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