear grade is typically evaluated for ductal carcinoma in situ (DCIS) only. There is currently no concept code for DCIS Nuclear Grade in LOINC, SNOMED, or NCI Metathesaurus."/> <definition value="An evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade. In breast cancer, nuclear grade is typically evaluated for ductal carcinoma in situ (DCIS) only. There is currently no concept code for DCIS Nuclear Grade in LOINC, SNOMED, or NCI Metathesaurus."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.dCISNuclearGrade"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-DCISNuclearGrade-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerHistologicGrade"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerHistologicGrade"/> <code> <system value="http://loinc.org"/> <code value="44648-4"/> <display value="Histologic grade [Score] in Breast cancer specimen Qualitative by Nottingham"/> </code> <short value="The Elston Grade/Nottingham Score, representative of the aggressive potential of the tumor. Well differentiated cells (Grade 1) look similar to normal cells and are usually slow growing, while poorly differentiated cells (Grade 3) look very different than normal and are fast-growing."/> <definition value="The Elston Grade/Nottingham Score, representative of the aggressive potential of the tumor. Well differentiated cells (Grade 1) look similar to normal cells and are usually slow growing, while poorly differentiated cells (Grade 3) look very different than normal and are fast-growing."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerHistologicGrade"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerHistologicGrade-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.stageTimingPrefix"> <path value="oncology-BreastCancerStageTopic-model.stageTimingPrefix"/> <code> <system value="http://snomed.info/sct"/> <code value="260869008"/> <display value="Timing of stage"/> </code> <short value="Indicates when the staging was done, in terms of treatment landmarks."/> <definition value="Indicates when the staging was done, in terms of treatment landmarks."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.stageTimingPrefix"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="required"/> <valueSetReference> <reference value="http://hl7.org/fhir/us/breastcancer/ValueSet/oncology-StageTimingPrefixVS"/> </valueSetReference> </binding> </element> </snapshot> <differential> <element id="oncology-BreastCancerStageTopic-model"> <path value="oncology-BreastCancerStageTopic-model"/> <definition value="The topic class for describing a breast cancer staging observation."/> <min value="0"/> <max value="*"/> <base> <path value="oncology-BreastCancerStageTopic-model"/> <min value="0"/> <max value="*"/> </base> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode"> <path value="oncology-BreastCancerStageTopic-model.topicCode"/> <short value="The concept representing the finding or action that is the topic of the statement."/> <definition value="The concept representing the finding or action that is the topic of the statement. For action topics, the TopicCode represents the action being described. For findings, the TopicCode represents the 'question' or property being investigated. For evaluation result findings, the TopicCode contains a concept for an observable entity, such as systolic blood pressure. For assertion findings, the TopicCode contains a code representing the condition, allergy, or other item being asserted. In all cases, the TopicCode describes the topic independent of the context of the action or the finding."/> <min value="1"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.topicCode"/> <min value="1"/> <max value="1"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.id"> <path value="oncology-BreastCancerStageTopic-model.topicCode.id"/> <representation value="xmlAttr"/> <short value="xml:id (or equivalent in JSON)"/> <definition value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/> <min value="0"/> <max value="1"/> <base> <path value="Element.id"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.extension"> <path value="oncology-BreastCancerStageTopic-model.topicCode.extension"/> <slicing> <discriminator> <type value="value"/> <path value="url"/> </discriminator> <description value="Extensions are always sliced by (at least) url"/> <rules value="open"/> </slicing> <short value="Additional Content defined by implementations"/> <definition value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/> <comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/> <min value="0"/> <max value="*"/> <base> <path value="Element.extension"/> <min value="0"/> <max value="*"/> </base> <type> <code value="Extension"/> </type> <mapping> <identity value="rim"/> <map value="n/a"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.system"> <path value="oncology-BreastCancerStageTopic-model.topicCode.system"/> <short value="Identity of the terminology system"/> <definition value="The identification of the code system that defines the meaning of the symbol in the code."/> <comment value="The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously."/> <requirements value="Need to be unambiguous about the source of the definition of the symbol."/> <min value="1"/> <max value="1"/> <base> <path value="Coding.system"/> <min value="0"/> <max value="1"/> </base> <type> <code value="uri"/> </type> <fixedUri value="http://ncimeta.nci.nih.gov"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.3"/> </mapping> <mapping> <identity value="rim"/> <map value="./codeSystem"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.version"> <path value="oncology-BreastCancerStageTopic-model.topicCode.version"/> <short value="Version of the system - if relevant"/> <definition value="The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged."/> <comment value="Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.version"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.7"/> </mapping> <mapping> <identity value="rim"/> <map value="./codeSystemVersion"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.code"> <path value="oncology-BreastCancerStageTopic-model.topicCode.code"/> <short value="Symbol in syntax defined by the system"/> <definition value="A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination)."/> <requirements value="Need to refer to a particular code in the system."