Specimen integrity, mesorectal assessment and IHC staining observables

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Microsoft Excel Spreadsheet S CT integrity examples.xlsx 2021-Dec-01 by Scott Campbell

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  1. Stefan put together a nice analysis of pathology items in which integrity of an organ or feature of an organ is important.  He also included a list of synonyms for intact.  I added a list of synoptic observables from the various protocols that reference integrity/intactness.

    In short, there are three distinct uses of intactness and/or completeness in the context of a synoptic question (thing to be observed and recorded):

    1. Integrity of the specimen.  
      1. This is found in anal excisions, colon biopsies, ovary/fallopian tube resections, uterine/cervix resections.  
      2. Value sets of observations include: Intact, opened, morcellated, disrupted, fragmented, ruptured
      3. Existing observable entity concept for this:  397191008 |Specimen integrity (observable entity)|

    2. Completeness/intactness of mesorectum.  
      1. This is found in colorectal resection protocol.
      2. Value set: Complete, near complete, incomplete
      3. Existing SCT observable entity concept: 408655002 |Status of intactness of mesorectal specimen (observable entity)|

    3. Nuclear expression/membraneous expression.  
      1. These pertain to immunohistochemistry observable entities.
      2. Value sets include: intact, not intact, complete
      3. There are no existing observable entity concepts for these in current SI releases.


    If we are to fully define the existing observable entity concepts in items 1 and 2, we need to determine the |Property| that the pathologist is assessing.  From a terminology perspective, it does not matter what the clinical implications of the particular observation are given any of the observations.  How the observable and subsequent observation are interpreted is in the domain of the clinical care team and beyond the scope of SNOMED.  What does matter is how the concept is modeled and if there is utility in fully defining these concepts.

    So, for items 1 and 2, the questions the group needs to answer are:

    1. Do these concepts need to be fully defined for existing or future computational use?
    2. If yes, then what is the specific property that we are trying to assert/measure.  Note for non-authors, the only valid concepts must be children of |Property (qualifier value)|.
    3. If yes, are the properties of measure for specimen integrity and mesorectal intactness the same or different?


    In my opinion, nuclear expression/membraneous expression concepts need further discussion.  (We did not get to that item on Monday, but we will next time, I hope.)

    Input is requested on this email....I will also post on confluence for those who prefer that venue.