The presence of distant metastases, based on criteria defined by the staging system being used.

The status of genes known or suspected to play a role in breast cancer risk, for example, the tumor suppressor genes, BRCA1 and BRCA2.

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.

Diagnosis of cancer originating in the tissues of the breast, and potentially spread to other organs of the body.

The size and extent of the primary tumor, based on criteria defined by the staging system being used.

The presence of metastases in regional lymph nodes, based on criteria defined by the staging system being used.

The stage of a breast cancer. Different staging systems use different staging groups, so there are currently no terminology bindings associated with this class.

Clinical assessment of lymph nodes for presence of cancer cells in staging the N category in cancers.

A body site specific to the lymph node structure.

Clinical assessment of lymph nodes for presence of cancer cells in staging the N category in cancers.

A body site specific to the breast structure.

Specimen resulting from biopsy or excision of breast and surrounding tissue.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm. (source: NCI)

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.

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).

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.

HER2 receptor status as determined by single-probe or dual-probe Fluorescence In Situ Hybridization (FISH).

HER2 presence in Breast cancer specimen by Immunohistochemistry (IHC).

Ki-67 is a protein phosphatase whose expression is strongly associated with cell proliferation and encoded by the MKI67 gene. The Ki67 labeling index is the fraction of Ki-67-positive cells to total cells in a tumor specimen and may be useful for determining prognosis with respect to survival and disease recurrence. The Ki-67 antigen is measured numerically as a percentage, and as an ordinal. The more positive cells there are, the more quickly they are dividing and forming new cells. ReferenceRange: Low <10, Intermediate 10-20, >20 High.

Breast cancer genomic signature assay for 10-year risk of distant recurrence score calculated by Mammaprint. In the United States, MammaPrint can only be used on cancers that are stage I or stage II, invasive, smaller than 5 centimeters, and estrogen-receptor-positive or -negative. Scores range from -1.0 to +1.0, with scores less than 0 indicating high risk, and scores greater than 0 indicating low risk. The is currently no LOINC code for Mammaprint test.

The Oncotype DX test for DCIS (Ductal Carcinoma in Situ) breast cancer. Risk scores range from 0 to 100 with the following interpretations: 0-38: Low-Risk, 39-54: Intermediate-Risk, 55+: High-Risk. No LOINC code currently exists for this test. We are seeking feedback on the value of separating OncotypeDx scores for DCIS and invasive breast carcinomas. Does it make more sense to report the OncotypeDx as a single score, regardless of the type of cancer?

The Oncotype DX test for invasive breast cancer examines the activity of 21 genes in a patient’s breast tumor tissue to provide personalized information for tailoring treatment based on the biology of their individual disease. The value from 0 to 100 indicates the estimated risk of recurrence, with the highest risk indicated by a score greater than 31. No LOINC code currently exists for this test. We are seeking feedback on the value of separating OncotypeDx scores for DCIS and invasive breast carcinomas. Does it make more sense to report the OncotypeDx as a single score, regardless of the type of cancer?

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.

Breast cancer genomic signature assay for 10-year risk of distant recurrence score calculated by Prosigna. The Prosigna Score is reported on a 0-100 scale (referred to as ROR Score or Risk of Recurrence Score in the literature), which is correlated with the probability of distant recurrence at ten years for post-menopausal women with hormone receptor positive, early stage breast cancer.

The end, remission or resolution.

Identifier assigned by the lab

If the ActiveFlag is false, it indicates the record or item is no longer to be used and should generally be hidden for the user in the UI.

If the ActiveFlag is false, it indicates the record or item is no longer to be used and should generally be hidden for the user in the UI.

True if the group is an actual group (as opposed to definitional).

Additive associated with container.

Part of an address that contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information. (Source: HL7 FHIR).

An address expressed using postal conventions (as opposed to GPS or other location definition formats). This data type may be used to convey addresses for use in delivering mail as well as for visiting locations and which might not be valid for mail delivery. There are a variety of postal address formats defined around the world. (Source: HL7 FHIR).

A gender classification used for administrative purposes. Administrative gender is not necessarily the same as a biological description or a gender identity. This attribute does not include terms related to clinical gender.

How long someone has been alive, or something has existed.

