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HdBe-TNMTumorClassificatie

WARNING This page contains a draft CBB, as raw output from the zib export and automatic conversion to CBB. It requires thorough review and adaption to the Belgian realm. This CBB is merely added for informative use.

CBB	Concept	Status
HdBe-TNMTumorClassification	TNM Classificatie van Maligne Tumoren (TNM) is het systeem voor de stadiëring van kanker dat is ontwikkeld door de Union Internationale Contre le Cancer of International Union Against Cancer (UICC). De TNM-classificatie wordt ook gebruikt door de American Joint Committee on Cancer (AJCC) en de International Federation of Gynecology and Obstetrics (FIGO). In 1987 werden de TNM-classificaties van de UICC en de AJCC tot één systeem gecombineerd met dezelfde definities. Desondanks zitten er nog altijd verschillen tussen beide systemen. De TNM-classificatie is ontwikkeld voor solide tumoren (waaronder carcinomen en sarcomen); niet-solide tumoren (bijvoorbeeld lymfomen en gliomen) kennen een ander systeem voor stadiëring. De algemene opzet is als volgt: De T staat voor tumor en beschrijft de grootte van de tumor en de lokale uitbreiding, de N staat voor lymfekliermetastasering (Engels: node) en de M staat voor metastase op afstand (uitbreiding van de kanker van één locatie in het lichaam naar een andere. Naast T, N en M bevat de classificatie nog een aantal andere parameters. Purpose TNM-classificatie is een belangrijke bepalende factor voor de juiste behandeling en prognose. Het stadium is een steeds belangrijker onderdeel van kankersurveillance en kankerbestrijding en een eindpunt voor de evaluatie van populatie screening en vroege detectie. Het TNM-stadiëringssysteem is de gemeenschappelijke taal waarin zorgprofessionals in de oncologie kunnen communiceren over de uitbreiding en verspreiding van kanker bij individuele patiënten als basis voor besluitvorming over behandeling en individuele prognose. Het kan ook worden gebruikt voor het opstellen en evalueren van behandelrichtlijnen, nationale beleid t.a.v. zorgplanning en onderzoek. De doelstellingen van de TNM-classificatie zijn: Hulp bij het plannen van de behandeling. Het geven van een indicatie van prognose op basis van historische gegevens over uitkomsten. Ondersteuning bij de evaluatie van behandelresultaten. De uitwisseling van informatie tussen behandelcentra vergemakkelijken. Bijdragen aan doorlopend onderzoek naar kanker. Ondersteuning van kankerbestrijding, onder meer via kankerregisters. De TNM-classificatie is een uniforme standaard. Het doel is breder dan alleen de toepassing binnen het primaire zorgproces en zorgt voor essentiële informatie voor beleidsmakers die kankerbestrijdings- en preventieplannen ontwikkelen of uitvoeren. Instructions Van een generieke TNM classificatie naar een ziekte specifieke TNM classificatie Bij het uitwerken van een tumor specifieke TNM-bouwsteen of implementatie moet gekeken worden hoe de waardelijsten kunnen worden ingeperkt, toegepast of uitgebreid. Inperken wil zeggen dat items in een codelijst worden weggelaten of specifiek worden gemaakt door binnen het voorgeschreven code systeem andere termen te kiezen. Het is de bedoeling dat in de toekomst kant en klare codelijsten per kankeraandoening beschikbaar worden gemaakt (zie ook issues). Codesystemen In deze zib worden 2 internationale codesystemen gebruikt: SNOMED CT (beheerder international SNOMED international, Nederlands beheer door Nictiz) International Classification of Diseases for Oncology, version 3 (ICD-O-3) beheerd door de WHO. Waar toepassing van één van deze codesystemen niet zinvol werd geacht of mogelijk was is gekozen voor beheer ervan als onderdeel van het beheer van de zibs. Wanneer er een eenduidige internationale verwijzing mogelijk is naar de TNM standaard zelf als codesysteem met waardelijsten kunnen deze worden aangepast in een volgende versie van de zib. Uitgangspunten vanuit de TNM standaard Eén TNM-classificatie per orgaan, maar in geval van gepaarde organen is er één classificatie per zijde. Bijvoorbeeld bij borstkanker met in iedere borst een primaire tumor zijn er dan dus ook twee instantiaties van de zib, waarbij de ene lateraliteit links en de andere lateraliteit rechts heeft (beiderzijds is niet toegestaan bij gepaarde organen). Niet alleen de uitkomst van de TNM, maar ook de exacte lokalisatie van de primaire tumor(en), positieve lymfeklieren en metastasen kan worden aangeduid. In het geval van meerdere primaire tumoren in één orgaan, moet de tumor met de hoogste T-categorie worden geclassificeerd en moet de veelvoud of het aantal tumoren tussen haakjes worden vermeld, bijvoorbeeld T2 (m) of T2 (5).De afwijking met de hoogste T-categorie bepaalt de classificatie van de tumor. Om het onderscheid hierin te