Lithuanian Breast Diagnostics Implementation Guide
0.0.1 - ci-build
Lithuanian Breast Diagnostics Implementation Guide
0.0.1 - ci-build
Lithuanian Breast Diagnostics Implementation Guide, published by Lithuanian Medical Library. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7LT/ig-lt-breast/ and changes regularly. See the Directory of published versions
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This page describes the five ESPBI (Electronic Health Services and Cooperation Infrastructure) questionnaire forms used in the Lithuanian breast cancer prevention programme. Each questionnaire captures a structured dataset defined in the ADP (Early Diagnostics and Preventive Programmes) research specification.
These Questionnaire resources are independent of the FHIR profile-based data model. They represent the ESPBI form structure as-is, while the narrative mapping tables below show how each questionnaire item maps to the corresponding FHIR profile and element.
| Questionnaire | ESPBI Form | Clinical Stage |
|---|---|---|
| Mammogram | ADP Table 7.1 | Imaging acquisition and radiological evaluation |
| Tomosynthesis | ADP Table 7.2 | Additional imaging (when BIRADS-0) |
| Ultrasound | ADP Table 7.3 | Targeted examination for dense tissue or findings |
| Biopsy | ADP Table 7.4 | Image-guided biopsy (BIRADS 4–5) |
| Pathology | ADP Table 7.5 | Histological examination and diagnosis |
The mammogram form captures the full screening mammography workflow: examination context, pre-examination clinical findings (palpable changes, scars, nipple status, surgical history), ACR gland density assessment, structured findings per breast (formations, calcifications, deformations, asymmetric tissue), comparison with prior studies, BI-RADS conclusion, and recommendations.
Example response: questionnaireresponse-mammogram-example
Narrative mapping to FHIR profiles:
| Questionnaire Item | FHIR Profile | Element |
|---|---|---|
| Date of test | MammographyReportLtBreast | effectiveDateTime |
| Radiation dose | ObservationLt | valueQuantity (mGy) |
| Palpable changes – Scars | BreastObservationFindingLtBreast | valueCodeableConcept |
| Palpable changes – Nipple | BreastNippleInversionLtBreast | valueCodeableConcept |
| Palpable changes – Surgery history | BreastHistoryAssessmentLtBreast | valueCodeableConcept |
| Gland density (ACR) | BreastGlandDensityLtBreast | valueCodeableConcept |
| Findings – Formations | MammographicExaminationFindingLtBreast | component[Type] |
| Findings – Size | MammographicExaminationFindingLtBreast | component[Diameter] |
| BI-RADS conclusion | BiradsAssessmentLtBreast | valueCodeableConcept |
| Recommendations | BreastServiceRequestLtBreast | code |
| Radiologist | PractitionerLt / PractitionerRoleLt | name |
| Facility | OrganizationLt | name |
The tomosynthesis form captures data for follow-up imaging when the initial mammogram result is BIRADS-0 (incomplete). Structure mirrors the mammogram form with additional detail on the indication and technologist.
Example response: questionnaireresponse-tomosynthesis-example
Narrative mapping to FHIR profiles:
| Questionnaire Item | FHIR Profile | Element |
|---|---|---|
| Date of test | MammographyReportLtBreast | effectiveDateTime |
| Test indication (BIRADS-0) | BiradsAssessmentLtBreast | Prior assessment triggering this study |
| Radiation dose | ObservationLt | valueQuantity (Gy) |
| Findings – Localization | BodyStructureLtBreast | includedStructure.laterality + qualifier |
| Findings – Entity/Deformation/Calcined | MammographicExaminationFindingLtBreast | component[Type] |
| Findings – Size | MammographicExaminationFindingLtBreast | component[Diameter] |
| BI-RADS conclusion | BiradsAssessmentLtBreast | valueCodeableConcept |
The ultrasound form captures targeted examination data when referred for dense tissue review (BIRADS 1–2 with dense gland) or finding evaluation (BIRADS 0, 4, 5). It records parenchyma structure, clock-face position findings, lesion characteristics, duct condition, and lymph node assessment per breast.
Example response: questionnaireresponse-ultrasound-example
Narrative mapping to FHIR profiles:
| Questionnaire Item | FHIR Profile | Element |
|---|---|---|
| Parenchyma structure | BreastGlandDensityLtBreast | valueCodeableConcept |
| Finding localization (clock) | BreastUltrasoundFindingLtBreast | component[clock-position] |
| Change properties | BreastUltrasoundFindingLtBreast | component[lesion] |
| Size (length, width) | BreastUltrasoundFindingLtBreast | component[length-mm], component[width-mm] |
| Nature of change | BreastUltrasoundFindingLtBreast | valueCodeableConcept |
| Lymph node changes | BreastObservationFindingLtBreast | component |
| BI-RADS conclusion | BiradsAssessmentLtBreast | valueCodeableConcept |
The biopsy form captures image-guided biopsy procedure data when BIRADS 4–5 triggers a tissue sampling recommendation. It records the guidance modality, specimen containers, lesion localization, and lymph node status.
Example response: questionnaireresponse-biopsy-example
Narrative mapping to FHIR profiles:
| Questionnaire Item | FHIR Profile | Element |
|---|---|---|
| Type of procedure | ProcedureLt | code (ACHI codes 31548-00, 90724-00) |
| Sample containers | Specimen | container |
| Localization | BodyStructureLtBreast | includedStructure |
| Size of entity | ProcedureLt or Specimen | note |
| BI-RADS conclusion | BiradsAssessmentLtBreast | valueCodeableConcept |
| Lymph node changes | BreastObservationFindingLtBreast | component |
The pathology form is the most comprehensive, capturing the entire histological examination workflow: referral data, specimen details, macroscopic and microscopic descriptions, immunohistochemistry (ER, PR, HER2, Ki67), molecular tests (FISH, CISH/SISH), and the final WHO classification diagnosis with grading, tumour size, and lymphovascular invasion.
Example response: questionnaireresponse-pathology-example
Narrative mapping to FHIR profiles:
| Questionnaire Item | FHIR Profile (cross-IG) | Element |
|---|---|---|
| Clinical diagnosis (ICD-10-AM) | PathologyReportLtLab (ig-lt-lab) | conclusionCode.coding[icd10] |
| Material fixation | Specimen | processing.method |
| Previous procedures | ConditionLt | evidence |
| Macroscopic examination | PathologyCompositionLtLab (ig-lt-lab) | section[macroscopic].text |
| Microscopic examination | PathologyCompositionLtLab (ig-lt-lab) | section[microscopic].text |
| ER / PR status | ObservationLt | valueCodeableConcept |
| HER2 status | ObservationLt | valueCodeableConcept |
| Ki67 proliferation index | ObservationLt | valueQuantity (%) |
| FISH / CISH result | ObservationLt | valueCodeableConcept |
| WHO diagnosis | PathologyCompositionLtLab (ig-lt-lab) | section[synthesis].text |
| Tumour grade | ObservationLt | valueCodeableConcept (AJCC G1–G3) |
| Tumour size | ObservationLt | valueQuantity (mm) |
| Lymphovascular invasion | ObservationLt | valueCodeableConcept (pLVI-0 to pLVI-9) |
The questionnaire mapping connects to resources defined in several Lithuanian FHIR IGs: