Breast Cancer Specification - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Integrated Report (BET + SLN)

This example demonstrates the integrated report model, where the breast-conserving excision (BET) and sentinel lymph node (SLN) biopsy are reported as a single pathology document under one accession number. This reflects standard German clinical practice, where both specimens are obtained in a single operation and evaluated by the same pathologist (see Clinical Context — Lymph node reporting for background).

Architecture

• One Encounter (IntegratedEncounter, case ID E_25_300) — a single surgical procedure
• One ServiceRequest (IntegratedReportRequest) — referencing both specimen parts
• One DiagnosticReport (IntegratedReport) — with two result slices:
  • result[macroscopic-observations] — combined macroscopic grouper
  • result[diagnostic-conclusion] — combined diagnostic conclusion grouper
• One Composition (IntegratedComposition) — with combined narrative covering both BET and SLN
• One Bundle (IntegratedDocument) — containing all resources (~119 entries)
• Two QuestionnaireResponses — one for the breast resection questionnaire, one for the lymph node questionnaire

Specimen Hierarchy

Two independent specimen hierarchies share the accession identifier E_25_300:

A) BET Excision Specimen (22 instances)

Level	Instance	Description
Part	IntegratedBETSpecimenPart	BCS excision specimen, left breast, with skin and wire localisation, 42×35×18 mm, 10 g

Paraffin Blocks

Instance	Description
IntegratedBETSpecimenBlock01	Central tumour area, slice III (incl. anterior/posterior margins)
IntegratedBETSpecimenBlock02	Central tumour area, slice V (incl. anterior/posterior margins)
IntegratedBETSpecimenBlock03	Resection margin superior
IntegratedBETSpecimenBlock04	Resection margin inferior
IntegratedBETSpecimenBlock05	Resection margin medial (slice I)
IntegratedBETSpecimenBlock06	Resection margin lateral (slice VIII)

Slides — H&E (Block 01, Tumour)

Instance	Description
IntegratedBETSlideHE01	H&E slide, tumour area, section level 1
IntegratedBETSlideHE02	H&E slide, tumour area, section level 2

Slides — H&E (Block 02, Tumour)

Instance	Description
IntegratedBETSlideBlock02-HE01	H&E slide, tumour area slice V, section level 1
IntegratedBETSlideBlock02-HE02	H&E slide, tumour area slice V, section level 2

Slides — H&E Resection Margins (Blocks 03–06)

Instance	Description
IntegratedBETSlideRR-Superior-HE01	H&E slide, resection margin superior
IntegratedBETSlideRR-Inferior-HE01	H&E slide, resection margin inferior
IntegratedBETSlideRR-Medial-HE01	H&E slide, resection margin medial
IntegratedBETSlideRR-Lateral-HE01	H&E slide, resection margin lateral

Slides — Immunohistochemistry (Block 01)

Instance	Stain	Description
IntegratedBETSlideER01	ER IHC	Oestrogen receptor immunohistochemistry
IntegratedBETSlidePR01	PR IHC	Progesterone receptor immunohistochemistry
IntegratedBETSlideHER2IHC01	HER2 IHC	HER2 immunohistochemistry
IntegratedBETSlideKi67-01	Ki-67 IHC	Ki-67 immunohistochemistry
IntegratedBETSlideCK18-01	CK18 IHC	Cytokeratin 18 immunohistochemistry
IntegratedBETSlidep40-01	p40 IHC	p40 immunohistochemistry
IntegratedBETSlideECad-01	E-Cadherin IHC	E-Cadherin immunohistochemistry

B) SLN Excision Specimen (7 instances)

Level	Instance	Description
Part	IntegratedSLNSpecimenPart	Sentinel lymph node excision specimen, left axilla, 2 SLN identified (patent blue dye)

Paraffin Blocks

Instance	Description
IntegratedSLNSpecimenBlock01	SLN #1, bisected — contains micrometastasis (1.2 mm)
IntegratedSLNSpecimenBlock02	SLN #2, bisected — tumour-free

Slides — H&E (SLN #1, Block 01)

Instance	Description
IntegratedSLNSlideHE01	H&E slide, SLN #1, section level 1
IntegratedSLNSlideHE02	H&E slide, SLN #1, section level 2

Slides — H&E (SLN #2, Block 02)

Instance	Description
IntegratedSLNSlideHE03	H&E slide, SLN #2, section level 1
IntegratedSLNSlideHE04	H&E slide, SLN #2, section level 2