Cancer Pathology Data Sharing
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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-ballot 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

Cancerreport

Page standards status: Informative

Cancer Pathology Report Structure

Cancer Pathology Report Structure

This document illustrates the 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 based on the IHE SDC/eCP on FHIR Observation Profile, 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

Status: final

Type: Breast.Invasive.Res.189_4.009.021.REL_sdcFDF

Subject: Annie Oakley

Date: 2025-01-01

Author: Wise Owl

Section Observation: SPECIMEN observation-section-specimen

Status: final

Category: SECTION

Code: 16182.100004300 (SPECIMEN)

Subject: Annie Oakley

Effective Date: 2024-12-05

Child Observations (hasMember):

hasMember Observation/observation-procedure-breast-excision
hasMember Observation/observation-specimen-laterality
Question Observation: Procedure (Note A) observation-procedure-breast-excision

Status: final

Category: QUESTION

Code: 58807-100004300 (Procedure (Note A))

Value: 40307-100004300 Excision (less than total mastectomy)

Parent Observation (derivedFrom):

derivedFrom Observation/observation-section-specimen
Question Observation: Specimen Laterality observation-specimen-laterality

Status: final

Category: QUESTION

Code: 16214-100004300 (Specimen Laterality)

Value: 16215-100004300 Right

Parent Observation (derivedFrom):

derivedFrom Observation/observation-section-specimen
Section Observation: TUMOR observation-section-tumor

Status: final

Category: SECTION

Code: 16249.100004300 (TUMOR)

Subject: Annie Oakley

Effective Date: 2024-12-05

Child Observations (hasMember):

hasMember Observation/observation-tumor-site
hasMember Observation/observation-histologic-type
hasMember Observation/observation-histologic-grade
hasMember Observation/observation-tumor-size
hasMember Observation/observation-tumor-focality
hasMember Observation/observation-ductal-carcinoma
Question Observation: Tumor Site (Note B) observation-tumor-site

Status: final

Category: QUESTION

Code: 51180-100004300 (Tumor Site (Note B))

Child Observations (hasMember):

hasMember Observation/observation-clock-position

Parent Observation (derivedFrom):

derivedFrom Observation/observation-section-tumor
Question Observation: Clock position observation-clock-position

Status: final

Code: 51180-100004300 (Clock position)

Value: 42418-100004300 Clock position

Child Observations (hasMember):

hasMember Observation/observation-clock-position-8

Parent Observation (derivedFrom):

derivedFrom Observation/observation-tumor-site
Question Observation: Specify Clock Position observation-clock-position-8

Status: final

Code: 16259-100004300 (Specify Clock Position)

Value: 6643-100004300 8 o'clock

Section Observation: LYMPH NODES observation-section-lymph-nodes

Status: final

Category: SECTION

Code: 868263.100004300 (Lymph Nodes)

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist

Section Observation: MARGINS observation-section-margins

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 Observation/observation-margins-margin-status-for-invasive-carcinoma
Section Observation: REGIONAL LYMPH NODES observation-section-regional-lymph-nodes

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 Observation/observation-regional-lymph-node-status
Section Observation: DISTANT METASTASIS observation-section-distant-metastasis

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 Observation/observation-distant-metastasis
Section Observation: pTNM CLASSIFICATION observation-section-ptnm-classification

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 Observation/observation-ptnm-classification-pT-Category
hasMember Observation/observation-ptnm-classification-pN-Category
Section Observation: ADDITIONAL FINDINGS observation-section-additional-findings

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 Observation/observation-additional-findings-specify
Section Observation: SPECIAL STUDIES observation-section-special-studies

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 Observation/observation-special-studies-breast-biomarker
hasMember Observation/observation-special-studies-estrogen-receptor
hasMember Observation/observation-special-studies-her2
Section Observation: COMMENTS observation-section-comments

Status: final

Category: SECTION

Code: 16784.100004300 (Comment(s))

Subject: Annie Oakley

Effective Date: 2024-12-05

Performer: Practitioner/practitioner-oncologist