TEMPLATE British Columbia Cancer agency Breast Cancer Synoptic Report (British Columbia Cancer agency Breast Cancer Synoptic Report)

TEMPLATE IDBritish Columbia Cancer agency Breast Cancer Synoptic Report
ConceptBritish Columbia Cancer agency Breast Cancer Synoptic Report
DescriptionThis template demonstrates representation of a NEHTA Synoptic report for Melanoma histopathology
PurposeThis template demonstrates representation of a NEHTA Synoptic report for Melanoma histopathology
References
OtherDetails Language Independent{MetaDataSet:Sample Set =Template metadata sample set}
Language useden
Citeable Identifier1013.26.199
AllOperationalTemplate [rootArchetypeId=openEHR-EHR-COMPOSITION.report.v1, otherContributors=null, tshis=[ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1], code=at0000, itemType=COMPOSITION, level=0, text=British Columbia Cancer agency Breast Cancer Synoptic Report, description=Document to communicate information to others, commonly in response to a request from another party., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=COMPOSITION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=null, code=null, itemType=UNSUPPORTEDTOPLEVELATTRIBUTE, level=1, text=Other Context, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=UNSUPPORTEDTOPLEVELATTRIBUTE, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/context/other_context[at0001]/items[at0002], code=at0002, itemType=ELEMENT, level=2, text=Report ID, description=Identification information about the report., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/context/other_context[at0001]/items[at0005], code=at0005, itemType=ELEMENT, level=2, text=Status, description=The status of the entire report. Note: This is not the status of any of the report components., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='Patient Identity'], code=at0000, itemType=SECTION, level=1, text=Patient Identity, description=A generic section header which should be renamed in a template to suit a specific clinical context., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=SECTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='Diagnostic Summary'], code=at0000, itemType=SECTION, level=1, text=Diagnostic Summary, description=A generic section header which should be renamed in a template to suit a specific clinical context., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=SECTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='Diagnostic Summary']/items[openEHR-EHR-EVALUATION.problem-diagnosis.v1], code=at0000.1, itemType=EVALUATION, level=2, text=Diagnosis, description=A diagnosis defined by a clinician which is coded in an accepted terminology and may include the stage of the condition and the diagnostic criteria, comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=EVALUATION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='Diagnostic Summary']/items[openEHR-EHR-EVALUATION.problem-diagnosis.v1]/data[at0001]/items[at0002.1], code=at0002.1, itemType=ELEMENT, level=3, text=Diagnosis, description=The index diagnosis, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=Value set: ac0.1, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='Diagnostic Summary']/items[openEHR-EHR-EVALUATION.problem-diagnosis.v1]/data[at0001]/items[at0009], code=at0009, itemType=ELEMENT, level=3, text=Clinical description, description=Description of the clinical aspects of the problem, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='Diagnostic Summary']/items[openEHR-EHR-EVALUATION.problem-diagnosis.v1]/data[at0001]/items[at0010], code=at0010, itemType=ELEMENT, level=3, text=Date clinically recognised, description=Date the problem was recognised by clinicians, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings'], code=at0000, itemType=SECTION, level=1, text=2. Current biopsy findings, description=A generic section header which should be renamed in a template to suit a specific clinical context., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=SECTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1], code=at0000.1, itemType=OBSERVATION, level=2, text=Breast cancer biopsy result, description=Simple histopathology lab test result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=OBSERVATION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001], code=at0001, itemType=UNSUPPORTEDTOPLEVELATTRIBUTE, level=3, text=Data, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=UNSUPPORTEDTOPLEVELATTRIBUTE, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002], code=at0002, itemType=EVENT, level=4, text=Any event, description=*, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=EVENT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003], code=at0003, itemType=UNSUPPORTEDTOPLEVELATTRIBUTE, level=5, text=Data, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=UNSUPPORTEDTOPLEVELATTRIBUTE, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0005], code=at0005, itemType=ELEMENT, level=6, text=Test name, description=Specific identifier for this lab test. e.g. Full blood count , blood glucose, urine microbiology. May equate to the result name for a single value result. Commonly a coded term e.g from LOINC or SNOMED-CT., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=
  • Breast Biopsy