Activities that reduce the severity of the pathology

Anatomical location or specimen further detailing directionality.

A location or structure in the body, including tissues, regions, cavities, and spaces; for example, right elbow, or left ventricle of the heart.

The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.

Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race.

The parent class of contexts that can associate with AssertionTopic and its subclasses.

Statement that a finding is present.

A clinical statement that asserts presence or absence.

The base topic for conditions, allergies, adverse events, etc. These are things asserted to exist or not. The Value is interpreted in the context of the class; for an AdverseSensitivityToSubstance, the TopicCode is the substance, for a Condition, the TopicCode represents the type of condition found.

Average number CEP17 signals per cell (dual probe only)

Average number of HER2 signals per cell

Whether the patient has a mutation in the BRCA1 gene.

Whether the patient has a mutation in the BRCA2 gene.

The data itself.

If the product is branded, and if so, the brand name of a product.

The marketing name for a brand name product

The topic class for describing a breast cancer staging observation.

Identification of whether tumor cells have extended to the lymph nodes. Formerly known as BreastNodeInvolvementValues

Container volume or size.

A class or division of people or things having particular shared characteristics

The degree of confidence in a conclusion or assertion.

The name of a municipality, city, town, village or other community or delivery center. (Source: HL7 FHIR).

A special type of information entry consisting of a topic and a context. The ClinicalStatement class provides the core pattern for more specific clinical statement classes, such as a statement that a finding has been found in a patient or that a procedure has been proposed by a clinical decision support system. The ClinicalStatement pattern defines the core attributes common to most clinical statements and specifies a composition pattern that encourage model component reuse and better alignment with the SNOMED CT Concept Model. A clinical statement is composed of the StatementTopic class (grouping of attributes for capturing information about a procedure or a clinical finding) and the StatementContext class (grouping of attributes providing the context for the statement topic such as whether a procedure was performed, requested, not performed or whether a finding is suspected present or absent in the patient). At the archetype level, the topic and context components are coordinated to form the clinical statement. For instance, the composition of the ProcedureTopic with the NotPerformed context indicates that the given procedure was not performed.

A flag indicating whether the condition is active or inactive, recurring, in remission, or resolved (as of the last update of the Condition).

A direction indicated by an angle relative to 12 o’clock.

A formal terminology system.

The version of the vocabulary being used, if applicable.

An evaluation component whose value is a code (concept).

A coded finding from a laboratory test.

The time period between the chilling of a tissue or tissue sample and the time it is warmed. CIMI Alignment: In CIMI Version 0.0.4, specimen processing is represented as a ‘SpecimenProcessingPerformed’ clinical statement, mapped to FHIR Procedure. However, specimen processing maps to FHIR Specimen.processing, part of the Specimen resource. It would be a difficult mapping exercise (and beyond the scope of this IG) to express the mapping rule that any CIMI SpecimenProcessingPerformed clinical statement needs to mapped to FHIR by (1) finding the corresponding Specimen entity, and (2) mapping the content of (possibly multiple) SpecimenProcessingPerformed into the FHIR Specimen resource. To avoid this complexity, the breast cancer model expresses the cold ischemia time as an attribute of the BreastSpecimen rather than a separate procedure.

How the specimen was obtained.

The body site where specimen was collected

The person or thing the sample was obtained from.

When the sample was obtained, as a specific time or time period.

Percentage of cells with uniform intense complete membrane staining.

An observation with components, but without a result value or panel members.

A condition, independent of context. ‘Condition’ is interpreted broadly to include disorder, abnormality, problem, injury, complaint, functionality, concern, illness, disease, ailment, sickness, affliction, upset, difficulty, disorder, symptom, worry, or trouble, independent of context.

The cause of the condition. This includes such causes as disease vectors and endogenous states (e.g., macular degeneration due to diabetes), substances, medications, micro-organisms, and forces associated with the occurrence of a Condition from temporal or causative perspectives

The context for a condition that is known, suspected, or possibly present.

A condition that is or may be present in a subject. ‘Condition’ is interpreted broadly and could be a disorder, abnormality, problem, injury, complaint, functionality, illness, disease, ailment, sickness, affliction, upset, difficulty, disorder, symptom, worry, or trouble.

An electronic means of contacting an organization or individual.