/> <min value="1"/> <max value="1"/> <base> <path value="Coding.code"/> <min value="0"/> <max value="1"/> </base> <type> <code value="code"/> </type> <fixedCode value="C2216702"/> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.1"/> </mapping> <mapping> <identity value="rim"/> <map value="./code"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.display"> <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable"> <valueBoolean value="true"/> </extension> <path value="oncology-BreastCancerStageTopic-model.topicCode.display"/> <short value="Representation defined by the system"/> <definition value="A representation of the meaning of the code in the system, following the rules of the system."/> <requirements value="Need to be able to carry a human-readable meaning of the code for readers that do not know the system."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.display"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="C*E.2 - but note this is not well followed"/> </mapping> <mapping> <identity value="rim"/> <map value="CV.displayName"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.topicCode.userSelected"> <path value="oncology-BreastCancerStageTopic-model.topicCode.userSelected"/> <short value="If this coding was chosen directly by the user"/> <definition value="Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays)."/> <comment value="Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely."/> <requirements value="This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing."/> <min value="0"/> <max value="1"/> <base> <path value="Coding.userSelected"/> <min value="0"/> <max value="1"/> </base> <type> <code value="boolean"/> </type> <isSummary value="true"/> <mapping> <identity value="v2"/> <map value="Sometimes implied by being first"/> </mapping> <mapping> <identity value="rim"/> <map value="CD.codingRationale"/> </mapping> <mapping> <identity value="orim"/> <map value="fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]"/> </mapping> </element> <element id="oncology-BreastCancerStageTopic-model.findingMethod"> <path value="oncology-BreastCancerStageTopic-model.findingMethod"/> <short value="The technique used to create the finding, for example, the specific imaging technical, lab test code, or assessment vehicle."/> <definition value="The technique used to create the finding, for example, the specific imaging technical, lab test code, or assessment vehicle."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.findingMethod"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="preferred"/> <valueSetReference> <reference value="http://loinc.org/vs"/> </valueSetReference> </binding> </element> <element id="oncology-BreastCancerStageTopic-model.details"> <path value="oncology-BreastCancerStageTopic-model.details"/> <code> <system value="http://ncimeta.nci.nih.gov"/> <code value="C0947611"/> </code> <short value="A text note containing additional details, explanation, description, comment, or summarization. Details can discuss, support, explain changes to, or dispute information."/> <definition value="A text note containing additional details, explanation, description, comment, or summarization. Details can discuss, support, explain changes to, or dispute information."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.details"/> <min value="0"/> <max value="1"/> </base> <type> <code value="string"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.media"> <path value="oncology-BreastCancerStageTopic-model.media"/> <short value="A file that contains audio, video, image, or similar content."/> <definition value="A file that contains audio, video, image, or similar content."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.media"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/shr-core-Media-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.category"> <path value="oncology-BreastCancerStageTopic-model.category"/> <short value="A class or division of people or things having particular shared characteristics"/> <definition value="A class or division of people or things having particular shared characteristics"/> <min value="1"/> <max value="*"/> <base> <path value="oncology-BreastCancerStageTopic-model.category"/> <min value="1"/> <max value="*"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="extensible"/> <valueSetReference> <reference value="http://hl7.org/fhir/ValueSet/observation-category"/> </valueSetReference> </binding> </element> <element id="oncology-BreastCancerStageTopic-model.anatomicalLocation"> <path value="oncology-BreastCancerStageTopic-model.anatomicalLocation"/> <code> <system value="http://loinc.org"/> <code value="72369-2"/> </code> <short value="A location or structure in the body, including tissues, regions, cavities, and spaces; for example, right elbow, or left ventricle of the heart."/> <definition value="A location or structure in the body, including tissues, regions, cavities, and spaces; for example, right elbow, or left ventricle of the heart."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.anatomicalLocation"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-element-AnatomicalLocation-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.device"> <path value="oncology-BreastCancerStageTopic-model.device"/> <short value="A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients."/> <definition value="A specific durable physical device used in diagnosis or treatment. The value is the coding for a type of device, for example, a CPAP machine. The same device might be used on multiple patients."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.device"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-entity-Device-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.specimen"> <path value="oncology-BreastCancerStageTopic-model.specimen"/> <short value="A specimen is a substance, physical object, or collection of objects, that the laboratory considers a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory workflow. A specimen may include multiple physical pieces as long as they are considered a single unit within the laboratory workflow. A specimen results from one to many specimen collection procedures, and may be contained in multiple specimen containers. Specimen may have one or more processing activities."/> <definition value="A specimen is a substance, physical object, or collection of objects, that the laboratory considers a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory workflow. A specimen may include multiple physical pieces as long as they are considered a single unit within the laboratory workflow. A specimen results from one to many specimen collection procedures, and may be contained in multiple specimen containers. Specimen may have one or more processing activities."