Predictive Value of the International Classification of Diseases, 9th Revision Codes for Identifying Ocular Oncology Diagnoses

Introduction

The aim of this study was to determine the predictive value of International Classification of Diseases, 9th Revision (ICD-9) billing codes for identifying ocular oncology diagnoses.

Methods

Population-based retrospective cohort study of all Olmsted County, Minnesota residents with any ocular neoplasm-related ICD-9 code from January 1, 2006 to October 1, 2015. All medical records were reviewed for confirmation of ocular neoplasm. Diagnoses with ≥5 cases confirmed via a medical record review were compared to corresponding ICD-9 codes. Main outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-9 codes.

Results

Among 3,932 subjects with ≥1 ocular neoplasm-related ICD-9 code, 21 diagnoses met study criteria. The most frequent intraocular, extraocular/orbital, and ocular surface diagnoses were choroidal nevus (n = 824), epidermal inclusion cyst (n = 263), and conjunctival nevus (n = 74), respectively. PPVs ranged from 1.2% to 73.8%, NPVs from 96.9% to 100%, sensitivity from 0% to 100%, and specificity from 85.7% to 100%. Among malignant neoplasms, PPV ranged from 0% to 73.8%: ocular surface squamous neoplasia (PPV: 0%), choroidal melanoma (PPV: 25.0%), eyelid squamous cell carcinoma (PPV: 46.7%), and eyelid basal cell carcinoma (PPV: 73.8%). Among benign neoplasms, PPV ranged from 1.2% (dermoid cyst) to 61.6% (choroidal nevus).

Conclusion

There was a wide variation in a predictive value of ocular neoplasm-related ICD-9 billing codes, which suggests that ocular oncology-related claims data alone may overestimate the true number of ocular oncology diagnoses.

The novel and powerful ICD-11 classification system for neoplasm coding: a comparative study with the ICD-O

BACKGROUND

The International Classification of Diseases (ICD) and the International Classification of Diseases for Oncology (ICD-O) are both widely used global classification systems. In 2018, the initial release of the ICD-11 was published by the World Health Organization (WHO), integrating the morphology section of the ICD-O.

METHODS

This paper aims to provide potential ICD-11 users with a profound understanding of the neoplasm classifications of the ICD-11 by analysing the differences and relationships between the ICD-11 and ICD-O in terms of the coding framework, compatibility and intelligence level.

RESULTS

The ICD-11 and ICD-O have remarkable differences in coding structure. Compared to the ICD-O, the ICD-11 has the following advantages: adding histopathology to the stem codes, obtaining a meaningful minimum amount of information through stem codes for statistics, supporting the usage of ICD-O morphology categories and capturing clinical details via extension codes for multiaxial coding. In addition, the rich Foundation Component, linearization derived from the Foundation Component and updating mechanism all support the compatibility of the ICD-11 with other classification systems. Notably, the WHO provides terminology coding with a smart coding tool, and coding in the ICD-11 can draw on statistical codes and uniform resource identifiers (URIs) simultaneously.

CONCLUSIONS

The ICD-11 represents a novel classification system with distinguishing features that include facilitating statistics, multiaxial coding, coding granularity, compatibility and intelligence. These features enable the ICD-11 to be more powerful for neoplasm coding than the ICD-O and basically meet the needs of stakeholders.

Mapping of ICD-O Tuples to OncoTree Codes Using SNOMED CT Post-Coordination

Around 500,000 oncological diseases are diagnosed in Germany every year which are documented using the International Classification of Diseases for Oncology (ICD-O). Apart from this, another classification for oncology, OncoTree, is often used for the integration of new research findings in oncology. For this purpose, a semi-automatic mapping of ICD-O tuples to OncoTree codes was developed. The implementation uses a FHIR terminology server, pre-coordinated or post-coordinated SNOMED CT expressions, and subsumption testing. Various validations have been applied. The results were compared with reference data of scientific papers and manually evaluated by a senior pathologist, confirming the applicability of SNOMED CT in general and its post-coordinated expressions in particular as a viable intermediate mapping step. Resulting in an agreement of 84,00 % between the newly developed approach and the manual mapping, it becomes obvious that the present approach has the potential to be used in everyday medical practice.

Cytogenetic Resources and Information

The main databases devoted stricto sensu to cancer cytogenetics are the "Mitelman Database of Chromosome Aberrations and Gene Fusions in Cancer" ( http://cgap.nci.nih.gov/Chromosomes/Mitelman ), the "Atlas of Genetics and Cytogenetics in Oncology and Haematology" ( http://atlasgeneticsoncology.org ), and COSMIC ( http://cancer.sanger.ac.uk/cosmic ).However, being a complex multistep process, cancer cytogenetics are broadened to "cytogenomics," with complementary resources on: general databases (nucleic acid and protein sequences databases; cartography browsers: GenBank, RefSeq, UCSC, Ensembl, UniProtKB, and Entrez Gene), cancer genomic portals associated with recent international integrated programs, such as TCGA or ICGC, other fusion genes databases, array CGH databases, copy number variation databases, and mutation databases. Other resources such as the International System for Human Cytogenomic Nomenclature (ISCN), the International Classification of Diseases for Oncology (ICD-O), and the Human Gene Nomenclature Database (HGNC) allow a common language.Data within the scientific/medical community should be freely available. However, most of the institutional stakeholders are now gradually disengaging, and well-known databases are forced to beg or to disappear (which may happen!).