Abstract ancestor of all concrete content types. A unit of content that makes up a composition - e.g., a clinical statement in a patient record, a simple or composite action is a knowledge document, a catalog entry in a catalog.

Mime type of the content, with charset etc.

A code representing the ontological status of the statement, e.g., whether it exists, does not exist, is planned, etc. Attribute aligns with the SNOMED CT Situation with Explicit Context (SWEC) Concept Model context attributes: ‘Finding context (attribute)’ (SCTID: 408729009) and ‘Procedure context (attribute)’ (SCTID: 408730004). The range allowed for this attribute shall be consistent with the SNOMED CT concept model specification for SWEC.

The number of items (0 or more), as an integer.

Country - a nation as commonly understood or generally accepted, expressed in ISO 3166 Alpha-2 (2-letter) codes.

The point in time when the information was recorded in the system of record.

A date of birth or approximate year or period (year or date range), if estimated.

Indicator of significant change (delta) from the last or previous measurement.

The divisor of a fraction.

A text note containing additional details, explanation, description, comment, or summarization. Details can discuss, support, explain changes to, or dispute information.

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.

Unique Device Identifier (UDI) Barcode string number for a device, assigned by the organization using the device.

The service completing the observations, e.g. biochemistry, microbiology, blood bank.

A string meant for reading by a person, for example, accompanying a code.

Distance between the feature of interest (e.g., the tumor) and the nipple.

The name of the administrative area at a level below that of a state but above that of a city or town. In the US, a county. Outside the US, a district or the equivalent. (Source: HL7 FHIR).

The form in which active and/or inert ingredient(s) are physically presented.

The date and time span for which something is active, valid, or in force.

Abstract class defining the common metadata of all types of encapsulated data, such as images.

A description of an interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.

Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).

Root class for entities such as people, organizations, and devices that have a separately identifiable existence.

Parent class entity and role.

The degree or magnitude of staining across positively stained tumor cells on the entire tissue section relative to the intensity of positive controls run with the same batch.

The percentage of cells that test (stain) positive for the presence of estrogen receptors. We are seeking feedback on whether nuclear positivity should be an exact percentage or a range of percentages. As currently defined, an exact nuclear positivity could be represented by a zero-width range, where the lower and upper bounds would be the same number.

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.

Activities that increase the severity of the pathology

Reason that a value associated with a test or other finding is missing.

If true, exclude the subjects that match the criterion.

When the item (medication, device, etc.) will expire.

Status for presence of extranodal extension of carcinoma where extranodal extension is the perforation of a cancer through the capsule of a lymph node into the tissue surrounding the node.

The portion of a person’s name that reflects the genealogy of the person. In western cultures, this is the ‘last’ name. In eastern cultures, the family name appears before the person’s given name(s). In some cultures (e.g. Eritrea) the family name of a son is the first name of his father. (Source: HL7 V3).

The base class for representing the ontological status of a finding, e.g., present, absent, goal, risk, expectation, etc. This class aligns with the SNOMED Situation with Explicit Context.

The technique used to create the finding, for example, the specific imaging technical, lab test code, or assessment vehicle.

Presence of a distinct anatomical or pathological morphological feature or organizational pattern, acquired or innate. Examples include tissue types, tumors, and wounds. Body structures are continuants that allow observations of the same body structure to be related to be tracked over time.

Presence (or absence) of a distinct anatomical or pathological morphological feature or organizational pattern, acquired or innate. Examples include tissue types, tumors, and wounds. The FindingSiteCondition topic provides not only the AnatomicalLocation (as in CIMI FindingSiteAssertionTopic), tbut also the type of structure found at that location, such as a wound or tumor.

A human-readable identifier for the condition at the finding site, for example, a wound number or tumor identifier.

Any clinical statement representing a finding.

Indicates whether the finding is preliminary, amended, final, etc.

Base class - independent of context - for all kinds of determinations: questions/answers, conditions, observations, allergies, and other findings. 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.

The countries of the world and major geopolitical subregions, such as US states.

The person’s given name - e.g., John

A code describing the characteristic present, absent, or having a value in this group.