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.specimen"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-entity-Specimen-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.precondition"> <path value="oncology-BreastCancerStageTopic-model.precondition"/> <short value="A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar."/> <definition value="A description of the conditions or context of an observation, for example, under sedation, fasting or post-exercise. Body position and body site are also qualifiers, but handled separately. A qualifier cannot modify the measurement type; for example, a fasting blood sugar is still a blood sugar."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.precondition"/> <min value="0"/> <max value="0"/> </base> <type> <code value="Coding"/> </type> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-statement-Observation-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.referenceRange"> <path value="oncology-BreastCancerStageTopic-model.referenceRange"/> <code> <system value="http://ncimeta.nci.nih.gov"/> <code value="C0883335"/> </code> <short value="The usual or acceptable range for a test result."/> <definition value="The usual or acceptable range for a test result."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.referenceRange"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-topic-ReferenceRange-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.evaluationComponent"> <path value="oncology-BreastCancerStageTopic-model.evaluationComponent"/> <short value="A simplified, non-separable evaluation consisting of a finding code (represented by the Concept), value (or exception value), reference range, and interpretation. The subject of the evaluation component is the same as in the parent evaluation."/> <definition value="A simplified, non-separable evaluation consisting of a finding code (represented by the Concept), value (or exception value), reference range, and interpretation. The subject of the evaluation component is the same as in the parent evaluation."/> <min value="0"/> <max value="0"/> <base> <path value="oncology-BreastCancerStageTopic-model.evaluationComponent"/> <min value="0"/> <max value="0"/> </base> <type> <code value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/cimi-topic-EvaluationComponent-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers"> <path value="oncology-BreastCancerStageTopic-model.panelMembers"/> <short value="PanelMembers represent the elements of a group of a related but independent evaluations."/> <definition value="PanelMembers represent the elements of a group of a related but independent evaluations. Examples are the measurements that compose a complete blood count (CBC), or the elements of a pathology report. Each member is an independent evaluation, but the grouping reflects a composite lab order, shared specimen, or a single report author. Typically the Category and Reason are not given for individual findings that are part of the panel, but rather given at the level of the panel itself."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers"/> <min value="0"/> <max value="1"/> </base> <type> <code value="BackboneElement"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation"/> <short value="Represents the result of evaluations (measurements, tests, or questions) that have been performed."/> <definition value="Represents the result of evaluations (measurements, tests, or questions) that have been performed. Observation has a value representing the result (answer), or an ExceptionValue indicating why the value is not present. The subject of a finding can be the entire patient, or an entity such as a location body structure, intervention, or condition. Things observed about the subject can include social and behavioral factors, subjective and objective observations, and assessments."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation"/> <min value="0"/> <max value="1"/> </base> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerPrimaryTumorClassification"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerPrimaryTumorClassification"/> <code> <system value="http://snomed.info/sct"/> <code value="78873005"/> <display value="T category"/> </code> <short value="The size and extent of the primary tumor, based on criteria defined by the staging system being used."/> <definition value="The size and extent of the primary tumor, based on criteria defined by the staging system being used."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerPrimaryTumorClassification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerPrimaryTumorClassification-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerRegionalNodesClassification"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerRegionalNodesClassification"/> <code> <system value="http://snomed.info/sct"/> <code value="277206009"/> <display value="N category"/> </code> <short value="The presence of metastases in regional lymph nodes, based on criteria defined by the staging system being used."/> <definition value="The presence of metastases in regional lymph nodes, based on criteria defined by the staging system being used."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerRegionalNodesClassification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerRegionalNodesClassification-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerDistantMetastasesClassification"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerDistantMetastasesClassification"/> <code> <system value="http://snomed.info/sct"/> <code value="277208005"/> <display value="M category (observable entity)"/> </code> <short value="The presence of distant metastases, based on criteria defined by the staging system being used."/> <definition value="The presence of distant metastases, based on criteria defined by the staging system being used."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerDistantMetastasesClassification"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerDistantMetastasesClassification-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.hER2ReceptorStatus"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.hER2ReceptorStatus"/> <code> <system value="http://loinc.org"/> <code value="48676-1"/> <display value="HER2 [Interpretation] in Tissue"/> </code> <short value="HER2 receptor status. HER2 is a member of the human epidermal growth factor receptor family of proteins and is encoded by the ERBB2 oncogene. HER2 is overexpressed in 20-30% of breast tumors, and is associated with an aggressive clinical course and poor prognosis. HER2 status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options."