Summary
Update 25th May: Please see below a revision to the original Briefing Note that proposes changes to primary malignancy and metastatic malignancy in morphologic abnormality and disorder content, also impacting observable entity concepts, following feedback from the Community of Practice, including CMAG.
Initial summary:
Please see the attached briefing note on planned quality improvements for the hierarchies of 372087000 Primary malignant neoplasm (disorder) and 128462008 Secondary malignant neoplastic disease (disorder).
Please note: Lymphoid and hematopoietic neoplasms are excluded at this stage.
This Member Forum Briefing Note has been posted here as part of a user information and feedback gathering exercise, please share with your domain experts as appropriate, for example, pathologists or oncologists. Also uploaded is a longer draft Briefing Note that was presented to the Editorial Advisory Group on the 23rd February for their discussion and decision making, and contains more background information, explains the reasons behind this work and more fully describes the solution. The project addresses the way we define primary and metastatic in disorders (and certain observable entities) and does not change the morphologic abnormality cell type and behavior (i.e. benign, in-situ, unknown behavior and malignant) which originate from the ICD-O-3 morphology classification. (Note: there are no plans for any neoplastic disorders to change semantic tag from disorder to finding).
All feedback should be sent to Nicki Ingram via nin@snomed.org by Tuesday 5th April.
Actions:
| Date | Requested action | Requester(s) | Response required by: |
|---|---|---|---|
| Review the briefing note and provide any feedback direct to Nicki Ingram. |
Relevant documents
9 Comments
Elze de Groot
Oh no that is loads of work that comes out of this!! We have alot of metastatic and primary neoplasms in our extension. I hope you are really really really sure about this, and not going to change it again and again. I understand the choice to define primary/metastatic in a concept, but I would rather have seen this with a relationship in the morphologic abnormality hierarchy, because it actually is a characteristic of the morphologic abnormality and not of the disease. It will be really hard for me to explain to the pathologists that a benign neoplasm is a morphologic abnormality and a (primary or metastatic) malignant neoplasm isn't. Because for example a malignant melanoma is per definition primary for the pathologist. So they don't see any difference between a morphologic abnormality 'malignant melanoma' and a disorder 'primary malignant melanoma'. When keeping the primary and metastatis as a relationship in the mprphologic abnormality hierarchy is more how pathologist see this is my experience when talking to pathologist in the Netherlands.
I will talk ask the pathologist for feedback and sent this to Nikki.
I am curious how other countries think about this change?
Daniel Karlsson
Elze,
I do believe neoplasms still will be morphologic abnormalities, and that the proposal is to change the way the primari-/secondariness (are those words?) is represented. It will no longer be possible to represent primary/secondary neoplasms using only morphologic abnormality concepts. Will this be a problem for Dutch users? Malignant melanoma I believe will also in the future be represented as a finding and may have a pathological process to indicate it is primary.
Cheers,
Daniel
Katrien Scheerlinck
Hi,
I agree with Daniel. As I understand it well (hopefully?), the neoplasms (primary/secondary) do remain morphological abnormalities but the target values of the relationships do change in order to receive a more unambigues/correct/consistent modeling.
gr, Katrien
Elze de Groot
Hi,
The way I understand it, is that it will no longer be possible to represent primary and secondary in the morphologic abnormality anymore. In ICD-O a malignant melanoma is primary with /3 code and metastatic with /6 code. So I don't see how this can only be represented in the finding hierarchy. Will in future the mapping with ICD-O be morphologic abnormalities for benign and uncertain morphologys and disorders for malignant/metastatic morphologies?
Our pathologist see the morphologic abnormality 'malignant melanoma' as primary. They didn't understand the existence of an agnostic concept (with primary and metastatic as descendant) for some in the first place. So I do think this is a complete mind change for them. It would also be possible to keep the primary/metastatic in the morphologic abnormality with a defining relationship instead of ISA relationship. I know such a relationship does not exist yet but it is possible and that would be a more consistent modelling as well.
I will have to move like thousand of concepts to the disorder hierarchy in our extension and the pathologist have to change the codes in the existing mapping in the PALGA thesaurus, but I don't mind if the pathologist understand this change, so fingers crossed...
It definitely is a change with very big impact.
Gr Elze
Nicola Ingram
Elze de GrootDaniel Karlsson Thank you for your comments. Katrien ScheerlinckYes the aim of the project is to reduce ambiguity and achieve consistency.
The project addresses the way we define primary and metastatic in disorders (and certain observable entities) and does not change the morphologic abnormality cell type and behavior (i.e. benign, in-situ, unknown behavior and malignant) which originate from the ICD-O-3 morphology classification. (Note: there are no plans for any neoplastic disorders to change semantic tag from disorder to finding).
Hope this clarifies these points - please email your feedback to me, including from your domain experts, and I will be collating all feedback and taking it back to our internal working group to further inform this proposal.
Best wishes, Nicki
Elze de Groot
Thanks Nikki, also for the additional information.
One note
does not change the morphologic abnormality cell type and behavior (i.e. benign, in-situ, unknown behavior and malignant) which originate from the ICD-O-3 morphology classification
→ in fact you do change that in a way because the /3 behaviour code = Malignant neoplasms stated or presumed to be primary and behaviour code /6 = Malignant neoplasms, stated or presumed to be secondary. They both can't be represented in the morphologic abnormality hierarchy anymore (because they will be inactivated there) so can only be mapped to disorders when moving primary/metastatic to the disorders.
Gr Elze
Nicola Ingram
Thanks Elze de Grootfor your additional comment.
Re: Proposed inactivation of 86049000 Malignant neoplasm, primary (morphologic abnormality) and 367651003 |Malignant neoplasm of primary, secondary, or uncertain origin (morphologic abnormality)| and there will be a new replacement concept "Malignant neoplasm (morphologic abnormality)" which will be /3.
For /6 and proposed inactivation of 14799000 |Neoplasm, metastatic (morphologic abnormality)| please send me your feedback regarding this concept which will inform the discussion and development of the solution.
Linda Parisien
From a Canadian stakeholder:
The proposal does not identify what will happen with local recurrence of malignant tumors. Suggesting to consider incorporating this into the proposal for disambiguation. We presume a local recurrence of a malignant neoplasm is primary if it is unqualified. These concepts should be modelled in the same way as the primary and secondary malignancies.
Of note, the changes proposed will not impact the way we map as we follow WHO rules.
Elze de Groot
Nicola Ingram I agree with updated briefing note for primary and metastatic malignant disorders