Sabato 27 ottobre 2012 - Pacini Editore

COmuNiCaziONi ORali
in the leading Institutions of Anatomic Pathology in Italy and in
the most diffuse Laboratory Information Systems (LIS) to plan
a strategy to converge in a national coding system. This operation
should also re-direct Italian Pathology to the international
scenario, favouring and coordinating cultural and scientific collaborations
between the Associations involved in medical informatics,
epidemiology and tumour registry. Actors of this project
are Scientific Societies of the field (SIAPEC-IAP and AIRTum),
the Italian Contributor Centre of WHO for Health Codes (CC-
WHO) and few Regional Health Agencies (Friuli-Venezia Giulia,
Liguria and the cooperation of Emilia-Romagna and Lombardia).
Aim of the Nomenclature for Anatomic Pathology (NAP) is to
become the national reference, for improvements and updating,
shared by the Pathologists’ community.
Material and Methods. A common nomenclature for Italian Pathologies
has been built on the existing ones. This tool, namely
the Nomenclature of Pathology Italian (NAP), was designed with
the following characteristics:
Identification of a work group, constituted by Pathologists from
different Italian Anatomic Pathology, an operator editing different
tables (see below), sometimes in collaboration with other
centre; a group coordinator;
ICD-O 3 acquisition to create the core of NAP 3 ;
The tables in use in major Italian Institutions were compared with
ICD-O 3 and fused together: similar conceptual meaning of the
words with different codes have been unified;
As fare-nomenclature for procedure has been adopted that from
SIAPEC-IAP of 2002 and published on website of the Society;
The system to represent the results of laboratory methods, especially
those of molecular biology, has been derived from LOINC
- Logical Observation Identifiers Names and Codes, the largest
and most popular system for Clinical Pathology;
Where possible, a logical connection with SNOMED International
and, indirectly, with SNOMED CT was maintained;
Synonyms, obsolete terms and acronyms that have emerged from
the tables obtained to arrange the NAP are all managed.
NAP code. NAP is a multi-axes coding system, namely a complex
medical concept is broken into many simple concepts represented
by codes. This criterion is the same established for SNOP
and afterwards in SNOMED until the International NAP concepts
are organized in chapters or knowledge axes: Topography, Morphology,
Procedures, Diseases, Links, Chemicals, Physicals, Living
Organisms and other less important.
Each concept belongs to a Chapter (to whom is hierarchical
related by a connector, called SUPER) and is represented by a
CODE and a DESCRIPTION.
The code is composed of 10 alphanumerical characters, the
first of which is a letter representing the chapter, followed by
a hyphen. Central digits of code are derived from ICD-O or
SNOMED, while the last digit of each code, the more on the right,
is reserved to synonyms and acronyms: if 0 (zero) indicates the
main term, in any other case represents a synonymous.
The description consists in a scope describing the concept in Italian
and in English languages.
NAP and others nomenclatures
ICD-O. ICD-O 3 represents the core of NAP. In facts NAP code
is constituted by 10 digit and morphology chapters “M-8” e “M-
9” exactly include ICD-O codes.
NAP Code for cancer: M-8000300B - ICD-O Code for cancer:
M-8000/3
The letter at the beginning, hyphen (optional in ICD-O), and
initial 4 numbers are identical to ICD-O, last three digit of NAP
code allows to manage synonyms and acronyms, that are not essential
for Tumour Registries, but may be very useful for medical
(and pathological) records.
For topographic codes have been adopted criteria followed in
SNOMED International and were added link to ICD-O topography,
too broad for applications in Anatomic Pathology.
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SNOMED CT. Structure of NAP code is clearly inspired by
SNOP and to first version of SNOMED, but absolutely missing
the systematic of these two nomenclatures.
Semantic organization of SNOMED CT is markedly different
through the elaboration of knowledge engineering gradually
more elaborate (4): code is no longer “speaking” but a unique
16 digit code, unmanageable in a direct coding (manual). Each
concept identified by unique code, can be expressed by more
terms, one of them “preferred”. A strict system of reference and
attribute manages relations between terms and allows inference,
logical and semantic links.
SNOMED CT is the more widespread multilingual medical vocabulary
ever realized, but information system of Italian Pathology
are still bound to second version of SNOMED or in some
case to SNOMED International, but none apply the version “References
Terminology” (RT) nor “Clinical Terms” (CT).
In this view NAP has also the role of a bridge to unify Italian
codes into SNOMED CT and ICD 11, where presumably it will
converge.
LOINC. The system, utilized for Clinical Pathology Laboratory
and for quantification of exams, can easily be applied to molecular
biology to. However in Pathologic Anatomy, even if there are
study to map or link parts of SNOMED to LOINC 5 , these two
coding systems are not exclusive, namely the use of one of them
is not sufficient.
Release of NAP versions. First target of NAP is to maintain
aligned the different versions produced after addiction or modification
of codes resulting from comparison with new tables:
presumably a four or six-monthly updating.
Results and discussion. Advantages of NAP. The availability
of a unified nomenclature, realized and diffuse from the Italian
Scientific Society of Anatomic Pathology represents the basis to
cancel differences between diagnostic nomenclatures of Italian
Pathologists and to recognize the value of the big work in terms
of coding produced every day from Pathologies in our country.
The outcome in terms of data entirety, information sharing in
medical records (local or network), case studies, epidemiology
analysis, relation with Tumour and Pathology Registries has a big
potential scientific and practice, to improve the role of Pathology.
Limits of NAP. The NAP is a local vocabulary to drive Italian
Pathologies to SNOMED and more generally to ICD 11, that will
be available in 2015.
NAP has been built from the fusion of many tables validated from
many years use in important Institutions, but without systematic
in many fields of medical science, or in other words doesn’t cover
the huge vocabulary of systematic nomenclature drawn by Roger
Coté into SNOP and later into SNOMED 6 .
NAP needs in fact periodic maintenance of terms and a scientific
committee to validate new terms, corrections and to drive relations
with international catalogues, first of all WHO, to coherently
direct evolution.
references
1 Bondi A, Nesti P, Rossi Mori A. SNOMED International. Microglossario
di patologia (Lingua italiana), ed 1. Udine:, Pubblicazioni
Medico Scientifiche 1995.
2 International Health Terminology Standards Development Organisation
(IHTSDO). http://www.ihtsdo.org/.
3 Giacomin A, Ferretti S. ICD-O Classificazione Internazionale delle
Malattie per l’Oncologia. Terza Edizione. Traduzione Italiana di
“International Diseases Classification for Oncology” (C) WHO 2000.
Milano: Inferenze Scarl 2005.
4 Lee D, Cornet R, Lau F. Implications of SNOMED CT versioning. Int
J Med Inform 2011;80:442-53.
5 Bodenreider O. Issues in mapping LOINC laboratory tests to SNOMED
CT. AMIA Annu Symp Proc 2008;51-5.
6 Cote’ RA. The SNOP-SNOMED concept: evolution towards a common
medical nomenclature and classification. Pathologist 1977;31:383-98.