Default value: Breast Biopsy, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0077], code=at0077, itemType=ELEMENT, level=6, text=Diagnostic service, description=The type of high-level diagnostic service e.g. biochemistry, haematology., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.86], code=at0.86, itemType=CLUSTER, level=6, text=Macroscopic, description=Macroscopic findings - more than one set of findings may be recorded., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.86]/items[at0.76], code=at0.76, itemType=CLUSTER, level=7, text=Macroscopic finding, description=A single set of macroscopic pathology findings., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.86]/items[at0.76]/items[at0.90], code=at0.90, itemType=ELEMENT, level=8, text=Tissue present, description=Confirmation, or otherwise, that the tissue or structure referred to by this macroscopic finding is present in the specimen for analysis., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Present 
  • Absent 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.86]/items[at0.76]/items[at0.77], code=at0.77, itemType=ELEMENT, level=8, text=Description, description=Narrative text recorded at the time of specimen macroscopic dissection., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.86]/items[at0.88], code=at0.88, itemType=ELEMENT, level=7, text=Overall macroscopic description, description=General comment or description about macroscopy findings., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87], code=at0.87, itemType=CLUSTER, level=6, text=Microscopic, description=Microscopic findings - more than one set of findings may be recorded., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[at0078.2], code=at0078.2, itemType=ELEMENT, level=7, text=Histopathological result, description=A conclusion or 'pathological diagnosis' for this individual microscopic finding., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0], code=at0000, itemType=CLUSTER, level=7, text=Specimen, description=To record details of a laboratory specimen., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0029], code=at0029, itemType=ELEMENT, level=8, text=Specimen type, description=The type of specimen to be collected e.g venous blood, prostatic biopsy., comment=null, uncommonOntologyItems={fhir_mapping=Specimen.type}, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0015], code=at0015, itemType=ELEMENT, level=8, text=Datetime collected, description=The date and time that collection has been ordered to take place or has taken place., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_DATE_TIME, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0008], code=at0008, itemType=ELEMENT, level=8, text=Sampling conditions, description=Any conditions to be met before the sample should be taken., comment=e.g. fasting, 'full bladder', 'sterile field' or any special instructions on the handling or immediate processing of the sample e.g. centrifuge on receipt. Can also be used to document any known deviations from collection or handling instructions e.g patient was not fasted., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0007], code=at0007, itemType=ELEMENT, level=8, text=Collection method, description=The method of collection to be used eg Venepuncture, biopsy, resection., comment=null, uncommonOntologyItems={fhir_mapping=Specimen.collection.method}, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0079], code=at0079, itemType=ELEMENT, level=8, text=Collection method description, description=Additional detailed description of method of sample collection., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0005], code=at0005, itemType=ELEMENT, level=8, text=Potential risk, description=Any risk or biohazard associated with collecting or handling the specimen., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0067], code=at0067, itemType=ELEMENT, level=8, text=Collection setting, description=Identification of the setting at which the specimen was collected from a subject of care. The specimen is often collected by a healthcare provider, but may be collected directly by the patient or carer at home., comment=This specifies the specimen collection location within the healthcare environment. It enables the laboratory to ask questions about the collection of the specimen, if required. The specimen collection setting may provide additional information relevant to the analysis of the result., uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0070], code=at0070, itemType=ELEMENT, level=8, text=Specimen collector identifier, description=Identifier of the person or agency responsible for collecting the specimen., comment=null, uncommonOntologyItems={fhir_mapping=Specimen.collection.collector}, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_IDENTIFIER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0080], code=at0080, itemType=ELEMENT, level=8, text=Number of containers, description=The total number of containers holding this specimen., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=>=0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0039], code=at0039, itemType=CLUSTER, level=8, text=Specimen quality, description=Problems with the received specimen., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0039]/items[at0042], code=at0042, itemType=ELEMENT, level=9, text=Specimen received issues, description=Specific issue with a received specimen., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=
  •  Coded Text
    • Haemolysed 
    • Lipaemic 
    • Incorrect transport medium 
    • Insufficient sample 
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0039]/items[at0044], code=at0044, itemType=ELEMENT, level=9, text=Laboratory handling issues, description=Issue arising with handling or processing of the specimen within the laboratory., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=
  •  Coded Text
    • Handling error 
    • Age 