An inclusion or exclusion criterion as part of defining a cohort. If the criterion is an unary, then TopicCode must be SCT#385432009 (not applicable)

A set of entities (personnel, material, or places) to be considered together. May be a pool of like-type resources, a team, or combination of personnel, material and places.

HER2 to CEP17 Ratio (dual probe only)

Cautions on the handling of this specimen.

A hash code of the data (sha-1, base64ed)

A photograph showing a person’s face.

The CIMI person name, constrained to map correctly to FHIR.

A unique string that identifies a specific person or thing.

Base class for classes in CIMI that include enough context to stand alone. Analogous to FHIR’s DomainResource.

An entry in a patient record or in a report, generally used for the documentation of clinical information about a subject of information such as a patient or a relative of the patient, asserted by a particular source, recorded, and potentially verified.

The amount of an ingredient in a mixture, as a ratio. For example, 250 mg per tablet is expressed as a ratio where the numerator is 250mg and the denominator is 1 tablet.

Specifies an material component in a non-medication substance.

A Quantity that is an integer.

A clinical interpretation of a finding (applies to both assertions and observation).

True if the ingredient is an active ingredient in the medication.

The date and time this observation was made available to providers, typically after the results have been reviewed and verified.

An organization who issues a qualification, identifier, or license.

Ki-67 is a protein phosphatase whose expression is strongly associated with cell proliferation and encoded by the MKI67 gene. The Ki-67 antigen is measured quantitatively as a percentage.

A coded finding based on a specimen collected from a patient.

The topic composition for laboratory observations. A specimen is required, anatomical location is excluded (since the specimen indicates the collection body site). Also includes a diagnostic service (indicating the type of laboratory), not present in general observations.

A human language, spoken or written.

Additional information about a person’s use of language.

Language used for communication by a human, either the subject of record, parent, or other involved person.

Anatomical location or specimen further detailing the side(s) of interest.

Abstract top level class in the CIMI hierarchy. The Locatable class reflects CIMI’s implementation using Archetype Description Language (ADL). Its attributes (archetype_node_id, name, and archetype_details) are necessary to serialize CIMI definitions in ADL, but have no clinical relevance. To avoid complicating the profiles with irrelevant extensions, the attributes of Locatable have been omitted.

A distinctive alpha-numeric identification code assigned by the manufacturer or distributor to a specific quantity of manufactured material or product within a batch.

The lower limit on a range

Lymph node palpable

The procedure method used to obtain the specimen analyzed for the pathological lymph node involvement.

Size of the lymph node or lymph node group which is being clinically assessed.

When the item (medication, device, etc.) was produced.

The organization producing the product or test.

The name of the company who produce the device.

A file that contains audio, video, image, or similar content.

Specifies an material component in a medication.

A type of prescription drug or over-the-counter drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition, but excluding vaccines.

A person or entity in a group.

The person’s middle name.

The degree of mitotic activity in breast carcinoma is one component of the Nottingham histologic grade, which is a prognostic indicator for patients with breast carcinoma. Mitotic activity is assessed as the number of mitoses per 10 high power fields (HPF), with increasing mitotic activity being an indicator of more aggressive cancer. The specific scores assigned to the number of mitoses depends on the size of the HPF. For example, for a HPF size of 0.274 mm^2, less than 10 mitoses per 10 HPF gets a score of 1, 10-19 gets a score of 2, and greater than or equal to 20 gets a score of 3. When larger or smaller HPFs are used, the cutoffs for the number of mitoses corresponding to a specific score are adjusted according to published guidelines.

A description of the morphology and behavioral characteristics of the cancer.

The name as plain unstructured or semi-structured text.

Abstract supertype for the name of an entity.

A unique 10 digit number to allow US healthcare providers to identify themselves in a standard way throughout the healthcare industry.

Parent for classes in CIMI that do not have enough context to stand alone. These reusable building blocks/data elements can be used to create classes by composition.

An observation not based on a specimen.

The degree of nuclear pleomorphism (variability of nuclei) in breast carcinoma is one component of the Nottingham histologic grade, which is a prognostic indicator for patients with breast carcinoma. Increasing degrees of pleomorphism are associated with increasingly aggressive cancers.

