This page is part of the MII IG Kerndatensatz-Modul Onkologie (v2027.0.0-ballot.1: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Further Classifications: Terminologies

This page documents the terminologies for other classifications in oncology, including haematological and organ-specific staging systems.

Background

The oBDS mainly defines TNM as the staging system; many further disease- or organ-specific staging and grading systems are represented in the oBDS via the free-text field "Weitere Klassifikationen" (other classifications). These include, for example, Nottingham grading for breast cancer or Ann Arbor for The section 65c platform provides Some of the staging systems are used internationally and are already contained in CodeSystems such as SNOMED CT and NCIt/UMLS, while others are used primarily in the German-speaking context.

Even though a SNOMED code exists for some staging systems and is preferable to a dedicated CodeSystem in terms of interoperability, we decided in favour of the representation according to the oBDS, because the data may be available at the sites directly in this format. A SNOMED annotation can be pursued here in future versions via ConceptMaps.

Hierarchical CodeSystem for Classification Systems

The Weitere Klassifikationen CodeSystem uses a hierarchical structure to organise the various staging and classification systems:

CodeSystem: mii-cs-onko-weitere-klassifikationen-obds

The concepts with code and display as well as their child concepts are shown on the artifact page mii-cs-onko-weitere-klassifikationen-obds.

Structure of the Hierarchical Approach

All Classification Systems (Parent Concepts)

ValueSets with descendant-of Filter

The ValueSets use descendant-of filters for maintainable terminology management.

Main ValueSet for All Classification Values

The definition and content (codes with display) of the main ValueSet are shown on the artifact page mii-vs-onko-weitere-klassifikationen.

mCODE STU4 Pattern Integration

The implementation follows the mCODE STU4 code+method+value pattern:

Profile Elements for the code+method+value Pattern

Cardinalities, short descriptions and binding strengths of the elements Observation.code, Observation.method and Observation.value[x]:valueCodeableConcept are shown on the artifact page mii-pr-onko-weitere-klassifikationen.

Example Implementation

Instance: mii-exa-onko-weitere-klassifikationen-binet
InstanceOf: MII_PR_Onko_Weitere_Klassifikationen

// Allgemeiner Code für Staging
* code = $sct#385388004 "Tumorstadium-Befund"

// Spezifische Methode
* method = $mii-cs-onko-weitere-klassifikationen#binet "BINET Staging System"

// Tatsächlicher Wert
* valueCodeableConcept = $mii-cs-onko-weitere-klassifikationen#binet-a "BINET A"

Available ValueSets

All ValueSets for Other Classifications (already in SNOMED + MII-defined)

For the other classifications, the ValueSets mii-vs-onko-weitere-klassifikationen (classification systems) and mii-vs-onko-weitere-klassifikationen-auspraegungen (classification values) are available; name, description and status are stated there in each case.

Complete CodeSystem - Overview of All MII-defined Codes

The parent and child concepts of the MII-defined codes are shown on the artifact page mii-cs-onko-weitere-klassifikationen-obds.

Mapping to the oBDS

The other classifications correspond to oBDS field 9 "Weitere Klassifikationen":

The oBDS mappings of the individual elements are shown on the artifact page mii-pr-onko-weitere-klassifikationen in the Mappings section.

SNOMED CT Mappings

SNOMED CT equivalents exist for some classification systems:

• BINET → SNOMED CT: 1149214008 (Binet chronic lymphocytic leukemia staging)
• Ann Arbor → SNOMED CT: 254373007 (Ann Arbor lymphoma staging)
• WHO Grade → SNOMED CT: 277612008 (WHO tumor grade)

Examples

FIGO stage IVB (ovarian tumours)

mii-exa-onko-weitere-klassifikationen-1

Ann Arbor stage IIIX

mii-exa-onko-weitere-klassifikationen-2

FIGO grade 2

mii-exa-onko-weitere-klassifikationen-3