    • Laboratory accident 
    • Technical failure 
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0039]/items[at0041], code=at0041, itemType=ELEMENT, level=9, text=Adequacy for testing, description=Is the specimen adequate for testing?, comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=
  •  Coded Text
    • Satisfactory 
    • Unsatisfactory - processed 
    • Unsatisfactory - not processed 
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0039]/items[at0045], code=at0045, itemType=ELEMENT, level=9, text=Comment, description=An additional text comment on the quality of the received specimen., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0081], code=at0081, itemType=CLUSTER, level=8, text=Related specimen, description=Details of a related specimen., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.specimen.v0]/items[at0081]/items[at0003], code=at0003, itemType=ELEMENT, level=9, text=Parent specimen identifier, description=Unique identifier of the parent specimen, where the specimen is split into sub-samples., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_IDENTIFIER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1], code=at0000, itemType=CLUSTER, level=7, text=Microscopic findings - Breast cancer, description=Microscopic anatomic pathology findings related to breast cancer., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015], code=at0015, itemType=CLUSTER, level=8, text=Histologic grading, description=Histologic grading of breast cancer., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015]/items[at0020], code=at0020, itemType=CLUSTER, level=9, text=Bloom and Richardson Grade, description=Bloom and Richardson Histology Grade ( with modification by Elston and Ellis) is composed of three components which are combined to produce a calculated Histology Grade., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015]/items[at0020]/items[at0014], code=at0014, itemType=ELEMENT, level=10, text=Mitosis count, description=Mitotic frequency is calculated from the number of mitoses per 10 high-power fields., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015]/items[at0020]/items[at0175], code=at0175, itemType=ELEMENT, level=10, text=Mitotic frequency score, description=Mitotic frequency score calculated from the mitosis count and the microscopy field diameter via a lookup table., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_ORDINAL, bindings=null, values=
  • 1: Score 1 
  • 2: Score 2 
  • 3: Score 3 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015]/items[at0020]/items[at0016], code=at0016, itemType=ELEMENT, level=10, text=Nuclear score, description=Nuclear score., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_ORDINAL, bindings=null, values=
  • 1: Score 1 
  • 2: Score 2 
  • 3: Score 3 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015]/items[at0020]/items[at0017], code=at0017, itemType=ELEMENT, level=10, text=Tubular formation score, description=Tubular formation score, representing the extent of tubular formation within invasive carcinoma cells., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_ORDINAL, bindings=null, values=
  • 1: Tubular formation score 1 
  • 2: Tubular formation score 2 
  • 3: Tubular formation score 3 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015]/items[at0020]/items[at0018], code=at0018, itemType=ELEMENT, level=10, text=Histologic grade, description=Bloom and Richardson Grade of breast cancer, derived from the total score of its components: Mitotic frequency score, Nuclear score and Tubular formation score., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_ORDINAL, bindings=null, values=
  • 1: Grade 1 
  • 2: Grade 2 
  • 3: Grade 3 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0015]/items[at0020]/items[at0043], code=at0043, itemType=ELEMENT, level=10, text=Confounding issues, description=A text description of any assessment issues which may confound the accuracy of the Bloom and Richardson histologic grade., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0054], code=at0054, itemType=CLUSTER, level=8, text=Non-neoplastic cellular changes, description=Findings of non-neoplastic cellular changes., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0054]/items[at0023], code=at0023, itemType=ELEMENT, level=9, text=Non-neoplastic cellular change, description=Finding of non-neoplastic cellular change., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0060], code=at0060, itemType=CLUSTER, level=8, text=Lobular neoplasia, description=Findings of lobular neoplasia and variants., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0060]/items[at0061], code=at0061, itemType=ELEMENT, level=9, text=Lobular neoplasia, description=Finding of lobular neoplasia., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=
  •  Coded Text
    • Present - classical 
    • Present - pleomorphic 
    • Absent 
    • Indeterminate 
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0060]/items[at0055], code=at0055, itemType=ELEMENT, level=9, text=Atypical lobular hyperplasia, description=Finding of atypical lobular hyperplasia., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=
  •  Coded Text
    • Present - classical 
    • Present - pleomorphic 
    • Absent 
    • Indeterminate 
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0060]/items[at0058], code=at0058, itemType=ELEMENT, level=9, text=Lobular carcinoma-in-situ, description=Finding of lobular carcinoma-in-situ., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=
  •  Coded Text
    • Present - classical 
    • Present - pleomorphic 
