{
  "resourceType": "StructureDefinition",
  "id": "uicc-tnm",
  "url": "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm",
  "name": "UICC_TNM",
  "title": "Profile UICC TNM",
  "status": "draft",
  "publisher": "VISION ZERO E.V.",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.vision-zero-oncology.de/"
        }
      ]
    }
  ],
  "description": "Profile for the tumor classification using TNM stage groups (I, II, III, or IV) and TNM staging elements (T, N, and M).",
  "fhirVersion": "4.0.1",
  "mapping": [
    {
      "identity": "workflow",
      "uri": "http://hl7.org/fhir/workflow",
      "name": "Workflow Pattern"
    },
    {
      "identity": "sct-concept",
      "uri": "http://snomed.info/conceptdomain",
      "name": "SNOMED CT Concept Domain Binding"
    },
    {
      "identity": "v2",
      "uri": "http://hl7.org/v2",
      "name": "HL7 v2 Mapping"
    },
    {
      "identity": "rim",
      "uri": "http://hl7.org/v3",
      "name": "RIM Mapping"
    },
    {
      "identity": "w5",
      "uri": "http://hl7.org/fhir/fivews",
      "name": "FiveWs Pattern Mapping"
    },
    {
      "identity": "sct-attr",
      "uri": "http://snomed.org/attributebinding",
      "name": "SNOMED CT Attribute Binding"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation.code.coding",
        "path": "Observation.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "$this"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "Observation.code.coding:snomed",
        "path": "Observation.code.coding",
        "sliceName": "snomed",
        "min": 0,
        "max": "*",
        "patternCoding": {
          "code": "258235000",
          "system": "http://snomed.info/sct"
        }
      },
      {
        "id": "Observation.code.coding:loinc",
        "path": "Observation.code.coding",
        "sliceName": "loinc",
        "min": 1,
        "max": "1",
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-classification-type-loinc"
        }
      },
      {
        "id": "Observation.subject",
        "path": "Observation.subject",
        "min": 1,
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "http://hl7.org/fhir/StructureDefinition/Patient"
            ]
          }
        ]
      },
      {
        "id": "Observation.value[x]",
        "path": "Observation.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-stage-group-uicc"
        }
      },
      {
        "id": "Observation.hasMember",
        "path": "Observation.hasMember",
        "slicing": {
          "discriminator": [
            {
              "type": "profile",
              "path": "resolve()"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Observation.hasMember:R-classification",
        "path": "Observation.hasMember",
        "sliceName": "R-classification",
        "short": "Residual Tumor (R) Classification",
        "definition": "The absence or presence of residual tumour after treatment is described by the symbol R.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm-r-classification"
            ]
          }
        ]
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "code"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Observation.component:y-symbol",
        "path": "Observation.component",
        "sliceName": "y-symbol",
        "short": "y Symbol",
        "definition": "In those cases in which classification is performed during or following multimodality therapy, the cTNM or pTNM category is identified by a y prefix.",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:y-symbol.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "277649004",
              "system": "http://snomed.info/sct",
              "display": "y - During therapy/following treatment (tumor staging)"
            }
          ]
        }
      },
      {
        "id": "Observation.component:y-symbol.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "y",
              "system": "urn:oid:2.16.840.1.113883.15.16",
              "display": "y"
            }
          ]
        }
      },
      {
        "id": "Observation.component:r-symbol",
        "path": "Observation.component",
        "sliceName": "r-symbol",
        "short": "r Symbol",
        "definition": "Recurrent tumours, when classified after a disease free interval, are identified by the prefix r.",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:r-symbol.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "277647002",
              "system": "http://snomed.info/sct",
              "display": "r - Tumor recurrence (tumor staging)"
            }
          ]
        }
      },
      {
        "id": "Observation.component:r-symbol.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "r",
              "system": "urn:oid:2.16.840.1.113883.15.16",
              "display": "r"
            }
          ]
        }
      },
      {
        "id": "Observation.component:a-symbol",
        "path": "Observation.component",
        "sliceName": "a-symbol",
        "short": "a Symbol",
        "definition": "The prefix a indicates that classification is first determined at autopsy.",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:a-symbol.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "277646006",
              "system": "http://snomed.info/sct",
              "display": "a - At autopsy (tumor staging)"
            }
          ]
        }
      },