maken en alle afwijkingen te kunnen weergeven bestaat de container ‘afwijking’ in de zib. Elke afwijking heeft een nummer. Welke afwijking (b.v. 1, 2 of 4) de hoogste t-categorie heeft wordt niet in de zib aangegeven. Dit is logische want dit is pas duidelijk na de inschatting van de zorgverlener o.b.v. de pathologie dan wel beeldvorming. Gebruikte versie van de UICC (http://www.uicc.org/resources/tnm) **/ AJCC (http://cancerstaging.org/references-tools/deskreferences/Pages/default.aspx )** TNM Classification of Malignant Tumours. Hoewel er geen verschillen in definities en verwoordingen tussen AJCC en UICC TNM classificaties zouden mogen voorkomen zijn er helaas wel enkele verschillen ingeslopen (bijvoorbeeld bij de definitie van regionale lymfeklieren bij slokdarm- en endometriumcarcinomen). Daarom kan in deze zib gekozen worden tussen de UICC en AJCC versie. Criteria die in het TNM-classificatiesysteem worden gebruikt, zijn in de loop van de jaren veranderd en er zijn verschillende edities uitgebracht. Als gevolg hiervan kan een bepaalde stagering een heel andere prognose hebben, afhankelijk van welke editie wordt gebruikt. Verder is een belangrijke overweging het effect van een verbeterde behandeling in de tijd Naast de stagering via UICC of AJCC classificaties is er ook ‘Essential TNM’. Dit is een versimpelde vorm van TNM die is gemaakt voor het weergeven van het voorkomen van kanker in lage lonen landen. In deze landen zijn vaak de middelen voor vroege diagnose niet aanwezig en het gebruik van TNM beperkt (kanker wordt in de regel in deze landen pas in een zeer laat stadium ontdekt). Deze speciale TNM is niet meegenomen in de uitwerking van deze zib. Overigens wordt deze speciale TNM meestal alleen gebruikt voor het kunnen betrekken van deze landen in de statistiek over het voorkomen van bepaalde kankers in deze landen. Prefix en suffix zijn geïntegreerd in codelijsten. Alhoewel het mogelijk zou zijn om voor de mogelijke voor en achtervoegsels op zowel de T, N en M losse codelijsten te maken is voor het eenvoudig toepassen ervan gekozen om deze te integreren in de codelijsten. Dit is besloten omdat de huidige inzichten zijn dat hiermee het maken van verkeerde combinaties wordt voorkomen Prefix c: Klinische classificatie, gebaseerd op gegevens vóór behandeling, zoals klinisch onderzoek, beeldvorming, endoscopie, biopten, chirurgische exploratie of onderzoek onder narcose, en andere onderzoeken. yc: Classificatie uitgevoerd tijdens of na een initiële multimodaliteitsbehandeling (zijnde niet- chirurgisch). p: De post-chirurgische histologische pathologische classificatie. Dit is gebaseerd op de gegevens van voor de behandeling, aangevuld met pathologisch onderzoek na een heelkundige behandeling. yp: Classificatie uitgevoerd tijdens of na een initiële multimodaliteitsbehandeling (waaronder ook chirurgische behandeling). rc: Klinische classificatie in geval van een recidiverende tumor (na een ziektevrij interval). rp: Post-operatieve pathologische classificatie in geval van een recidiverende tumor (na een ziektevrij interval). a: Classificatie vastgesteld tijdens autopsie Suffix (mi): Gevallen met alleen micrometastase (sn): Gevallen waarbij schildwachtklier onderzoek heeft plaatsgevonden. (f): Gevallen waarbij FNA of biopsie heeft plaatsgevonden op de regionale lymfeklieren (i-): negatieve morfologische bevindingen voor geïsoleerde tumorcellen (i+): positieve morfologische bevindingen voor geïsoleerde tumorcellen (mol-): negatieve niet-morfologische bevindingen voor geïsoleerde tumorcellen (mol+): positieve niet- morfologische bevindingen voor geïsoleerde tumorcellen (0): zonder verhoogd lactaatdehydrogenase (LDH) (1): met verhoogd lactaatdehydrogenase (LDH) Patient Population Volwassen patiënten met een solide tumor waarop een TNM-classificatie kan worden toegepast. Issues Bruikbaarheid van deze zib als ook de ziekte specifieke codelijsten worden gemaakt in de eerste proeftuin(en), gepland in de zomer van 2020. Gedurende dit project zal IKNL het beheer voor deze codelijsten verzorgen. Wanneer deze proeftuin(en) zijn afgerond worden de bevindingen meegenomen als wijzigingsverzoeken in het reguliere beheerproces van het zib centrum. References TNM Classification of Malignant Tumours, 8th Edition - James D. Brierley (Editor), Mary K. Gospodarowicz (Editor), Christian Wittekind (Editor)- International Union Against Cancer (UICC)- ISBN: 9781119263562 (epub) https://www.uicc.org/resources/tnm [ONLINE geraadpleegd: 04 mei 2020] International Classification of diseases for oncology (ICD-O) – 3rd edition, 1st revision – April Frits, Constance Percy, Andrew Jack, Kanagaratnam Shanmugaratnam, Leslie Sobin, D Max Parkin, Sharon Whelan – World Health Organisation – WHO library cataloguing – ISBN 978 92 4 069212 1 (PDF)	draft

