Tumor Registry Dx Date 112010 Dx Code C343 Dx Code Desc Malignant neoplasm of lower lobe bronchus or lung Dx laterality Left Staging Date 112010 Staging Code Tc2b Nc2 Mc1b ID: 930186
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Slide1
Source Data (de-id’ed)
Tumor Registry
Dx
Date
1/1/2010
Dx Code
C34.3
Dx Code
Desc
Malignant neoplasm of lower lobe,
bronchus or lung
Dx laterality
Left
Staging Date
1/1/2010
Staging Code
Tc2b Nc2 Mc1b
Staging Group
Stage IV
Histology Date
1/6/2010
Histology Code
8140/3
Histology
Desc
Adenocarcinoma, NOS
Metastatic Date
1/1/2010
Value
Metastatic Liver
Slide2Conditions
SNOMED
Code = 187868006SNOMED Code Desc = Malignant neoplasm of lower lobe, bronchus or lung
Tumor RegistryDx Date1/1/2010Dx CodeC34.3Dx Code DescMalignant neoplasm of lower lobe, bronchus or lungDx lateralityLeft
Conditions
SNOMED Code = 1078881000119102SNOMED Code Desc = Primary adenocarcinoma of lower lobe of left lung
Conditions
SNOMED Code = 93880001SNOMED Code Desc = Primary malignant neoplasm of lung
OR
ConditionsSNOMED Code = 93864006SNOMED Code Desc = Primary malignant neoplasm of lower lobe of left lung
OR
= OMOP Mapped To Standard Concept
Slide3Tumor Registry
Staging Date
1/1/2010Staging CodeTc2b
Clinical Findings SNOMED Code = 261652002SNOMED Code Desc = Tumor Stage T2bOR
Answer-Measures
LOINC Code = LA3626-4LOINC Code Desc = T2b
Observation
SNOMED Code = 371508000SNOMED Code Desc = Tumor StageValue = Tc2bNc2Mc1b (or cT2bN2M1b)
Slide4Clinical Findings
SNOMED
Code = 46059003
SNOMED Code Desc = N2 CategoryOR
Answer-Measures
LOINC Code = LA4534-9LOINC Code Desc = N2
ObservationSNOMED Code = 277206009SNOMED Code Desc
= N CategoryValue = Nc2 (or N2? or 2?)Tumor RegistryStaging Date1/1/2010Staging CodeNc2
Slide5Tumor Registry
Staging Date
1/1/2010Staging CodeMc1b
Clinical Findings SNOMED Code = 261928007SNOMED Code Desc = Metastasis stage M1bOR
Answer-Measures
LOINC Code = LA4626-3LOINC Code Desc = M1b
Clinical Findings
SNOMED Code = 370044009SNOMED Code Desc = M1b: Distant metastasis other than to non-regional lymph nodes and lungsOR
Slide6Clinical Findings
SNOMED
Code = 2640006
SNOMED Code Desc = Clinical Stage 4OR
Observation
LOINC Code = 21908-9LOINC Code Desc = Stage Group.clinical cancerValue = IV (or 4?)ORTumor Registry
Staging Date1/1/2010Staging GroupStage IV
ObservationSNOMED Code = 399390009SNOMED Code Desc = TNM Stage GroupingValue = IV (or 4?)
Observation
LOINC Code = 21910-5LOINC Code Desc
= Stager.clinical cancer
Value = IV (or 4?)
Observation
SNOMED
Code =
399537006
SNOMED Code
Desc
= Clinical
Tumor Stage Grouping
Value =
IV
(or 4?)
