Cancer Pathology Data Sharing
2.0.0 - STU 2

Cancer Pathology Data Sharing, published by HL7 International / Orders and Observations. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cancer-reporting/ and changes regularly. See the Directory of published versions

## Cancer Pathology Observation Example

Page standards status: Informative

Cancer Pathology Report Structure

# Cancer Pathology Report Structure

This document illustrates an example hierarchical structure of FHIR resources in a cancer pathology report, showing the relationships between Composition and Observation resources.

## Observation Profile Structure

The US Pathology Observation profile is inspired by the [IHE SDC/eCP on FHIR Observation Profile] (http://hl7.org/fhir/uv/ihe-sdc-ecc/StructureDefinition-ihe-sdc-ecc-Observation.html), which maps CAP protocol's structured elements into FHIR Observations. The profile defines two main categories:

- Sections: Represent major divisions within the protocol (e.g., "SPECIMEN," "TUMOR") that organize related content. Sections do not have values but contain references to Questions through hasMember relationships.
- Questions: Individual data elements which store captured responses. Questions reference their parent Section through derivedFrom relationships and contain value elements.

## Pathology Report Hierarchy

Composition: Invasive Carcinoma of the Breast composition-invasive-carcinoma-of-the-breast

Title: INVASIVE CARCINOMA OF THE BREAST: Resection

Type: Breast.Invasive.Res.123_4.567.321.REL_sdcFDF

Subject: Annie Oakley

Date: 2025-01-01

Author: Wise Owl

Section Observation: SPECIMEN urn:uuid:f3a8457e-1d31-42f3-9d98-5a9de6547993

Identifier.System: http://example.org/codes

Identifier.Value: urn:uuid:f3a8457e-1d31-42f3-9d98-5a9de6547993

Status: final

Category: SECTION

Code: 25481 (SPECIMEN)

Subject: Annie Oakley

Effective Date: 2024-12-05

### Child Observations (hasMember):

hasMember urn:uuid:d9c8b5a1-e67f-4b95-bc78-2ec69a4fe3b2
hasMember urn:uuid:b19f3c6d-7d42-48a0-91e5-7e8fd6087f2c
Question Observation: Procedure (Note A) urn:uuid:d9c8b5a1-e67f-4b95-bc78-2ec69a4fe3b2

Identifier.System: http://example.org/codes

Identifier.Value: urn:uuid:d9c8b5a1-e67f-4b95-bc78-2ec69a4fe3b2

Status: final

Category: QUESTION

Code: 39574 (Procedure (Note A))

Value: 62183 Excision (less than total mastectomy)

### Parent Observation (derivedFrom):

derivedFrom urn:uuid:f3a8457e-1d31-42f3-9d98-5a9de6547993
Question Observation: Specimen Laterality urn:uuid:b19f3c6d-7d42-48a0-91e5-7e8fd6087f2c

Identifier.System: http://example.org/codes

Identifier.Value: urn:uuid:b19f3c6d-7d42-48a0-91e5-7e8fd6087f2c

Status: final

Category: QUESTION

Code: 74825 (Specimen Laterality)

Value: 31592 Right

### Parent Observation (derivedFrom):

derivedFrom urn:uuid:f3a8457e-1d31-42f3-9d98-5a9de6547993
Section Observation: TUMOR urn:uuid:a7d92e3f-5c14-47e8-b63a-15af83c21658

Identifier.System: https://cap.org/eCC

Identifier.Value: urn:uuid:cb7657fb-8127-41ef-9912-8f6fc52a5f85

Status: final

Category: SECTION

Code: 16249.100004300 (TUMOR)

Subject: Annie Oakley

Effective Date: 2024-12-05

### Child Observations (hasMember):

hasMember urn:uuid:79ab15c8-4b0e-48e5-a477-7f72e62c002b
hasMember urn:uuid:cb7657fb-8127-41ef-9912-8f6fc52a5f85
hasMember urn:uuid:cb7657fb-8127-41ef-9912-8f6fc52a5f85
hasMember urn:uuid:66153175-f304-443e-99cb-4058f350248b
hasMember urn:uuid:309f8a1c-8311-4751-8718-4b2573a09633
hasMember urn:uuid:c2f916f9-7438-4ba6-9cba-9e9064edbe3c
Question Observation: Tumor Site (Note B) urn:uuid:79ab15c8-4b0e-48e5-a477-7f72e62c002b

