Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Apr 2, 2026
Date Accepted: Sep 16, 2026
Real-World Applicability of Multiple International Terminology Systems in Oncology: A Mapping Study of Clinical Terms for Cancer Diagnosis and Treatment
ABSTRACT
Background:
With the rapid expansion of healthcare data, multiple international standardized terminology systems have been developed and refined to ensure semantic interoperability, which is a crucial factor in facilitating collaborative use.
Objective:
This study aimed to evaluate the real-world utility and applicability of standardized terminology systems by mapping clinical terms from routine cancer care and to propose guidelines that optimize mapping.
Methods:
Clinical terms generated during cancer care at the National Cancer Center Korea were extracted and mapped to multiple target terminology systems: the Korean Standard Classification of Diseases (KCD); International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM); Logical Observation Identifiers Names and Codes (LOINC); RxNorm; Anatomical Therapeutic Chemical classification (ATC); and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT). Healthcare information managers, data experts, and oncologists cross-verified the mapping outcomes, calculated concordance, and compared the coverage across systems.
Results:
A total of 3,565 source terms were identified across seven domains: chief complaint, diagnosis, laboratory test, imaging test, surgery/procedure, medication, and radiation therapy. With post-coordination and predefined mapping guidelines, SNOMED CT achieved at least 89.9% exact semantic match across domains, exceeding 90% in most domains, while inter-mapper discordance remained low (0.3–1.3%). RxNorm and LOINC showed complementary strengths within their specialized domains, adding detail or specificity where SNOMED CT was less complete.
Conclusions:
Standardized terminology systems are feasible and effective in encoding clinical terms for cancer care. SNOMED CT was the most comprehensive, and predefined mapping guidelines markedly reduced discrepancies among mappers. Domain-specific systems should be used alongside SNOMED CT, and all systems should be updated regularly to reflect evolving clinical practice.
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