CBB

Concept

Status

HdBe-TNMTumorClassification

TNM Classificatie van Maligne Tumoren (TNM) is het systeem voor de stadiëring van kanker dat is ontwikkeld door de Union Internationale Contre le Cancer of International Union Against Cancer (UICC). De TNM-classificatie wordt ook gebruikt door de American Joint Committee on Cancer (AJCC) en de International Federation of Gynecology and Obstetrics (FIGO). In 1987 werden de TNM-classificaties van de UICC en de AJCC tot één systeem gecombineerd met dezelfde definities. Desondanks zitten er nog altijd verschillen tussen beide systemen. De TNM-classificatie is ontwikkeld voor solide tumoren (waaronder carcinomen en sarcomen); niet-solide tumoren (bijvoorbeeld lymfomen en gliomen) kennen een ander systeem voor stadiëring. De algemene opzet is als volgt: De T staat voor tumor en beschrijft de grootte van de tumor en de lokale uitbreiding, de N staat voor lymfekliermetastasering (Engels: node) en de M staat voor metastase op afstand (uitbreiding van de kanker van één locatie in het lichaam naar een andere. Naast T, N en M bevat de classificatie nog een aantal andere parameters.

Purpose

TNM-classificatie is een belangrijke bepalende factor voor de juiste behandeling en prognose. Het stadium is een steeds belangrijker onderdeel van kankersurveillance en kankerbestrijding en een eindpunt voor de evaluatie van populatie screening en vroege detectie. Het TNM-stadiëringssysteem is de gemeenschappelijke taal waarin zorgprofessionals in de oncologie kunnen communiceren over de uitbreiding en verspreiding van kanker bij individuele patiënten als basis voor besluitvorming over behandeling en individuele prognose. Het kan ook worden gebruikt voor het opstellen en evalueren van behandelrichtlijnen, nationale beleid t.a.v. zorgplanning en onderzoek. De doelstellingen van de TNM-classificatie zijn:

Hulp bij het plannen van de behandeling.
Het geven van een indicatie van prognose op basis van historische gegevens over uitkomsten.
Ondersteuning bij de evaluatie van behandelresultaten.
De uitwisseling van informatie tussen behandelcentra vergemakkelijken.
Bijdragen aan doorlopend onderzoek naar kanker.
Ondersteuning van kankerbestrijding, onder meer via kankerregisters.

De TNM-classificatie is een uniforme standaard. Het doel is breder dan alleen de toepassing binnen het primaire zorgproces en zorgt voor essentiële informatie voor beleidsmakers die kankerbestrijdings- en preventieplannen ontwikkelen of uitvoeren.

Instructions

Van een generieke TNM classificatie naar een ziekte specifieke TNM classificatie Bij het uitwerken van een tumor specifieke TNM-bouwsteen of implementatie moet gekeken worden hoe de waardelijsten kunnen worden ingeperkt, toegepast of uitgebreid. Inperken wil zeggen dat items in een codelijst worden weggelaten of specifiek worden gemaakt door binnen het voorgeschreven code systeem andere termen te kiezen. Het is de bedoeling dat in de toekomst kant en klare codelijsten per kankeraandoening beschikbaar worden gemaakt (zie ook issues). Codesystemen In deze zib worden 2 internationale codesystemen gebruikt:

SNOMED CT (beheerder international SNOMED international, Nederlands beheer door Nictiz)
International Classification of Diseases for Oncology, version 3 (ICD-O-3) beheerd door de WHO.

Waar toepassing van één van deze codesystemen niet zinvol werd geacht of mogelijk was is gekozen voor beheer ervan als onderdeel van het beheer van de zibs. Wanneer er een eenduidige internationale verwijzing mogelijk is naar de TNM standaard zelf als codesysteem met waardelijsten kunnen deze worden aangepast in een volgende versie van de zib. Uitgangspunten vanuit de TNM standaard