    • Absent 
    • Indeterminate 
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0060]/items[at0056], code=at0056, itemType=ELEMENT, level=9, text=Description, description=A text description of finding of lobular neoplasia., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0062], code=at0062, itemType=CLUSTER, level=8, text=Paget's disease of nipple, description=Findings related to Paget's disease of the nipple., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0062]/items[at0063], code=at0063, itemType=ELEMENT, level=9, text=Paget's disease of nipple, description=Finding of Paget's disease of the nipple., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Present 
  • Absent 
  • Indeterminate 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0024], code=at0024, itemType=CLUSTER, level=8, text=Microcalcification, description=Findings related to microcalcification., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0024]/items[at0025], code=at0025, itemType=ELEMENT, level=9, text=Microcalcification, description=Findings of microcalcification., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Present 
  • Absent 
  • Indeterminate 
  • Present - no evidence of necrosis 
  • Present - with evidence of necrosis 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0024]/items[at0026], code=at0026, itemType=ELEMENT, level=9, text=Associated pathology, description=A text description of pathology associated with microcalcification., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064], code=at0064, itemType=CLUSTER, level=8, text=DCIS features, description=Findings related to Ductal carcinoma-in-situ (DCIS)., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0154], code=at0154, itemType=ELEMENT, level=9, text=Calcification, description=Finding of calcification in DCIS tissue., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Present with necrosis 
  • Present without necrosis 
  • Absent 
  • Indeterminate 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0125], code=at0125, itemType=CLUSTER, level=9, text=Histologic grade, description=Histologic grading of DCIS., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0125]/items[at0075], code=at0075, itemType=ELEMENT, level=10, text=Necrosis, description=Findings of tumour necrosis., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Present (non-comedo type) 
  • Present (Comedo type) 
  • Absent or minimal 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0125]/items[at0070], code=at0070, itemType=ELEMENT, level=10, text=Nuclear score, description=Nuclear score, using the Elston and Ellis modification of the Bloom and Richardson system for grading invasive carcinoma., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_ORDINAL, bindings=null, values=
  • 1: Score 1 
  • 2: Score 2 
  • 3: Score 3 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0125]/items[at0080], code=at0080, itemType=ELEMENT, level=10, text=Van Nuys Prognostic Index, description=The Van Nuys Prognostic Index (VNPI)., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_ORDINAL, bindings=null, values=
  • 1: Van Nuys Group 1 
  • 2: Van Nuys Group 2 
  • 3: Van Nuys Group 3 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0125]/items[at0179], code=at0179, itemType=ELEMENT, level=10, text=Comment, description=Comment on estimation of the histologic grade., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0128], code=at0128, itemType=CLUSTER, level=9, text=DCIS Architecture, description=Findings related to architecture of the ductal carcinoma-in-situ., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0128]/items[at0130], code=at0130, itemType=ELEMENT, level=10, text=Dominant pattern, description=Findingof the dominant DCIS architectural pattern., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=
  •  Coded Text
    • Solid 
    • Cribriform 
    • Micropapillary 
    • Apocrine 
    • Papillary 
    • Indeterminate 
  •  Text
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0064]/items[at0128]/items[at0131], code=at0131, itemType=ELEMENT, level=10, text=Description, description=A text description of the architectural pattern., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094], code=at0094, itemType=CLUSTER, level=8, text=Hormone Receptor assays, description=Immunohistochemical assays of oestrogen receptor (ER) and progesterone receptor (PR)., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0095], code=at0095, itemType=CLUSTER, level=9, text=Oestrogen receptor assay (ER), description=Oestrogen Receptor assay (ER)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..2, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0095]/items[at0096], code=at0096, itemType=ELEMENT, level=10, text=ER result, description=Oestrogen Receptor assay result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Positive 
  • Negative 
  • Equivocal 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0095]/items[at0100], code=at0100, itemType=ELEMENT, level=10, text=Proportion of nuclei stained, description=An estimate of the percentage of nuclei stained., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0095]/items[at0101], code=at0101, itemType=ELEMENT, level=10, text=Predominant staining intensity, description=Predominant intensity of staining., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Low 
  • Intermediate 
  • High 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0102], code=at0102, itemType=CLUSTER, level=9, text=Progesterone receptor assay (PR), description=Progesterone Receptor (PR) assay., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0102]/items[at0138], code=at0138, itemType=ELEMENT, level=10, text=PR result, description=Progesterone Receptor assay result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Positive 