Squamous cell carcinoma: morphological & topographical spectrum: a two year analysis

Squamous cell carcinoma, which is a malignant tumor of the squamous epithelium, has been a major cause of morbidity and mortality worldwide. It is a major health problem across the world and among the most common cancers seen in both Indian men and women as can be gauged from the records of the National Cancer Registry Programme. This study was undertaken to analyze the spectrum of squamous cell carcinoma cases presenting at M.Y. Hospital, Indore, during 2 years between 2007 and 2008, to understand the morphological patterns of squamous cell carcinoma lesions and classify them into morphological categories given by International Classification of Diseases for Oncology (ICD-O, third edition), to analyze the anatomical site distribution pattern of squamous cell carcinoma lesions and categorize them in topographical classes given by ICD-O. Over a 2-year period, 959 cases were retrieved from the files of histopathology laboratory, department of pathology, M.G.M. Medical College, Indore. Out of total 959 cases, the maximum cases-290 (30.24 %)-of squamous cell carcinoma were found between the fourth and fifth decades of life. The frequency of squamous cell carcinoma in patients older than 30 years was 96.35 %, while in cases of less than 30 years, it was 03.65 %. Most of the reported cases of squamous cell carcinoma included invasive types (i.e., 94.3 %). Cases with distant metastasis constituted 4.7 %, while only 1 % were noninvasive or in situ. The frequency of squamous cell carcinoma presenting at our institution was highest among those involving the lip, oral cavity, and pharynx (56.50 %), followed by those involving female genital organs (30.24 %). The respective involvement of skin, digestive organs, and respiratory systems was 4.70, 3.86, and 2.40 % in decreasing order of frequency. Frequency was least (1.05 %) among the cases reported to show metastatic deposits of squamous cell carcinoma in lymph nodes. Regarding the topographical spectrum, the maximum number of cases (26.07 %) of squamous cell carcinoma encountered belonged to ICD-O category C-53 (i.e., cervix). Among the morphological categories, the most frequently encountered was that of squamous cell carcinoma, keratinizing (35.2 %).

Index-based dietary patterns and risk of esophageal and gastric cancer in a large cohort study

BACKGROUND & AIMS

Diet could affect risk for esophageal and gastric cancers, but associations have been inconsistent. The diet is complex, so studies of dietary patterns, rather than studies of individual foods, might be more likely to identify cancer risk factors. There is limited research on index-based dietary patterns and esophageal and gastric cancers. We prospectively evaluated associations between the Healthy Eating Index-2005 (HEI-2005) and alternate Mediterranean Diet (aMED) scores and risk of esophageal and gastric cancers.

METHODS

We analyzed data from 494,968 participants in the National Institutes of Health-AARP Diet and Health study, in which AARP members (age, 51-70 y) completed a self-administered baseline food frequency questionnaire between 1995 and 1996. Their answers were used to estimate scores for each index.

RESULTS

During the follow-up period (1995-2006), participants developed 215 esophageal squamous cell carcinomas (ESCCs), 633 esophageal adenocarcinomas (EACs), 453 gastric cardia adenocarcinomas, and 501 gastric noncardia adenocarcinomas. Higher scores from the HEI-2005 were associated with a reduced risk of ESCC (comparing the highest quintile with the lowest quintile: hazard ratio, 0.51; 95% confidence interval, 0.31-0.86; Ptrend = .001) and EAC (hazard ratio, 0.75; 95% confidence interval, 0.57-0.98; Ptrend = .01). We observed an inverse association between ESCC, but not EAC, and a higher aMED score (meaning a higher-quality diet). HEI-2005 and aMED scores were not associated significantly with gastric cardia or noncardia adenocarcinomas.

CONCLUSIONS

By using data collected from 1995 through 2006 from the National Institutes of Health-AARP Diet and Health Study, HEI-2005 and aMED scores were associated inversely with risk for esophageal cancers, particularly ESCC. Adherence to dietary recommendations might help prevent esophageal cancers.

Adult cerebellar glioblastoma: understanding survival and prognostic factors using a population-based database from 1973 to 2009

OBJECTIVE

Glioblastoma (GB) is rarely found in the cerebellum. Because of its rarity, it is poorly understood if cerebellar GB (CGB) behaves similarly to supratentorial GB. Studies have been limited to case reports and small case series. A better understanding of CGB may help guide treatment strategies.

METHODS

Surveillance, Epidemiology and End Results database was analyzed from 1973 to 2009 for all adult patients with GB located in the cerebellum. Stepwise multivariate proportional hazards regression analyses were used to identify factors independently associated with survival.

RESULTS

Two hundred eight (0.9%) patients with CGB were identified from 23,329 GB patients with known locality. The mean age was 58 years. Median survival was 8 months, with 1-, 2- and 5-year survival rates of 21%, 13%, and 2%. When compared to supratentorial GB, CGB occurred in younger patients (58 ± 16 vs. 61 ± 13 years, P = 0.001), less commonly in Whites (85.6% vs. 91.3%, P = 0.005), and were smaller (3.7 ± 1.1 vs. 4.5 ± 1.7 cm, P = 0.001). A cerebellar location independently predicted poorer survival when compared to other GB locations (P = 0.048). In multivariate analysis for patients with CGB, younger age (P < 0.001), Asian or Pacific Islander race (P = 0.046), and radiation therapy (P < 0.001) were independently associated with prolonged survival.

CONCLUSION

CGBs are difficult to analyze using institutional series because of their rarity. This study shows they are clinically different from supratentorial GB. Among patients with CGB, radiation therapy may prolong survival. This may help guide treatment strategies aimed at prolonging survival for patients with these extremely rare lesions.