Eén TNM-classificatie per orgaan, maar in geval van gepaarde organen is er één classificatie per zijde. Bijvoorbeeld bij borstkanker met in iedere borst een primaire tumor zijn er dan dus ook twee instantiaties van de zib, waarbij de ene lateraliteit links en de andere lateraliteit rechts heeft (beiderzijds is niet toegestaan bij gepaarde organen).
Niet alleen de uitkomst van de TNM, maar ook de exacte lokalisatie van de primaire tumor(en), positieve lymfeklieren en metastasen kan worden aangeduid.
In het geval van meerdere primaire tumoren in één orgaan, moet de tumor met de hoogste T-categorie worden geclassificeerd en moet de veelvoud of het aantal tumoren tussen haakjes worden vermeld, bijvoorbeeld T2 (m) of T2 (5).De afwijking met de hoogste T-categorie bepaalt de classificatie van de tumor. Om het onderscheid hierin te maken en alle afwijkingen te kunnen weergeven bestaat de container ‘afwijking’ in de zib. Elke afwijking heeft een nummer. Welke afwijking (b.v. 1, 2 of 4) de hoogste t-categorie heeft wordt niet in de zib aangegeven. Dit is logische want dit is pas duidelijk na de inschatting van de zorgverlener o.b.v. de pathologie dan wel beeldvorming.

Gebruikte versie van de ****UICC (http://www.uicc.org/resources/tnm) ****/ ****AJCC (http://cancerstaging.org/references-tools/deskreferences/Pages/default.aspx** )**** TNM Classification of Malignant Tumours.**

Hoewel er geen verschillen in definities en verwoordingen tussen AJCC en UICC TNM classificaties zouden mogen voorkomen zijn er helaas wel enkele verschillen ingeslopen (bijvoorbeeld bij de definitie van regionale lymfeklieren bij slokdarm- en endometriumcarcinomen). Daarom kan in deze zib gekozen worden tussen de UICC en AJCC versie. Criteria die in het TNM-classificatiesysteem worden gebruikt, zijn in de loop van de jaren veranderd en er zijn verschillende edities uitgebracht. Als gevolg hiervan kan een bepaalde stagering een heel andere prognose hebben, afhankelijk van welke editie wordt gebruikt. Verder is een belangrijke overweging het effect van een verbeterde behandeling in de tijd
Naast de stagering via UICC of AJCC classificaties is er ook ‘Essential TNM’. Dit is een versimpelde vorm van TNM die is gemaakt voor het weergeven van het voorkomen van kanker in lage lonen landen. In deze landen zijn vaak de middelen voor vroege diagnose niet aanwezig en het gebruik van TNM beperkt (kanker wordt in de regel in deze landen pas in een zeer laat stadium ontdekt). Deze speciale TNM is niet meegenomen in de uitwerking van deze zib. Overigens wordt deze speciale TNM meestal alleen gebruikt voor het kunnen betrekken van deze landen in de statistiek over het voorkomen van bepaalde kankers in deze landen.

Prefix en suffix zijn geïntegreerd in codelijsten. Alhoewel het mogelijk zou zijn om voor de mogelijke voor en achtervoegsels op zowel de T, N en M losse codelijsten te maken is voor het eenvoudig toepassen ervan gekozen om deze te integreren in de codelijsten. Dit is besloten omdat de huidige inzichten zijn dat hiermee het maken van verkeerde combinaties wordt voorkomen **Prefix **

**c: **Klinische classificatie, gebaseerd op gegevens vóór behandeling, zoals klinisch onderzoek, beeldvorming, endoscopie, biopten, chirurgische exploratie of onderzoek onder narcose, en andere onderzoeken.
yc: Classificatie uitgevoerd tijdens of na een initiële multimodaliteitsbehandeling (zijnde niet- chirurgisch).
p: De post-chirurgische histologische pathologische classificatie. Dit is gebaseerd op de gegevens van voor de behandeling, aangevuld met pathologisch onderzoek na een heelkundige behandeling.
yp: Classificatie uitgevoerd tijdens of na een initiële multimodaliteitsbehandeling (waaronder ook chirurgische behandeling).
rc: Klinische classificatie in geval van een recidiverende tumor (na een ziektevrij interval).
rp: Post-operatieve pathologische classificatie in geval van een recidiverende tumor (na een ziektevrij interval).
a: Classificatie vastgesteld tijdens autopsie

Suffix

(mi): Gevallen met alleen micrometastase
(sn): Gevallen waarbij schildwachtklier onderzoek heeft plaatsgevonden.
(f): Gevallen waarbij FNA of biopsie heeft plaatsgevonden op de regionale lymfeklieren
(i-): negatieve morfologische bevindingen voor geïsoleerde tumorcellen
(i+): positieve morfologische bevindingen voor geïsoleerde tumorcellen
(mol-): negatieve niet-morfologische bevindingen voor geïsoleerde tumorcellen
(mol+): positieve niet- morfologische bevindingen voor geïsoleerde tumorcellen
(0): zonder verhoogd lactaatdehydrogenase (LDH)
(1): met verhoogd lactaatdehydrogenase (LDH)

Patient Population

Volwassen patiënten met een solide tumor waarop een TNM-classificatie kan worden toegepast. Issues Bruikbaarheid van deze zib als ook de ziekte specifieke codelijsten worden gemaakt in de eerste proeftuin(en), gepland in de zomer van 2020. Gedurende dit project zal IKNL het beheer voor deze codelijsten verzorgen. Wanneer deze proeftuin(en) zijn afgerond worden de bevindingen meegenomen als wijzigingsverzoeken in het reguliere beheerproces van het zib centrum. References