Slide7Clinical Findings
SNOMED
Code = 424993006
SNOMED Code Desc = Adenocarcinoma of lung, stage IVTumor RegistryHistology Date1/6/2010Histology Code8140/3Histology DescAdenocarcinoma, NOS
OR
Clinical Findings SNOMED Code = 307226002SNOMED Code Desc = Metastatic adenocarcinoma of unknown origin
Morph Abnormality
SNOMED Code = 35917007SNOMED Code Desc = AdenocarcinomaOR
Morph Abnormality
SNOMED Code = 4590003SNOMED Code Desc = Adenocarcinoma, metastaticOR
Clinical Finding
SNOMED
Code =
254626006
SNOMED Code
Desc
=
Adenocarcinoma of lung
Answer-Measures
LOINC
Code =
LA26493-9
LOINC
Code
Desc
=
Adenocarcinoma, NOS
OR
Answer-Measures
LOINC
Code =
LA11900-0
LOINC
Code
Desc
=
Adenocarcinoma
= No OMOP Mapped To Standard Concept
Slide8Clinical Findings
SNOMED
Code = 307226002
SNOMED Code Desc = Metastatic adenocarcinoma of unknown origin
Morph Abnormality
SNOMED Code = 4590003SNOMED Code Desc = Adenocarcinoma, metastaticORTumor RegistryMetastatic Date1/1/2010Value
Metastatic Liver
Clinical Findings SNOMED Code = 169100119104SNOMED Code Desc = Metastasis to liver from adenocarcinomaOR
Clinical Findings
SNOMED Code = 94381002SNOMED Code Desc = Secondary malignant neoplasm of liver
Slide9How would I map this data today?
Tumor Registry
OMOPDx Date
1/1/20101/1/2010Dx CodeC34.3
Conditions
93864006: Primary malignant neoplasm of lower lobe of left lungDx Code DescMalignant neoplasm of lower lobe, bronchus or lung
SNOMEDDx laterality
LeftStaging Date1/1/2010Observations
1/1/2010Staging Code
Tc2b Nc2 Mc1bSNOMED371508000: Tumor StageValue = cT2bN2M1bStaging GroupStage IV
Observations
SNOMED
399390009: TNM Stage Grouping
Value =
IV
Histology Date
1/6/2010
1/6/2010
Histology Code
8140/3
Measures
LA11900-0:
Adenocarcinoma
Histology
Desc
Adenocarcinoma, NOS
LOINC
Metastatic Date
1/1/2010
1/1/2010
Value
Metastatic Liver
Clinical Findings
SNOMED
94381002:
Secondary malignant neoplasm of liver
Slide10Overall Data Mapping Strategy Questions
Tumor Staging:
Discrete Concept Representation(i.e., Clinical Findings –> SNOMED = 261652002 -> Tumor Stage T2b)Value based Concept Representation(i.e., Observations –> SNOMED = 399537006 -> Clinical Tumor Stage Grouping -> Value =
T2bN2M1b)ProsProsAllows for clear query representation with no ambiguity across network sitesCan use same approach for all stage values, no need to create some custom conceptsETL implementation specs are clear and transferable across institutionsMuch easier and quicker to implementConsCons
Discrete concepts aren’t fully established, forces ETL implementers to create custom concepts
Leaves site ETL code to vary by implementer: observation codes + value representationTimeline delay in new standard concepts being created and published (AJCC v8, non AJCC staging systems, international staging representation of AJCC = UICC)Makes network queries subject to limited results/ inaccurate results (missing cases)After standard concept is published, have to migrate old custom concepts to new standard = reworkDoesn’t allow for hierarchy based queries easily, can use query LIKE statements to get relatively accurate/ close value utilization
Slide11Overall Data Mapping Strategy Questions (cont’d)
Other General Considerations:
Use same dates of Dx for dates of below, or keep as reported (recognize across many systems the concordance on these dates is relatively low)?staging records (clinical and pathologic?)HistologyMetastases (if M present at disease presentation) Combine various elements into 1 concept code?MetastasesAnatomical siteLateralityStage Group, etc.Relationship of this data mapping to NCI thesaurus or UMLS Meta- thesaurusStaging is “loosely” represented in standard coding systems (as AJCC only), but doesn’t address non-AJCC staging.