<status value="draft" /> <experimental value="false" /> <description value="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. This 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. Rationale: 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. Thesis 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." /> <caseSensitive value="true" /> <content value="complete" /> <count value="4" /> <concept> <code value="primaryGrade" /> <display value="Primary Gleason grade" /> <definition value="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)." /> </concept> <concept> <code value="secondaryGrade" /> <display value="Secondary Gleason grade" /> <definition value="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)." /> </concept> <concept> <code value="gleasonSum" /> <display value="Gleason sum (primary + secondary)" /> <definition value="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)." /> </concept> <concept> <code value="missingFlag" /> <display value="Gleason missing indicator" /> <definition value="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)." /> </concept> </CodeSystem>