TNM Classification of Malignant Tumours, 8th Edition - James D. Brierley (Editor), Mary K. Gospodarowicz (Editor), Christian Wittekind (Editor)- International Union Against Cancer (UICC)- ISBN: 9781119263562 (epub)
https://www.uicc.org/resources/tnm [ONLINE geraadpleegd: 04 mei 2020]
International Classification of diseases for oncology (ICD-O) – 3rd edition, 1st revision – April Frits, Constance Percy, Andrew Jack, Kanagaratnam Shanmugaratnam, Leslie Sobin, D Max Parkin, Sharon Whelan – World Health Organisation – WHO library cataloguing – ISBN 978 92 4 069212 1 (PDF)

draft

TNMTumorClassification			TNMTumorClassification	Element id TNMTumorClassification Short description TNMTumorClassificatie Definition Rootconcept van de bouwsteen TNMTumorClassificatie. Dit rootconcept bevat alle gegevenselementen van de bouwsteen TNMTumorClassificatie. Data type TNMTumorClassification Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id TNMTumorClassification.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
PrimaryTumor		0..1	BackboneElement	Element id TNMTumorClassification.PrimaryTumor Short description PrimaireTumor Definition Container van het concept PrimaireTumor. Deze container bevat alle gegevenselementen van het concept PrimaireTumor. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id TNMTumorClassification.PrimaryTumor.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.PrimaryTumor.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.PrimaryTumor.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
MNumberOfPrimaryTumors		0..1	CodeableConcept	Element id TNMTumorClassification.PrimaryTumor.MNumberOfPrimaryTumors Short description m_AantalPrimaireTumoren Definition Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TPrimaryTumor		0..1	CodeableConcept	Element id TNMTumorClassification.PrimaryTumor.TPrimaryTumor Short description T_PrimaireTumor Definition Uitkomst van stadiëring van de omvang van de primaire tumor, de T-categorie inclusief prefix en suffix. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Abnormality		1..*	BackboneElement	Element id TNMTumorClassification.PrimaryTumor.Abnormality Short description Afwijking Definition Container van het concept Afwijking. Deze container bevat alle gegevenselementen van het concept Afwijking. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id TNMTumorClassification.PrimaryTumor.Abnormality.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.PrimaryTumor.Abnormality.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.PrimaryTumor.Abnormality.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
AbnormalityNumber		0..1	positiveInt	Element id TNMTumorClassification.PrimaryTumor.Abnormality.AbnormalityNumber Short description AfwijkingNummer Definition Het aan de afwijking toegewezen nummer, noodzakelijk om bij verschillende onderzoeken eenduidig aan te kunnen geven op welke afwijking de informatie betrekking heeft . Bij meerdere afwijkingen in één orgaan wordt de afwijking met de hoogste T-categorie geclassificeerd. Comments 32 bit number; for values larger than this, use decimal Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Morphology		0..1	CodeableConceptBinding	Element id TNMTumorClassification.PrimaryTumor.Abnormality.Morphology Short description Morfologie Definition Gedrag van de tumor en het celtype van de tumor uitgedrukt in de ICD-O-3 morfologie code. Beschrijft het celtype of histologie van de tumor als ook het gedrag van die cel (maligne of benigne). Deze wordt door een patholoog bepaald. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Morphology codes Morphology (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
GHistopathologicalGrading		0..1	CodeableConcept	Element id TNMTumorClassification.PrimaryTumor.Abnormality.GHistopathologicalGrading Short description G_DifferentiatiegraadTumor Definition Uitkomst van stadiëring van de G-categorie, de differentiatiegraad van de tumor, die door een patholoog wordt bepaald. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TumorLocalization	I	0..*	Reference(HdBe-AnatomicalLocation)	Element id TNMTumorClassification.PrimaryTumor.Abnormality.TumorLocalization Short description TumorLokalisatie Definition Container van het concept TumorLokalisatie. Deze container bevat alle gegevenselementen van het concept TumorLokalisatie. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-AnatomicalLocation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
RegionalLymphnodes		0..1	BackboneElement	Element id TNMTumorClassification.RegionalLymphnodes Short description RegionaleLymfeklieren Definition Container van het concept RegionaleLymfeklieren. Deze container bevat alle gegevenselementen van het concept RegionaleLymfeklieren. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id TNMTumorClassification.RegionalLymphnodes.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.RegionalLymphnodes.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.RegionalLymphnodes.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
NRegionalLymphnodes		0..1	CodeableConcept	Element id TNMTumorClassification.RegionalLymphnodes.NRegionalLymphnodes Short description N_RegionaleLymfeklieren Definition Uitkomst van stadiëring van de aan- of afwezigheid en omvang regionale lymfekliermetastase, de N-categorie van de TNM classificatie. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
