2021-12-13 - Cancer Synoptic Reporting Project Group Meeting

1. Three types of intactness of interest in synoptics
   1. Mesorectum (completeness)
   2. Others (ovary, fallopian tubes, uterus) - ruptured, morcelated, etc
   3. IHC nuclear staining

1. Suggest that we leave these concepts as primitive for now. Too much time being spent on low priority items?
   
   Consensus that items 1a and 1b can be left primitively defined.  Item 1c is a separate topic and will be addressed separately.

1. Two use cases:
   
   
   1. Prognostic stains - Primary cancer already determined.  Used for treatment decisions to be made.
      1. Pathologists knows where stain will/will not be expressed
      2. No need to declare location within cell that expresses the stain (nucleus, cytoplasm, membrane)
         
         
   2. Diagnostic stains - Used to differentiate between possible diagnoses.
      1. Where the protein is expressed informs the pathologist needed information to render a diagnosis.
      2. Need to declare location of protein expression in the cell.

Discussion was robust with discussion surrounding specific meaning of the observable (i.e., what is being measured by the pathologist) vs. how the observable and observations are interpreted by the pathologist.  For example, IHC scoring of HER2 in breast is 0,1+,2+.  However, clinical interpretation of HER2+ tissue based on the 0,1+,2+ has changed.  0 and 1+ are now considered NEGATIVE for HER2 and 2+ is considered equivocal.

For purposes of the observable entity concepts as exemplified by IHC HER2, interpretation of results is separate from the observation.  Therefore, a separate observable entity OR clinical finding should be used to represent the interpretation of the IHC staining observation (ordinal scale) in such situations.  Observable entities will be created to represent FISH and other testing methods used to realize the final diagnosis/interpretation

What are we measuring when assessing "treatment effect"?  

Is this a histologic change?  Viability of tumor cells?