{
  "resourceType": "CodeSystem",
  "id": "npcr-gleason-definition-type",
  "url": "https://npcr.se/fhir/CodeSystem/npcr-gleason-definition-type",
  "name": "NPCRGleasonDefinitionType",
  "title": "NPCR Gleason Reporting Definition Type Code System",
  "status": "draft",
  "experimental": false,
  "description": "NPCR-internal code system representing the three ways by which a Gleason score can be reported for targeted biopsies, based on NPCR Variabelbeskrivning variable D_RiktGleasTyp (Gleason angivet för = 'Gleason reported as'). This variable is unique to targeted biopsies because MRI-guided targeted sampling can produce multiple lesion-specific Gleason scores, requiring a convention for which value to report at the targeted-biopsy-level summary.\n\nApplicable only to NPCRGleasonScoreTargetedBiopsyObservation — systematic and unclear biopsies do not have equivalent reporting conventions because they yield a single Gleason assessment per sample group.\n\nHistorical note (per Variabelbeskrivning Kommentar): Option 1 was hidden 2023-06-19, replaced by option 3 (highest Gleason) as the preferred reporting method. Option 1 is retained for historical data compatibility.\n\nClinical context (per NPCR Manual page 17): 'I första hand rapporteras Gleasongrad med den högsta gleasonsumman i en enskild biopsi, om detta inte anges i PAD-svaret rapporteras den sammanfattande Gleasongraden i de riktade biopsierna.' ('First preference is to report the Gleason with the highest Gleason sum in a single biopsy; if not stated in the PAD, report the summary Gleason in the targeted biopsies.')\n\nTerminology binding rationale: NPCR documentation does not provide an international code system binding for this reporting convention. This NPCR-internal CodeSystem preserves Variabelbeskrivning Listvärden values directly.",
  "content": "complete",
  "caseSensitive": true,
  "count": 3,
  "concept": [
    {
      "code": "1",
      "display": "Gleason in the biopsy with the longest cancer lesion",
      "definition": "Gleason score reported from the single biopsy core that contains the longest cancer extent (Gleasonsumma i biopsin med längsta cancerhärden). Hidden 2023-06-19 but retained for historical data compatibility."
    },
    {
      "code": "2",
      "display": "Summary Gleason for all targeted biopsies",
      "definition": "Summary Gleason computed across multiple lesions from targeted biopsies, reporting the Gleason of the lesion with the highest Gleason sum (Sammanfattande Gleasonsumma i riktade biopsier). Used when the pathology report does not specify per-biopsy Gleason values for all targeted samples."
    },
    {
      "code": "3",
      "display": "Highest Gleason in a single biopsy",
      "definition": "The single highest Gleason sum observed across all targeted biopsy cores (Högsta gleasonsumman i en enskild biopsi). Added 2023-06-19 as the preferred reporting method per NPCR Manual guidance."
    }
  ]
}