RegionalLymphNodesLocalization	I	0..*	Reference(HdBe-AnatomicalLocation)	Element id TNMTumorClassification.RegionalLymphnodes.RegionalLymphNodesLocalization Short description RegionaleLymfeklierenLocalisatie Definition Container van het concept RegionaleLymfeklierenLocalisatie. Deze container bevat alle gegevenselementen van het concept RegionaleLymfeklierenLocalisatie. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-AnatomicalLocation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
DistantMetastasis		0..1	BackboneElement	Element id TNMTumorClassification.DistantMetastasis Short description AfstandsMetastasen Definition Container van het concept AfstandsMetastasen. Deze container bevat alle gegevenselementen van het concept AfstandsMetastasen. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id TNMTumorClassification.DistantMetastasis.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.DistantMetastasis.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id TNMTumorClassification.DistantMetastasis.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
MDistantMetastasis		0..1	CodeableConcept	Element id TNMTumorClassification.DistantMetastasis.MDistantMetastasis Short description M_AfstandsMetastasen Definition Uitkomst van stadiëring van de aan- of afwezigheid van metastasen op afstand, de M-categorie van de TNM classificatie. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
DistantMetastasisLocalization	I	0..*	Reference(HdBe-AnatomicalLocation)	Element id TNMTumorClassification.DistantMetastasis.DistantMetastasisLocalization Short description AfstandsMetastasenLocalisatie Definition Container van het concept AfstandsMetastasenLocalisatie. Deze container bevat alle gegevenselementen van het concept AfstandsMetastasenLocalisatie. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-AnatomicalLocation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
DateOfTnmclassification		0..1	dateTime	Element id TNMTumorClassification.DateOfTnmclassification Short description DatumTNMClassificatie Definition De datum waarop de TNM-Classificatie (de waarde) is vastgesteld. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Tnmversion		0..1	CodeableConceptBinding	Element id TNMTumorClassification.Tnmversion Short description TNMVersie Definition TNM-classificatie versie (AJCC of UICC) en de gebruikte editie (7e, 8e etc.). Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding TNMVersion codes TNMVersion (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
IntegratedTnmvalue		0..1	string	Element id TNMTumorClassification.IntegratedTnmvalue Short description GeintegreerdeTNMWaarde Definition De vastgestelde TNM-classificatie (de waarde), op basis van elke T-, N- en M-categorie (evt. incl. het aantal primaire tumoren (m) en/of de lokalisatie van M). Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Explanation		0..1	string	Element id TNMTumorClassification.Explanation Short description Toelichting Definition Toelichting met betrekking tot de interpretatie van de geïntegreerde TNM waarde zoals deze is geclassificeerd. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
TlLymphaticInvasion		0..1	CodeableConceptBinding	Element id TNMTumorClassification.TlLymphaticInvasion Short description L_LymfatischeInvasie Definition De aan- of afwezigheid van lymfatische invasie, de L-categorie. Het betreft een additionele beschrijving binnen de TNM-classificatie die door een patholoog wordt bepaald. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding TL-LymphaticInvasion codes InfusionCatheterType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
PnPerineuralInvasion		0..1	CodeableConcept	Element id TNMTumorClassification.PnPerineuralInvasion Short description Pn_PerineuraleInvasie Definition De aan- of afwezigheid van perineurale invasie, de Pn-categorie. Het betreft een additionele beschrijving binnen de TNM-classificatie die door een patholoog wordt bepaald. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
VVenousInvasion		0..1	CodeableConceptBinding	Element id TNMTumorClassification.VVenousInvasion Short description V_VeneuzeInvasie Definition De aan- of afwezigheid van veneuze invasie, de V-categorie. Het betreft een additionele beschrijving binnen de TNM-classificatie die door een patholoog wordt bepaald. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding V-VenousInvasion codes V-VenousInvasion (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
AnatomicalStage		0..1	CodeableConceptBinding	Element id TNMTumorClassification.AnatomicalStage Short description AnatomischStadium Definition Het stadium van de ziekte is de groepering op basis van de anatomische uitbreiding en verspreiding van de ziekte (de T, N en M categorieën). Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding AnatomicalStage codes AnatomicalStage (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
PrognosticStage		0..1	CodeableConceptBinding	Element id TNMTumorClassification.PrognosticStage Short description PrognostischStadium Definition Het prognostisch stadium van de ziekte. Hierin wordt in de groepering naast de anatomische uitbreiding en verspreiding van de ziekte ook additionele prognostische factoren meegenomen. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding PrognosticStage codes PrognosticStage (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
RResidualTumor		0..1	CodeableConcept	Element id TNMTumorClassification.RResidualTumor Short description R_ResidueleTumor Definition De aan- of afwezigheid van residuele tumor na behandeling, de R-categorie. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD

TNMTumorClassification		0..*
TNMTumorClassification.PrimaryTumor	BackboneElement	0..1
TNMTumorClassification.PrimaryTumor.MNumberOfPrimaryTumors	CodeableConcept	0..1
TNMTumorClassification.PrimaryTumor.TPrimaryTumor	CodeableConcept	0..1
TNMTumorClassification.PrimaryTumor.Abnormality	BackboneElement	1..*
TNMTumorClassification.PrimaryTumor.Abnormality.AbnormalityNumber	positiveInt	0..1
TNMTumorClassification.PrimaryTumor.Abnormality.Morphology	CodeableConcept	0..1
TNMTumorClassification.PrimaryTumor.Abnormality.GHistopathologicalGrading	CodeableConcept	0..1
TNMTumorClassification.PrimaryTumor.Abnormality.TumorLocalization	Reference(HdBe-AnatomicalLocation)	0..*
TNMTumorClassification.RegionalLymphnodes	BackboneElement	0..1
TNMTumorClassification.RegionalLymphnodes.NRegionalLymphnodes	CodeableConcept	0..1
TNMTumorClassification.RegionalLymphnodes.RegionalLymphNodesLocalization	Reference(HdBe-AnatomicalLocation)	0..*
TNMTumorClassification.DistantMetastasis	BackboneElement	0..1
TNMTumorClassification.DistantMetastasis.MDistantMetastasis	CodeableConcept	0..1
TNMTumorClassification.DistantMetastasis.DistantMetastasisLocalization	Reference(HdBe-AnatomicalLocation)	0..*
TNMTumorClassification.DateOfTnmclassification	dateTime	0..1
TNMTumorClassification.Tnmversion	CodeableConcept	0..1
TNMTumorClassification.IntegratedTnmvalue	string	0..1
TNMTumorClassification.Explanation	string	0..1
TNMTumorClassification.TlLymphaticInvasion	CodeableConcept	0..1
TNMTumorClassification.PnPerineuralInvasion	CodeableConcept	0..1
TNMTumorClassification.VVenousInvasion	CodeableConcept	0..1
TNMTumorClassification.AnatomicalStage	CodeableConcept	0..1
TNMTumorClassification.PrognosticStage	CodeableConcept	0..1
TNMTumorClassification.RResidualTumor	CodeableConcept	0..1