  • Negative 
  • Equivocal 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0102]/items[at0162], code=at0162, itemType=ELEMENT, level=10, text=Proportion of nuclei stained, description=An estimate of the percentage of nuclei stained., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0102]/items[at0163], code=at0163, itemType=ELEMENT, level=10, text=Predominant staining intensity, description=Predominant intensity of staining., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Low 
  • Intermediate 
  • High 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0103], code=at0103, itemType=CLUSTER, level=9, text=Human Oestrogen receptor 2 assay (HER2), description=Human Oestrogen receptor 2 (HER2) assay., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0103]/items[at0143], code=at0143, itemType=CLUSTER, level=10, text=Immunohistochemistry, description=HER2 Immunohistochemistry result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0103]/items[at0143]/items[at0107], code=at0107, itemType=ELEMENT, level=11, text=Immunohistochemistry score, description=HER2 immunohistochemistry score., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_COUNT, bindings=null, values=>=0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0103]/items[at0143]/items[at0142], code=at0142, itemType=ELEMENT, level=11, text=Immunohistochemistry result, description=HER2 Immunohistochemistry result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Positive 
  • Negative 
  • Equivocal 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0103]/items[at0144], code=at0144, itemType=CLUSTER, level=10, text=In situ hybridisation (ISH), description=HER2 In situ hybridisation (ISH)., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0103]/items[at0144]/items[at0108], code=at0108, itemType=ELEMENT, level=11, text=ISH result, description=HER2 In situ hybridisation (ISH) result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Positive 
  • Negative 
  • Equivocal 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0094]/items[at0103]/items[at0144]/items[at0145], code=at0145, itemType=ELEMENT, level=11, text=Comment, description=A text comment on HER2 In situ hybridisation (ISH) result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0180], code=at0180, itemType=CLUSTER, level=8, text=Non-neoplastic changes, description=Findings of non-neoplastic change., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[openEHR-EHR-CLUSTER.microscopy_breast_carcinoma.v1]/items[at0180]/items[at0181], code=at0181, itemType=ELEMENT, level=9, text=Non-neoplastic change, description=Finding of non-neoplastic change., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=
  • Columnar cell changes 
  • Intraductal papilloma 
  • Radial scars 
  • Atypical ductal hyperplasia (ADH) 
  • Absent 
  • Indeterminate 
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.81]/items[at0.82], code=at0.82, itemType=ELEMENT, level=7, text=Comments, description=Narrative text recorded at the time of specimen microscopic examination., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.87]/items[at0.89], code=at0.89, itemType=ELEMENT, level=7, text=Overall microscopic description, description=General comment or description about microscopy findings as a whole., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0078.1], code=at0078.1, itemType=ELEMENT, level=6, text=Histopathological result, description=Conclusions or 'pathological diagnoses' for the whole test., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0.100], code=at0.100, itemType=ELEMENT, level=6, text=Histopathological subtype, description=A subtype of the histopthological result., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/data[at0001]/events[at0002]/data[at0003]/items[at0057], code=at0057, itemType=ELEMENT, level=6, text=Overall interpretation, description=An overall interpretative comment on this test., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/protocol[at0004]/items[at0013], code=at0013, itemType=CLUSTER, level=3, text=Test identification, description=Unique identifiers used in delivery of the care process., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/protocol[at0004]/items[at0013]/items[at0062], code=at0062, itemType=ELEMENT, level=4, text=Placer order identifier, description=The ID assigned to the order by the order requester. Equivalent to the NEHTA Requester Order Identifier., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/protocol[at0004]/items[at0013]/items[at0063], code=at0063, itemType=ELEMENT, level=4, text=Filler order Identifier, description=The ID assigned to the test order by the order filler, usually by the (LIS) Laboratory Information System. Equivalent to the DICOM Accession Number and NEHTA Laboratory Request Identifier., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=[openEHR-EHR-COMPOSITION.report.v1]/content[openEHR-EHR-SECTION.adhoc.v1 and name/value='2. Current biopsy findings']/items[openEHR-EHR-OBSERVATION.lab_test-histopathology.v1]/protocol[at0004]/items[at0013]/items[at0068], code=at0068, itemType=ELEMENT, level=4, text=Laboratory test result identifier, description=The identifier given to the laboratory test result of a pathology investigation., comment=null, uncommonOntologyItems=null, occurencesFormal=null, occurencesText=null, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null]], templateType=normal]