Status: final

Category: QUESTION

Code: 51180.100004300 (Tumor Site (Note B))

### Child Observations (hasMember):

hasMember urn:uuid:ab9326c2-e1fe-4ba0-873c-41c923c7f772

### Parent Observation (derivedFrom):

derivedFrom urn:uuid:cb7657fb-8127-41ef-9912-8f6fc52a5f85
Question Observation: Clock position urn:uuid:ab9326c2-e1fe-4ba0-873c-41c923c7f772

Status: final

Code: 51180.100004300 (Clock position)

Value: 42418.100004300 Clock position

### Child Observations (hasMember):

hasMember urn:uuid:bf778f95-b1a8-4674-a73e-1f2dc0bfbdc4

### Parent Observation (derivedFrom):

derivedFrom urn:uuid:79ab15c8-4b0e-48e5-a477-7f72e62c002b
Question Observation: Specify Clock Position urn:uuid:ab9326c2-e1fe-4ba0-873c-41c923c7f772

Status: final

Code: 16259.100004300 (Specify Clock Position)

Value: 6643.100004300 8 o'clock

Section Observation: LYMPH NODES urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

Status: final

Category: SECTION

Code: 868263.100004300 (Lymph Nodes)

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

Section Observation: MARGINS urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

Status: final

Category: SECTION

Code: 1234567.100004300 (Margin Section)

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

### Child Observations (hasMember):

hasMember urn:uuid:ee170d9a-d5b5-481a-ac58-52dea11955b4
Section Observation: REGIONAL LYMPH NODES urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

Status: final

Category: SECTION

Code: 39858.100004300 (Regional Lymph Nodes)

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

### Child Observations (hasMember):

hasMember urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f
Section Observation: DISTANT METASTASIS urn:uuid:a0d2cb8e-ab6f-4efe-ad2b-03c20d625a9f

Status: final

Category: SECTION

Code: 16775.100004300 (Distant Metastasis)

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

### Child Observations (hasMember):

hasMember urn:uuid:edb54dd2-ddaf-4792-81ab-e252259facf6
Section Observation: pTNM CLASSIFICATION urn:uuid:4958b036-f88e-470b-b225-38e9fe6b6541

Status: final

Category: SECTION

Code: 16717.100004300 (PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note M))

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

### Child Observations (hasMember):

hasMember urn:uuid:7164b3a9-3061-4f7f-9bbb-2a4e6980d665
hasMember urn:uuid:4958b036-f88e-470b-b225-38e9fe6b6541
Section Observation: ADDITIONAL FINDINGS urn:uuid:7c9139fe-ddd5-49d9-b649-f37344e8b995

Status: final

Category: SECTION

Code: 16782.100004300 (ADDITIONAL FINDINGS (Note O))

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

### Child Observations (hasMember):

hasMember urn:uuid:9cfaa1f6-f0af-4e66-8fe0-130b2143b135
Section Observation: SPECIAL STUDIES urn:uuid:87335ed1-f468-4061-a401-8b8e3b54cf4c

Status: final

Category: SECTION

Code: 17834.100004300 (SPECIAL STUDIES)

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

### Child Observations (hasMember):

hasMember urn:uuid:4e854775-e318-4ac8-a2aa-35d1bc01e523
hasMember urn:uuid:1dd04911-c7b8-4bd2-8959-14ad533e439b
hasMember urn:uuid:08758a8a-b74c-46bb-8c56-5a62083e3705
Section Observation: COMMENTS uuid:c3189cd4-33a0-447f-9bbf-2b225e2aa305

Status: final

Category: SECTION

Code: 16784.100004300 (Comment(s))

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist