{
  "resourceType": "CodeSystem",
  "id": "npcr-gleason-observation-types",
  "url": "https://npcr.se/fhir/CodeSystem/npcr-gleason-observation-types",
  "name": "NPCRGleasonObservationTypes",
  "title": "NPCR Gleason Score Observation Component Types Code System",
  "status": "draft",
  "experimental": false,
  "description": "NPCR-internal code system identifying the four component types that together represent a Gleason score assessment in NPCR Anmälan: primary Gleason grade, secondary Gleason grade, Gleason sum, and Gleason missing flag.\n\nThis CodeSystem is used as the code binding for Observation.component.code in five Gleason-related Profiles: NPCRGleasonScoreObservation (Summary), NPCRGleasonScoreTargetedBiopsyObservation, NPCRGleasonScoreSystematicBiopsyObservation, NPCRGleasonScoreUnclearBiopsyObservation, and NPCRGleasonScoreTURPCystoObservation. All five profiles share the same component structure, enabling FHIR component slicing discrimination across the four elements of a Gleason assessment.\n\nRationale: NPCR Informationsspecifikation §7 does not provide terminology bindings for Gleason score components (systematic documentation gap, same pattern as MR findings). International terminology systems such as LOINC do contain some Gleason-related codes (e.g., 84904-2 for Gleason score at positive margin, 94734-1 for ISUP prostate cancer grade group), but these address specific clinical scenarios and do not collectively represent the NPCR-required primary/secondary/sum/missing structure. This NPCR-internal CodeSystem preserves documentation fidelity by mirroring NPCR's Variabelbeskrivning variable structure.\n\nThesis Discussion note: Component slicing in FHIR requires a discriminating code value on each component; Observation.code can be left unbound because meta.profile serves as resource identification, but component.code cannot be left empty. This pragmatic necessity forces an NPCR-internal binding where NPCR documentation provides none — a documented tradeoff between documentation fidelity and FHIR structural constraints.",
  "content": "complete",
  "caseSensitive": true,
  "count": 4,
  "concept": [
    {
      "code": "primaryGrade",
      "display": "Primary Gleason grade",
      "definition": "The Gleason grade (1-5) assigned to the most predominant histological pattern observed in the prostate tissue sample. Corresponds to NPCR Variabelbeskrivning variables D_GleasEtt (Summary), D_RiktPrimGleas (Targeted), D_SystPrimGleas (Systematic), and D_OklarPrimGleas (Unclear)."
    },
    {
      "code": "secondaryGrade",
      "display": "Secondary Gleason grade",
      "definition": "The Gleason grade (1-5) assigned to the second most predominant histological pattern observed in the prostate tissue sample. Corresponds to NPCR Variabelbeskrivning variables D_GleasTva (Summary), D_RiktSekGleas (Targeted), D_SystSekGleas (Systematic), and D_OklarSekGleas (Unclear)."
    },
    {
      "code": "gleasonSum",
      "display": "Gleason sum (primary + secondary)",
      "definition": "The Gleason sum (2-10), calculated as primary Gleason grade + secondary Gleason grade. Per NPCR Manual changelog 2025-06-10, Gleason sum is no longer automatically calculated by the INCA system; registrars manually enter this value from the pathology report. Corresponds to NPCR Variabelbeskrivning variables D_GleasSa (Summary), D_RiktGleasSa (Targeted), D_SystGleasSa (Systematic), and D_OklarGleasSa (Unclear)."
    },
    {
      "code": "missingFlag",
      "display": "Gleason missing indicator",
      "definition": "Boolean flag indicating that Gleason score data is missing or unavailable for the specimen. Corresponds to NPCR Variabelbeskrivning variables D_GleasSakn (Summary), D_RiktGleasUppSak (Targeted), D_SystGleasUppSak (Systematic), and D_OklarGleasUppSak (Unclear)."
    }
  ]
}