      {
        "id": "Observation.component:a-symbol.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "a",
              "system": "urn:oid:2.16.840.1.113883.15.16",
              "display": "a"
            }
          ]
        }
      },
      {
        "id": "Observation.component:T-code",
        "path": "Observation.component",
        "sliceName": "T-code",
        "short": "T - Primary Tumor",
        "definition": "The T-category describes the extent of the primary tumor.",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:T-code.extension",
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "Observation.component:T-code.extension:cpuPrefix",
        "path": "Observation.component.extension",
        "sliceName": "cpuPrefix",
        "short": "Clinical or pathological classification",
        "definition": "How the TNM-values are determined: clinically, by ultrasound or pathologically.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm-prefix-cpu"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:T-code.code",
        "path": "Observation.component.code",
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-t-staging-type-loinc"
        }
      },
      {
        "id": "Observation.component:T-code.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-t-category-uicc"
        }
      },
      {
        "id": "Observation.component:m-symbol",
        "path": "Observation.component",
        "sliceName": "m-symbol",
        "short": "m Symbol",
        "definition": "The suffix m, in parentheses, is used to indicate the presence of multiple primary tumors at a single site.",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:m-symbol.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "277650004",
              "system": "http://snomed.info/sct",
              "display": "m - Multiple tumors (tumor staging)"
            }
          ]
        }
      },
      {
        "id": "Observation.component:m-symbol.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-t-multiplicity-uicc"
        }
      },
      {
        "id": "Observation.component:N-code",
        "path": "Observation.component",
        "sliceName": "N-code",
        "short": "N - Regional Lymph Nodes",
        "definition": "The N-category describes the absence or presence and extent of regional lymph node metastasis.",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:N-code.extension",
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "Observation.component:N-code.extension:cpuPrefix",
        "path": "Observation.component.extension",
        "sliceName": "cpuPrefix",
        "short": "Clinical or pathological classification",
        "definition": "How the TNM-values are determined: clinically, by ultrasound or pathologically.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm-prefix-cpu"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:N-code.extension:itcSuffix",
        "path": "Observation.component.extension",
        "sliceName": "itcSuffix",
        "short": "Isolated Tumor Cells",
        "definition": "Isolated tumor cells (ITC) are single tumor cells or small clusters of cells not more than 0.2 mm in greatest extent that can be detected by routine H and E stains or immunohistochemistry.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm-suffix-itc"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:N-code.extension:snSuffix",
        "path": "Observation.component.extension",
        "sliceName": "snSuffix",
        "short": "Sentinel Lymph Node",
        "definition": "The sentinel lymph node is the first lymph node to receive lymphatic drainage from a primary tumor. If it contains metastatic tumor this indicates that other lymph nodes may contain tumor.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm-suffix-itc-sn"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:N-code.code",
        "path": "Observation.component.code",
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-n-staging-type-loinc"
        }
      },
      {
        "id": "Observation.component:N-code.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-n-category-uicc"
        }
      },
      {
        "id": "Observation.component:M-code",
        "path": "Observation.component",
        "sliceName": "M-code",
        "short": "M - Distant Metastasis",
        "definition": "The M-category describes the absence or presence of distant metastasis.",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:M-code.extension",
        "path": "Observation.component.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "ordered": false,
          "rules": "open"
        }
      },
      {
        "id": "Observation.component:M-code.extension:cpuPrefix",
        "path": "Observation.component.extension",
        "sliceName": "cpuPrefix",
        "short": "Clinical or pathological classification",
        "definition": "How the TNM-values are determined: clinically, by ultrasound or pathologically.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm-prefix-cpu"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:M-code.extension:itcSuffix",
        "path": "Observation.component.extension",
        "sliceName": "itcSuffix",
        "short": "Isolated Tumor Cells",