TNMTumorClassification
Definition	Root concept of the TNMTumorClassification information model.This root concept contains all data elements of the TNMTumorClassification information model.
Cardinality	0...*
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
TNMTumorClassification.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.PrimaryTumor
Definition	Container of the PrimaryTumor concept.This container contains all data elements of the PrimaryTumor concept.
Cardinality	0...1
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.PrimaryTumor.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
TNMTumorClassification.PrimaryTumor.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.PrimaryTumor.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.PrimaryTumor.MNumberOfPrimaryTumors
Definition	-
Cardinality	0...1
Type	CodeableConcept
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.PrimaryTumor.TPrimaryTumor
Definition	Staging result of the size extension of the primary tumor, the T-category of the TNM classification including the prefix and suffix.
Cardinality	0...1
Type	CodeableConcept
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.PrimaryTumor.Abnormality
Definition	Container of the Abnormality concept.This container contains all data elements of the Abnormality concept.
Cardinality	1...*
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.PrimaryTumor.Abnormality.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
TNMTumorClassification.PrimaryTumor.Abnormality.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.PrimaryTumor.Abnormality.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.PrimaryTumor.Abnormality.AbnormalityNumber
Definition	The number assigned to the abnormality, which is necessary in order to be able to clearly indicate to which abnormality the information relates in various examinations. In the case of multiple primary tumors in one organ, the tumor with the highest T category should be classified.
Cardinality	0...1
Type	positiveInt
Comments	32 bit number; for values larger than this, use decimal
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.PrimaryTumor.Abnormality.Morphology
Definition	Behavior of a tumor and cell type expressed in ICD-O-3 morphological or histology code. Describes the cell type (or histology) of the tumor, together with the behavior (malignant or benign). This is determined by a pathologist.
Cardinality	0...1
Type	CodeableConcept
Binding	Morphology codes Morphology (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.PrimaryTumor.Abnormality.GHistopathologicalGrading
Definition	Staging result of the histopathological grading, the G-category of theTNM classification. The differentiation grade of a tumor is determined by a pathologist.
Cardinality	0...1
Type	CodeableConcept
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.PrimaryTumor.Abnormality.TumorLocalization
Definition	Container of the TumorLocalization concept.This container contains all data elements of the TumorLocalization concept.
Cardinality	0...*
Type	Reference(HdBe-AnatomicalLocation)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
TNMTumorClassification.RegionalLymphnodes
Definition	Container of the RegionalLymphnodes concept.This container contains all data elements of the RegionalLymphnodes concept.
Cardinality	0...1
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.RegionalLymphnodes.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
TNMTumorClassification.RegionalLymphnodes.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.RegionalLymphnodes.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.RegionalLymphnodes.NRegionalLymphnodes
Definition	Staging result of the presence or absence of regional lymph nodes metastasis, the N-category of the TNM classification.
Cardinality	0...1
Type	CodeableConcept
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.RegionalLymphnodes.RegionalLymphNodesLocalization
Definition	Container of the RegionalLymphNodesLocalization concept.This container contains all data elements of the RegionalLymphNodesLocalization concept.
Cardinality	0...*
Type	Reference(HdBe-AnatomicalLocation)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
TNMTumorClassification.DistantMetastasis
Definition	Container of the DistantMetastasis concept.This container contains all data elements of the DistantMetastasis concept.
Cardinality	0...1
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.DistantMetastasis.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
TNMTumorClassification.DistantMetastasis.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.DistantMetastasis.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
TNMTumorClassification.DistantMetastasis.MDistantMetastasis
Definition	Staging result of the presence or absence of distant metastasis, the M-category of the TNM classification.
Cardinality	0...1
Type	CodeableConcept
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.DistantMetastasis.DistantMetastasisLocalization
Definition	Container of the DistantMetastasisLocalization concept.This container contains all data elements of the DistantMetastasisLocalization concept.
Cardinality	0...*
Type	Reference(HdBe-AnatomicalLocation)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
TNMTumorClassification.DateOfTnmclassification
Definition	The date at which the TNM Classification (the value) has been assigned.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.Tnmversion
Definition	TNM classification version (AJCC or UICC) and edition used (7th, 8th etc.).
Cardinality	0...1
Type	CodeableConcept
Binding	TNMVersion codes TNMVersion (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.IntegratedTnmvalue
Definition	The assigned TNM classification (the value), based on each T, N and M category (optional incl. multiple primary tumors (m) and/or the localization of M).
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.Explanation
Definition	Remark regarding interpretation of the integrated TNM value as is classified.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
TNMTumorClassification.TlLymphaticInvasion
Definition	Presence or absence of tissue invasion absence of lymphatic invasion, the L-category. It concerns an additional description within the TNM classification that is determined by a pathologist.
Cardinality	0...1
Type	CodeableConcept
Binding	TL-LymphaticInvasion codes InfusionCatheterType (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.PnPerineuralInvasion
Definition	Presence or absence of perineural invasion, the Pn-category. It concerns an additional description within the TNM classification that is determined by a pathologist.
Cardinality	0...1
Type	CodeableConcept
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.VVenousInvasion
Definition	Presence or absence of venous invasion, the V-category. It concerns an additional description within the TNM classification that is determined by a pathologist.
Cardinality	0...1
Type	CodeableConcept
Binding	V-VenousInvasion codes V-VenousInvasion (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.AnatomicalStage
Definition	The stage of the disease is the grouping based on the anatomical extent of the disease.
Cardinality	0...1
Type	CodeableConcept
Binding	AnatomicalStage codes AnatomicalStage (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.PrognosticStage
Definition	The Prognostic Stage group of the disease. Next to the anatomic extent of the disease additional prognostic factors are included in the grouping.
Cardinality	0...1
Type	CodeableConcept
Binding	PrognosticStage codes PrognosticStage (extensible)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
TNMTumorClassification.RResidualTumor
Definition	Presence or absence of Residual Tumor after treatment, the R-category.
Cardinality	0...1
Type	CodeableConcept
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD

Example instances

[CBB name]
[Concept name ]	[example value]

// example of NameInformation

## Example instances

| NameInformation      |                   |
|----------------------|-------------------|
| FirstNames | Johanna Petronella Maria   
| Initials | J.P.M. 
| GivenName | Jo 
| NameUsage | Geslachtsnaam partner gevolgd door eigen geslachtsnaam
| LastName.Prefix | van
| LastName.LastName | Putten
| LastNamePartner.PartnerPrefix | van der
| LastNamePartner.PartnerLastName | Giessen
| Titles |

zib [zib name + version](https://zibs.nl/wiki/[zib name + version(release)]) difference

Concept	Category	Description
`[element.path]`	[category of change]	[Description of change]([Reference to ticket/issue/zulip chat using MarkDown link])

Terminology Bindings

Path	Name	Strength	URL
PrimaryTumor.Abnormality.Morphology	Morphology	extensible	https://fhir.healthdata.be/ValueSet/Morphology
Tnmversion	TNMVersion	extensible	https://fhir.healthdata.be/ValueSet/TNMVersion
TlLymphaticInvasion	InfusionCatheterType	extensible	https://fhir.healthdata.be/ValueSet/InfusionCatheterType
VVenousInvasion	V-VenousInvasion	extensible	https://fhir.healthdata.be/ValueSet/V-VenousInvasion
AnatomicalStage	AnatomicalStage	extensible	https://fhir.healthdata.be/ValueSet/AnatomicalStage
PrognosticStage	PrognosticStage	extensible	https://fhir.healthdata.be/ValueSet/PrognosticStage