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oai:iuhw.repo.nii.ac.jp:02000517 2025-12-08T06:48:59Z 2:1753238456237

ICD-11導入による肺がん詳細不明コード増加の要因分析と がん登録実務者の立場からの院内がん登録項目追加に関する提言 Factor Analysis to Investigate the Increase in the Number of Code-unspecified Cases of Lung Cancer With the Transition from ICD-10 to ICD-11, and Proposals for the Addition of Cancer Registry Items from the Perspective of the Cancer Registry 山口, 千春 ヤマグチ, チハル YAMAGUCHI, Chiharu 山本, 康弘 ヤマモト, ヤスヒロ YAMAMOTO, Yasuhiro ICD-11 ICD分類 がん登録 肺癌 腫瘍 組織型 IDC-11 ICD cancer registry lung cancer tumor histological type 目的：多施設の院内がん登録データを用いてICD-11導入後のコーディング精度を調査し，がん登録実務者へのインタビュー調査により登録項目の提言を行うことを目的とした． 方法：1）5施設の肺がん症例をICD-10とICD-11でコーディングし有意差検定を行い，詳細不明症例と院内がん登録項目の関連性を分析した．2）がん登録実務者10名に分析結果を示しインタビュー調査を行った． 結果：1）ICD-10と比較しICD-11は詳細不明割合が増加した．診断根拠が「臨床検査」の場合に有意差が認められた．2）提言として，臨床診断による組織型と遺伝子情報の登録が挙げられた．ICD-10は画像検査で詳細コードが付与可能な症例もあるが，ICD-11は病理学的診断が求められ，分類構造の違いから詳細不明割合が異なったと考える．がん登録実務者は，現行ルールでは仕方ないことと受け止めているが，不充分であるとも捉えている． 結論：ICD-11導入により詳細不明割合が増加することが明らかとなった．画像および血液検査結果による治療 開始症例もあり，推定される組織型と遺伝子情報の登録の必要性が示唆された． Purpose: To investigate the accuracy of cancer coding with the use of cancer registration data from multiple facilities following the switch from ICD-10 to ICD-11, and propose the need for additional information for cancer registration based on interviews of staff members of the cancer registry. Methods: 1) Cases of lung cancer from 5 medical facilities were coded according to ICD-10 and ICD-11, and the differences in the codes between these two versions of ICD was tested, in order to analyze the relationship between the recent increase in code-unspecified cases and the information required for in-hospital cancer registration in accordance with the two versions of ICD. 2) We interviewed 10 staff members involved in our cancer registry, while presenting them with data from our analysis. Results: 1) The percentage of code-unspecified cases of lung cancer was higher after switching from ICD-10 to ICD-11. A significant difference was noted when the diagnosis was made based on the results of laboratory tests. 2) To reduce the number of code-unspecified cases, we propose addition of two more items for registration of cancer patients in the cancer registry,namely, the clinically judged histological type and genetic information.With ICD-10, exact coding is sometimes possible on the basis of diagnostic imaging. With ICD-11, however, histopathological rating is often required for coding. This difference in the structure of the classification system seems to explain the increase in the number of code-unspecified cases following switching to ICD-11. Conclusion: Following switching to ICD-11, the percentage of code-unspecified cases of lung cancer has been increasing. Considering that treatment is sometimes started on the basis of the findings/results from diagnostic imaging and blood tests, it seems necessary to add the estimated histological type and genetic information to the information required for lung cancer registration with a cancer registry. 国際医療福祉大学学会 2024-09-30 jpn journal article VoR https://doi.org/10.69203/iuhw292.006 https://iuhw.repo.nii.ac.jp/records/2000517 10.69203/iuhw292.006 AA12537130 21863652 国際医療福祉大学学会誌 Journal of the International University of Health and Welfare 29 2 6 19 https://iuhw.repo.nii.ac.jp/record/2000517/files/29_2(6-19p).pdf application/pdf 794.3 KB 2025-07-23