        "definition": "Isolated tumor cells (ITC) are single tumor cells or small clusters of cells not more than 0.2 mm in greatest extent that can be detected by routine H and E stains or immunohistochemistry.",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://www.vision-zero-oncology.de/fhir/StructureDefinition/uicc-tnm-suffix-itc"
            ]
          }
        ]
      },
      {
        "id": "Observation.component:M-code.code",
        "path": "Observation.component.code",
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-m-staging-type-loinc"
        }
      },
      {
        "id": "Observation.component:M-code.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-m-category-uicc"
        }
      },
      {
        "id": "Observation.component:L-descriptor",
        "path": "Observation.component",
        "sliceName": "L-descriptor",
        "short": "L - Lymphatic Invasion",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:L-descriptor.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "33739-4",
              "system": "http://loinc.org",
              "display": "Lymphatic.small vessel.invasion [Identifier] in Specimen by CAP cancer protocols"
            }
          ]
        }
      },
      {
        "id": "Observation.component:L-descriptor.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-l-lymphatic-invasion-uicc"
        }
      },
      {
        "id": "Observation.component:V-descriptor",
        "path": "Observation.component",
        "sliceName": "V-descriptor",
        "short": "V - Venous Invasion",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:V-descriptor.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "33740-2",
              "system": "http://loinc.org",
              "display": "Venous.large vessel.invasion [Identifier] in Specimen by CAP cancer protocols"
            }
          ]
        }
      },
      {
        "id": "Observation.component:V-descriptor.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-v-venous-invasion-uicc"
        }
      },
      {
        "id": "Observation.component:Pn-descriptor",
        "path": "Observation.component",
        "sliceName": "Pn-descriptor",
        "short": "Pn - Perineural Invasion",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:Pn-descriptor.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "92837-4",
              "system": "http://loinc.org",
              "display": "Perineural invasion [Presence] in Cancer specimen"
            }
          ]
        }
      },
      {
        "id": "Observation.component:Pn-descriptor.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-pn-perineural-invasion-uicc"
        }
      },
      {
        "id": "Observation.component:S-symbol",
        "path": "Observation.component",
        "sliceName": "S-symbol",
        "short": "Serum Tumor Markers",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:S-symbol.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "399424006",
              "system": "http://snomed.info/sct",
              "display": "Serum tumor marker category (observable entity)"
            }
          ]
        }
      },
      {
        "id": "Observation.component:S-symbol.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "required",
          "valueSet": "https://www.vision-zero-oncology.de/fhir/ValueSet/tnm-s-serum-tumor-markers-uicc"
        }
      },
      {
        "id": "Observation.component:numberOfNodesAffected",
        "path": "Observation.component",
        "sliceName": "numberOfNodesAffected",
        "short": "Number of regional lymph nodes positive",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:numberOfNodesAffected.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "21893-3",
              "system": "http://loinc.org",
              "display": "Regional lymph nodes positive [#] Specimen"
            }
          ]
        }
      },
      {
        "id": "Observation.component:numberOfNodesAffected.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "Observation.component:numberOfNodesAffected.value[x].system",
        "path": "Observation.component.value[x].system",
        "patternUri": "http://unitsofmeasure.org"
      },
      {
        "id": "Observation.component:numberOfNodesAffected.value[x].code",
        "path": "Observation.component.value[x].code",
        "patternCode": "1"
      },
      {
        "id": "Observation.component:numberOfNodesExamined",
        "path": "Observation.component",
        "sliceName": "numberOfNodesExamined",
        "short": "Number of regional lymph nodes examined",
        "min": 0,
        "max": "1"
      },
      {
        "id": "Observation.component:numberOfNodesExamined.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "code": "21894-1",
              "system": "http://loinc.org",
              "display": "Regional lymph nodes examined [#] Specimen"
            }
          ]
        }
      },
      {
        "id": "Observation.component:numberOfNodesExamined.value[x]",
        "path": "Observation.component.value[x]",
        "type": [
          {
            "code": "Quantity"
          }
        ]
      },
      {
        "id": "Observation.component:numberOfNodesExamined.value[x].system",
        "path": "Observation.component.value[x].system",
        "patternUri": "http://unitsofmeasure.org"
      },
      {
        "id": "Observation.component:numberOfNodesExamined.value[x].code",
        "path": "Observation.component.value[x].code",
        "patternCode": "1"
      }
    ]
  }
}