2023-02-20 - Cancer Synoptic Reporting Project Group Meeting

1

Record meeting

@Scott Campbell 

2

Status update

@Scott Campbell 

1. Protocols complete
   
   
   

2. Gaps
   
   
   

3. How to fill gaps 
   
   
   

4. Content release validation

1. Can I send "gap" questions to pathologists/reps and get a response in <=1 week time?
   
   
   

2. Content release maps discussed. @Scott Campbell @Jieun Hwang will populate ICCR templates and circulate to CSRWG members and ICCR for content review.  @Ian Green @Jane Millar to work with ICCR to see if such content can be included in implementation guide as appendices.  @Daniel Karlsson would like FHIR bindings discussed and articulated.

2

Closing gaps in content - dysplasia and neoplasia at margins

@Scott Campbell 

1. Continue discussion

Group present agrees that 127569003 |In situ neoplasm (morphologic abnormality)|  with renaming or PT(?) as non-invasive neoplasm works as appropriate supertype for /2 nenoplasms and #plasias

1. The concept: 127569003 |In situ neoplasm (morphologic abnormality)|  subsumes high-grade dysplasia, in situ carcinoma, high grade intraepithelial neoplasia and other concepts.  Using this term for those "blended" non-invasive tumors at the surgical margin (e.g., high grade dysplasia/in situ carcinoma)  will serve the clinical use case for these observable entity concepts.  No need to create "and/or" concepts here.

    

   Regarding the QI work in histologies, Brian made the observation during our extended #plasia discussion. Tuesday, that the framework for proper structure in this hierarchy may be present.  Specifically, this is what he and I propose:

    

   1. All histologies should have a parent concept that asserts behavior (/0, /1, /2, /3, /6)

   1.  

      1. <<3898006 |Neoplasm, benign (morphologic abnormality)|. (/0)

      2. <<86251006 |Neoplasm of uncertain behavior (morphologic abnormality)|

      3. <<127569003 |In situ neoplasm (morphologic abnormality)|. (/2)

      4. <<1240414004 |Malignant neoplasm (morphologic abnormality)| (/3)

      5. <<14799000 |Neoplasm, metastatic (morphologic abnormality)|. (/6)

      6. <<6219000 |Neoplasm, malignant, uncertain whether primary or metastatic (morphologic abnormality)|  (/9)

   1. All histologies will also be a subtype of their cell lineage type(s) (embryologic)

   Given these two overarching design features, we have a sound framework.  Item 1 is needed for both knowledge representation as well as alignment with WHO.  Item 2 is fundamental to knowledge management.

    

   I think this also allows us to remove "bad" concepts that include the organ references when not necessary.  As Thomas noted well on Monday, the organ is important for a clinical finding/disorder, that is the morphology is present in an organ.
   
   
   

2. Suggest that a parent of 127569003 |In situ neoplasm (morphologic abnormality)| be created to subsume ALL non-invasive neoplasms and not only in situ forms.  This will include High grade appendiceal lesions, Low grade appendiceal lesions, intramucosal carcinoma, etc

@Scott Campbell will create some possible alternatives and share with group for input.

3

Neuroendocrine grade/morphology

@Scott Campbell 

1. Blending grade and type
   
   
   

2. NET remodel

neuroendocrine protocols assume the neoplasm is neuroendocrine.  Thus, only grade is solicited but question phrased as Histology type and grade of tumor.  OK to use our content of Histologic grade of neuroendocrine neoplasm of organ X = G- well-defined neuroendocrine histologic grade

This is fine IF |Inheres in| = |well-defined neuroendocrine tumor|

Lots of discussion.  Several would like to participate in this exercise including @Laszlo Igali @dubois @rous 

4

Question from Irish NRC

@Scott Campbell 

Following up.  The Netherlands and Ireland use these.  Suggest we create appropriate concepts.

Confirmed that Ireland, The Netherlands and Sweden use this rubric.  Thus, international content development recommended.

Are there SNOMED CT equivalent codes for S codes, B codes and R codes used in Breastcheck Screening? https://www.euref.org/european-guidelines/4th-edition [euref.org]

Discussed.  May need to create observables.

5

Disorders

@Scott Campbell 

Question from Thomas

1. Disorders for high incidence cancers?  More discussion required

5

Business meeting

@Scott Campbell 

1. In person/mixed

April 2 and 4 for cancer synoptics; April 5 for pathology CRG

Date? for UK/RCPath in Cambridge