Number of lymph nodes with isolated metatstatic tumor cells examined for the presence of cancer cells

Number of lymph nodes with macrometastases examined

Number of lymph nodes with micrometastases examined

Number of regional lymph nodes examined for the presence of cancer cells

Number of sentinel lymph nodes examined for the presence of cancer cells

The dividend of a fraction.

Context for recording an evaluation result, used to indicate an evaluation has been made.

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.

The base class, independent of context for evaluations (measurements, tests, or questions). 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.

The person or organization who observed or informed the reporter about the characteristic, potentially the clinician, the patient, or a related person.

The beginning or first appearance of a mental or physical disorder.

A list of alternate names that the organization is known as, or was known as in the past.

An identifier of the organization. An NPI preferred, tax id is allowed, and a local id is allowed in addition to ‘authoritative’ identifier

A social or legal structure formed by human beings.

The name of the organization.

True if the medication is available to consumers without a prescription.

The kind of container the medication comes in.

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.

The larger entity that this is a portion of. For example, an organization might be part of a larger organization, or an encounter with a hospitalist might be part of a larger hospitalization encounter.

The point in time or span of time the participant is involved.

A person in the role of a patient, including extended demographic information about the subject of this health record.

A person relevant to the health or social situation of the subject (including the person of record him or herself).

A name used by a human being, written as it would be typically expressed. May include a breakdown of the various elements of the name (family name, given name, etc.).

The person this entry belongs to.

A sequence of letters and digits used as part of a postal address, often designating a geographic region

A person who practices a healing art.

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.

Contains a set of honorific terms that typically appear before a person’s name, for example Mr., Mrs., Dr., etc.

PresenceContext indicates that the finding in question exists or is present to some level of certainty. For example, if the finding involves a myocardial infarction, the presence context implies that cardiac arrest has (or may have) taken place. Note that the name Presence is used rather than Present to prevent confusion with the temporal meaning of present.

If the problem or condition existed before the current episode of care.

An indication of the importance of an action.

The degree or magnitude of staining across positively stained tumor cells on the entire tissue section relative to the intensity of positive controls run with the same batch.

The percentage of cells that test (stain) positive for the presence of progesterone receptors. We are seeking feedback on whether nuclear positivity should be an exact percentage or a range of percentages. As currently defined, an exact nuclear positivity could be represented by a zero-width range, where the lower and upper bounds would be the same number. We are seeking feedback on whether nuclear positivity should be an exact percentage or a range of percentages. As currently defined, an exact nuclear positivity could be represented by a zero-width range, where the lower and upper bounds would be the same number.

Why the item is used.

A right to practice medicine obtained by training and certification.

A quantity with units, whose value may be bounded from above or below, as defined in FHIR

An interval defined by a quantitative upper and/or lower bound. One of the two bounds must be specified, and the lower bound must be less than the upper bound. When Quantities are specified, the units of measure must be the same.

A unit of measurement for the quotient of the amount of one entity to another.

Time the item was delivered to, or accepted by, the receiving facility or unit.

Context for recording a finding, used to indicate an evaluation has been made.

The usual or acceptable range for a test result.

A person in a role defined in relationship to a patient

The relationship of the person to the subject of record.

The time or time period that the finding addresses. The clinically relevant time is not necessarily when the information is gathered or when a test is carried out, but for example, when a specimen was collected, or the time period referred to by the question. Use a TimePeriod for a measurement or specimen collection continued over a significant period of time (e.g. 24 hour Urine Sodium).

URI where data can be found.

Number of bytes of content in the resource (if url provided)

The finding itself, such as the blood pressure value recorded.

Capacity in which an actor is involved in an activity. For instance, ‘attending physician’. Note that attributes of the actor (an entity) that remain constant regardless of the role the actor plays should be part of the entity and not the role. For instance, a person may be a practitioner and a patient. In both cases their date of birth will be the same and thus such information should not be part of the role.

The sequence number for this specimen in a collection of specimens.

Degree of harshness or extent of a symptom, disorder, or condition.

A coded finding from a laboratory test without further panel members or components.

A coded finding from a laboratory test without further panel members or components.

A quantity where the comparator is not used, as defined in FHIR

The largest dimension of the gross tumor bed and surrounding fibrotic area.

Measurements for the primary tumor size which includes the longest diameter of the primary tumor and the longest perpendicular diameter of the primary tumor.