/> <definition value="HER2 receptor status. HER2 is a member of the human epidermal growth factor receptor family of proteins and is encoded by the ERBB2 oncogene. HER2 is overexpressed in 20-30% of breast tumors, and is associated with an aggressive clinical course and poor prognosis. HER2 status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.hER2ReceptorStatus"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-HER2ReceptorStatus-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.estrogenReceptorStatus"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.estrogenReceptorStatus"/> <code> <system value="http://loinc.org"/> <code value="16112-5"/> <display value="Estrogen receptor [Interpretation] in Tissue"/> </code> <short value="Estrogen receptor alpha is the predominant estrogen receptor expressed in breast tissue and is overexpressed in around 50% of breast carcinomas. ER status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options."/> <definition value="Estrogen receptor alpha is the predominant estrogen receptor expressed in breast tissue and is overexpressed in around 50% of breast carcinomas. ER status (positive=present or overexpressed; negative=absent) is a factor in determining prognosis and treatment options. The current approach is that positive/negative designation is a value, even though that value is (in fact) an interpretation of evidence (NuclearPositivity and AverageStainingIntensity)."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.estrogenReceptorStatus"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-EstrogenReceptorStatus-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.progesteroneReceptorStatus"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.progesteroneReceptorStatus"/> <code> <system value="http://loinc.org"/> <code value="16113-3"/> <display value="Progesterone receptor [Interpretation] in Tissue"/> </code> <short value="Progesterone receptor status is a factor in determining prognosis and treatment options. The value is the percentage of cells that test (stain) positive for the presence of a receptor. The interpretation of positive or negative (found in the interpretation property) is based on the staining percentage, and may take into account the staining intensity."/> <definition value="Progesterone receptor status is a factor in determining prognosis and treatment options. The value is the percentage of cells that test (stain) positive for the presence of a receptor. The interpretation of positive or negative (found in the interpretation property) is based on the staining percentage, and may take into account the staining intensity. Based on discussion with Cancer Interoperability Group subject matter experts, there was insufficient rationale to include the following components in the data model: StainingControl, PrimaryAntibody, Allred Score (both total and component scores). We are seeking feedback on whether or not those components should be included in this model."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.progesteroneReceptorStatus"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-ProgesteroneReceptorStatus-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.dCISNuclearGrade"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.dCISNuclearGrade"/> <code> <system value="urn:tbd"/> <code value="TBD"/> <display value="Nuclear Grade"/> </code> <short value="An evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade. In breast cancer, nuclear grade is typically evaluated for ductal carcinoma in situ (DCIS) only. There is currently no concept code for DCIS Nuclear Grade in LOINC, SNOMED, or NCI Metathesaurus."/> <definition value="An evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade. In breast cancer, nuclear grade is typically evaluated for ductal carcinoma in situ (DCIS) only. There is currently no concept code for DCIS Nuclear Grade in LOINC, SNOMED, or NCI Metathesaurus."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.dCISNuclearGrade"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-DCISNuclearGrade-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerHistologicGrade"> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerHistologicGrade"/> <code> <system value="http://loinc.org"/> <code value="44648-4"/> <display value="Histologic grade [Score] in Breast cancer specimen Qualitative by Nottingham"/> </code> <short value="The Elston Grade/Nottingham Score, representative of the aggressive potential of the tumor. Well differentiated cells (Grade 1) look similar to normal cells and are usually slow growing, while poorly differentiated cells (Grade 3) look very different than normal and are fast-growing."/> <definition value="The Elston Grade/Nottingham Score, representative of the aggressive potential of the tumor. Well differentiated cells (Grade 1) look similar to normal cells and are usually slow growing, while poorly differentiated cells (Grade 3) look very different than normal and are fast-growing."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.panelMembers.observation.breastCancerHistologicGrade"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Reference"/> <targetProfile value="http://hl7.org/fhir/us/breastcancer/StructureDefinition/oncology-BreastCancerHistologicGrade-model"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> </element> <element id="oncology-BreastCancerStageTopic-model.stageTimingPrefix"> <path value="oncology-BreastCancerStageTopic-model.stageTimingPrefix"/> <code> <system value="http://snomed.info/sct"/> <code value="260869008"/> <display value="Timing of stage"/> </code> <short value="Indicates when the staging was done, in terms of treatment landmarks."/> <definition value="Indicates when the staging was done, in terms of treatment landmarks."/> <min value="0"/> <max value="1"/> <base> <path value="oncology-BreastCancerStageTopic-model.stageTimingPrefix"/> <min value="0"/> <max value="1"/> </base> <type> <code value="Coding"/> </type> <mustSupport value="false"/> <isModifier value="false"/> <isSummary value="false"/> <binding> <strength value="required"/> <valueSetReference> <reference value="http://hl7.org/fhir/us/breastcancer/ValueSet/oncology-StageTimingPrefixVS"/> </valueSetReference> </binding> </element> </differential> </StructureDefinition>