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Scott Campbell 

1. The concept: 127569003 |In situ neoplasm (morphologic abnormality)|  subsumes high-grade dysplasia, in situ carcinoma, high grade intraepithelial neoplasia and other concepts.  Using this term for those "blended" non-invasive tumors at the surgical margin (e.g., high grade dysplasia/in situ carcinoma)  will serve the clinical use case for these observable entity concepts.  No need to create "and/or" concepts here.

    

   Regarding the QI work in histologies, Brian made the observation during our extended #plasia discussion. Tuesday, that the framework for proper structure in this hierarchy may be present.  Specifically, this is what he and I propose:

    

   1. All histologies should have a parent concept that asserts behavior (/0, /1, /2, /3, /6)
   1. <<3898006 |Neoplasm, benign (morphologic abnormality)|. (/0)
   2. <<86251006 |Neoplasm of uncertain behavior (morphologic abnormality)|
   3. <<127569003 |In situ neoplasm (morphologic abnormality)|. (/2)
   4. <<1240414004 |Malignant neoplasm (morphologic abnormality)| (/3)
   5. <<14799000 |Neoplasm, metastatic (morphologic abnormality)|. (/6)
   6. <<6219000 |Neoplasm, malignant, uncertain whether primary or metastatic (morphologic abnormality)|  (/9)
   1. All histologies will also be a subtype of their cell lineage type(s) (embryologic)

   Given these two overarching design features, we have a sound framework.  Item 1 is needed for both knowledge representation as well as alignment with WHO.  Item 2 is fundamental to knowledge management.

    

   I think this also allows us to remove "bad" concepts that include the organ references when not necessary.  As Thomas noted well on Monday, the organ is important for a clinical finding/disorder, that is the morphology is present in an organ.
   
   

2. Suggest that a parent of 127569003 |In situ neoplasm (morphologic abnormality)| be created to subsume ALL non-invasive neoplasms and not only in situ forms.  This will include High grade appendiceal lesions, Low grade appendiceal lesions, intramucosal carcinoma, etc

Scott Campbell 

neuroendocrine protocols assume the neoplasm is neuroendocrine.  Thus, only grade is solicited but question phrased as Histology type and grade of tumor.  OK to use our content of Histologic grade of neuroendocrine neoplasm of organ X = G- well-defined neuroendocrine histologic grade

Scott Campbell