Background
Methods
Results and discussion
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467 observations, which may refer to specimens, lesions, morphological items, results of special techniques, e.g. immunohistochemistry or molecular pathology, results of measurements, disorders, prognosis, staging and grading, and classification
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21 procedures, which may refer to specimens and images,
APSR template id | APSR element name (PathLex) | Generic element |
---|---|---|
e.g. 1.3.6.1.4.1.19376.1.8.1.4.54 | e.g. Cytological type | Class |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.164 | e.g. Lesion size, largest dimension | Diameter |
1.3.6.1.4.1.19376.1.8.1.4.146 | Distance of lesion from closest uninvolved margin | Distance |
1.3.6.1.4.1.19376.1.8.1.4.162 | Treatment effect | Treatment Effect |
1.3.6.1.4.1.19376.1.8.1.4.149 | Extent | Extent |
1.3.6.1.4.1.19376.1.8.1.4.143 | Lesion focality | Focality |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.151 | e.g. Histological grade (WHO) | Grade |
1.3.6.1.4.1.19376.1.8.1.4.168 | Macroscopic type | Growth pattern |
1.3.6.1.4.1.19376.1.8.1.4.174 | Specimen integrity | Integrity |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.141 | e.g. Margins involvement | Involvement |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.439 | e.g. Estrogen receptor | Marker |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.318 | e.g. Lesion ulceration | Neighborhood relationship |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.156 | e.g. Number of lymph nodes involved | Number |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.148 | e.g. Lymph node sampling | Procedure |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.169 | e.g. Lesion site | Site |
e.g. 1.3.6.1.4.1.19376.1.8.1.4.161 | e.g. pT | Stage |
1.3.6.1.4.1.19376.1.8.1.4.160 | Specimen weight | Weight |
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occurs always in a context of location, pathological problem and observation method,
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consists of three basic elements (target of observation, property of observation, additional qualifiers and permissible values, which again may be generic terms).
ObservationTargetName
(SNOMED-CT Axis)
| SNOMED-CT code |
---|---|
Cell
|
362837007
(cell structure)
|
Disease
|
64572001
(disorder)
|
Lesion
|
49755003
(morphologic abnormality)
|
Margin
|
82868003
(body structure)
|
Mitotic nucleus
|
49307000
(cell structure)
|
Nucleolus
|
15982001
(cell structure)
|
Nucleus
|
84640000
(cell structure)
|
Organ
|
272625005
(body structure)
|
Specimen
|
123038009
(specimen)
|
Tissue
|
85756007
(body structure)
|
ObservationPropertyName
(SNOMED-CT Axis)Area
| SNOMED-CT code |
---|---|
Area
|
42798000
(qualifier value)
|
Class
|
277046005
(attribute)
|
Colour
|
263714004
(qualifier value)
|
Consistency
|
246191002
(attribute)
|
CytologicAtypia
|
50673007
(morphologic abnormality)
|
Diameter
|
81827009
(qualifier value)
|
Distance
|
246132006
(qualifier value)
|
General clinical stage for disease AND/OR neoplasm
|
106240007
(qualifier value)
|
Grade
|
103421006
(attribute)
|
Involvement
|
278112009
(attribute)
|
MarkerStatus
|
246110002
(attribute)
|
Measurement
|
122869004
(procedure)
|
NeighborhoodRelationship
|
(408739003)
(attribute)
|
Number
|
410680006
(attribute)
|
Pattern
|
255711007
(attribute)
|
Regularity
|
246202005
(attribute)
|
ResidualDisease
|
65320000
(qualifier value)
|
Shape
|
300842002
(attribute)
|
Size
|
246115007
(attribute)
|
SpecificDeposits
|
46595003
(morphologic abnormality)
|
(Treatment)Effect
|
(253861007)
(qualifier value)
|
Weight
|
272102008
(qualifier value)
|
ObservationQualifierName |
SNOMED-CT code
|
---|---|
Laterality
|
272741003
(attribute)
|
Focality
| |
Invasiveness
|
10179008
(qualifier value)
|
ScaleType
|
370132008
(attribute)
|
normalStructure
|
361083003
(body structure)
|
abnormalStructure
|
49755003
(morphologic abnormality)
|
specialAttributes, like nearest, biggest, most, least, smallest, etc.
|
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systematic consideration of all the aspects mentioned above in each single term (pre-coordination approach)
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focusing of the generic elements of terms and combining this with the structure of communication, reflecting the non-obvious elements of the terminology (post-coordination approach).