Measurements for the primary tumor size which includes the longest diameter of the primary tumor and the longest perpendicular diameter of the primary tumor.

Identifier for the source specimen from which this specimen was derived.

Information about the proper handling of the specimen.

Direct container of specimen (tube/slide, etc.)

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.

Quantity of specimen within container.

State of the specimen, such as obtained, processed, used.

Treatment performed on the specimen.

Accuracy and fluency in spoken communication in a language.

The full staging information

The relative advancement in the course of a disease. The value is the summary stage or stage group. StageDetail optionally contains the full staging information.

A suffix used in conjuction with certain cancer stages, based on criteria defined by the staging system being used.

Indicates when the staging was done, in terms of treatment landmarks.

Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (i.e. US 2 letter state codes). (Source: HL7 FHIR).

Compositional and reusable grouping of clinical statement attributes that provides the context for the topic of a clinical statement. The StatementContext class aligns with the SNOMED CT Situations with Explicit Context (SWEC) Concept Model. The StatementContext provides the expressivity required to specify that an act was performed or not performed or that a finding was asserted to be present or absent for the given subject of information. It also often holds provenance information relevant to the context of the clinical statement. It is important to note that by default the context applies to the conjunction of the attribute specified in the statement. For instance, if a clinical statement has a topic describing a rash on left arm and a context of ‘absent’, then the statement states that the subject of interest did not have a rash on the left arm but might have had one on the right arm.

Compositional and reusable grouping of clinical statement attributes that make up the clinical focus of a statement.

StatementTopic class attributes are aligned with SNOMED CT Concept Model attributes when such an overlap exists. Note that this class does not include contextual attributes such as the nature of the action (ordered, proposed, planned, etc…), the nature of the patient state being described (e.g., present, suspected present, absent), and the attribution of this information (the who, when, where, how, why of the information recorded).

The current standing or state.

Any matter of defined composition that has discrete existence, whose origin may be biological, mineral or chemical.

Part of the name that is acquired as a title due to academic, legal, employment or nobility status, etc. and that appears at the end of the name.

A user name or other identifier on a telecommunication network, such as a telephone number (including country code and extension, if necessary), email address, or SkypeID.

The time at which something is to end or did end. Boundary is considered inclusive.

A period of time defined by a start and end time, date, or year. If the start element is missing, the start of the period is not known. If the end element is missing, it means that the period is ongoing, or the start may be in the past, and the end date in the future, which means that period is expected/planned to end at the specified time. The end value includes any matching date/time. For example, the period 2011-05-23 to 2011-05-27 includes all the times from the start of the 23rd May through to the end of the 27th of May.

The time at which something is to take effect, start, or did start. Boundary is considered inclusive.

A distinguishing word or group of words naming an item.

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.

Total number of lymph nodes examined for the presence of cancer cells

The degree of glandular differentiation or tubule formation in breast carcinoma is one component of the Nottingham histologic grade, which is a prognostic indicator for patients with breast carcinoma. Less aggressive cancers have more tubule formation.

Dimension size of the tumor sample evaluated for staging. Dimensions include a size measurements for the longest diameter and the short axis (per RECIST guidelines) as well as margin measurements.

A human-readable identifier for the lesion; e.g., a letter or integer.

Description of the edge or border of tumor in situ by radiologist or of removed tumor by pathologist.

The edge or border of the tissue removed in cancer surgery. The margin is described as negative or clean when the pathologist finds no cancer cells at the edge of the tissue, suggesting that all of the cancer has been removed. The margin is described as positive or involved when the pathologist finds cancer cells at the edge of the tissue, suggesting that all of the cancer has not been removed.

The most specific code (lowest level term) describing the kind or sort of thing being represented.

Code for the unit of measure of the quantity.

The upper limit on a quantitative value.

A unique URL on which the device may be contacted directly.

The model number of the device, assigned by the manufacturer or vendor.

Whether an assessment has been confirmed by testing or observation. CIMI Alignment: This attribute corresponds to FindingContext.status, but has been defined to align with FHIR. In AllergyIntolerance, the type is code.

A number or code associated with the product that identifies a particular release iteration.

The time at which a condition or condition was first identified in a healthcare context.

Accuracy and fluency of reading and writing in a language.