{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T08:49:51Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 26.4, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094cd-d45c-7372-a9e6-a03be477bc5e\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: congenital cystic adenomatoid malformation\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 100", "usd": 0.0, "recall": true }, "codex": { "seconds": 79.4, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a094cd-d44e-76c2-9626-adadc56ca0d3\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: congenital cystic adenomatoid malformation\nRegistry id: vr.tr.congenital-cystic-adenomatoid-malformation\nPlane / domain: XCT / XCT.STA\nRegistry defin" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:15:11+00:00", "fields": [ "agent_conduct", "ethics", "failure_modes_and_hazards", "owners" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:29+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q246040", "registryId": "vr.tr.congenital-cystic-adenomatoid-malformation", "name": "congenital cystic adenomatoid malformation", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q246040/", "model": { "registry_id": "vr.tr.congenital-cystic-adenomatoid-malformation", "name": "congenital cystic adenomatoid malformation", "purpose": "Enable an agent to recognise congenital cystic adenomatoid malformation, assess lesion-specific evidence and clinical state, and support accountable specialist evaluation and follow-up.", "definition": "Congenital cystic adenomatoid malformation (CCAM), now generally termed congenital pulmonary airway malformation (CPAM), is a developmental lung malformation characterized by abnormal airway structures that form cystic or solid-appearing lesions and replace normally developed lung tissue.", "scope_statement": "This model owns the identity, diagnostic uncertainty, pulmonary anatomy, developmental course and management decision context of congenital cystic adenomatoid malformation under vr.tr.congenital-cystic-adenomatoid-malformation, retaining XCT / XCT.STA as registry metadata; contemporary clinical terminology commonly calls it congenital pulmonary airway malformation (CPAM). [CHOP terminology](https://www.chop.edu/centers-programs/center-fetal-diagnosis-and-treatment/physician-toolkit-managing-fetal-lung-lesions)", "in_scope": [ "Historical CCAM terminology, contemporary CPAM terminology and evidence supporting their mapping in individual records.", "Suspected or confirmed lesions, including anatomical extent, cyst morphology and vascular relationships.", "Prenatal lesion measurements, growth trajectory and associated fetal compromise.", "Postnatal diagnostic confirmation, respiratory manifestations and lesion-associated complications.", "Specialist decisions about observation, intervention and continuing surveillance." ], "out_of_scope": [ "General fetal development and normal pulmonary anatomy.", "Independent models of bronchopulmonary sequestration, bronchogenic cyst and congenital diaphragmatic hernia.", "Pleuropulmonary blastoma classification, staging and cancer treatment.", "General management of neonatal respiratory failure or pneumonia.", "Technical execution of fetal procedures, anaesthesia and lung resection." ], "distinguishing_features": [ "Assess whether imaging demonstrates malformed intrapulmonary cystic or microcystic tissue, rather than identifying every fetal thoracic mass as CCAM.", "Document arterial supply and airway relationships when distinguishing an isolated airway malformation from sequestration or a hybrid lesion; retain uncertainty when vascular anatomy is incomplete.", "Check diaphragmatic continuity and the identity of thoracic contents when distinguishing a pulmonary lesion from congenital diaphragmatic hernia.", "Separate imaging morphology from tissue diagnosis: a cyst-size category alone must not establish a histopathological subtype.", "Do not treat a cystic appearance as proof of benign developmental disease: type I pleuropulmonary blastoma can resemble developmental lung cysts and may require expert pathology review. [NCI diagnostic boundary](https://www.cancer.gov/types/lung/hp/child-pleuropulmonary-blastoma-treatment-pdq)" ], "characteristics": [ { "name": "Diagnostic certainty", "kind": "state", "unit_or_values": "suspected; imaging-supported; histologically confirmed; disputed; reclassified", "why_it_matters": "Prevents a prenatal working diagnosis from silently becoming a definitive tissue diagnosis." }, { "name": "Observation age", "kind": "measurement", "unit_or_values": "gestational weeks and days, or postnatal age, with observation date", "why_it_matters": "Makes lesion measurements and clinical changes interpretable across birth." }, { "name": "Pulmonary distribution", "kind": "relation", "unit_or_values": "affected lung, lobe or lobes and relation to adjacent structures", "why_it_matters": "Connects imaging, operative observations and pathology to the same lesion." }, { "name": "Cyst morphology", "kind": "category", "unit_or_values": "macrocystic; microcystic; mixed; indeterminate, with the reporting convention", "why_it_matters": "Preserves the observed phenotype without substituting it for histological classification." }, { "name": "Lesion and dominant cyst dimensions", "kind": "measurement", "unit_or_values": "three lesion dimensions and maximum dominant cyst diameter in mm, with modality and date", "why_it_matters": "Supports reproducible comparison of total lesion burden and individual cyst expansion." }, { "name": "Prenatal lesion volume ratio", "kind": "measurement", "unit_or_values": "reported CVR with calculation convention, input units, head circumference and gestational age", "why_it_matters": "Records lesion size relative to fetal head circumference while preserving the basis for comparison. [CHOP CVR description](https://www.chop.edu/conditions-diseases/congenital-cystic-adenomatoid-malformation-ccam)" }, { "name": "Vascular anatomy", "kind": "relation", "unit_or_values": "documented arterial origin and venous drainage; unresolved vessels explicitly identified", "why_it_matters": "Supports assessment for a sequestration component and planning of specialist procedures." }, { "name": "Histopathological classification", "kind": "category", "unit_or_values": "reported classification system and subtype; unclassified; tissue unavailable", "why_it_matters": "Keeps classification tied to the specimen, report and scheme actually used." }, { "name": "Lesion-associated compromise", "kind": "state", "unit_or_values": "dated assessment of hydrops, mediastinal displacement, respiratory symptoms, infection and pneumothorax; absent, present or unknown for each", "why_it_matters": "Distinguishes anatomical burden from observed physiological consequences." }, { "name": "Management status", "kind": "state", "unit_or_values": "under evaluation; surveillance; intervention planned; intervention completed; residual lesion; follow-up incomplete", "why_it_matters": "Identifies the current decision, responsible team and outstanding evidence." } ], "affordances": [ "Reconcile CCAM and CPAM labels while preserving the original diagnosis and its evidential basis.", "Compare serial prenatal measurements using compatible methods and identify changes needing specialist review.", "Prepare a lesion-specific differential review from imaging, vascular anatomy and pathology.", "Assemble a fetal-to-neonatal handover covering lesion location, diagnostic uncertainty and anticipated care needs.", "Record the evidence, alternatives and clinician responsibility behind observation or intervention.", "Track postnatal confirmation, specimen results and surveillance obligations through changes in diagnosis." ], "agent_conduct": { "may": [ "Explain the condition in general terms, citing medical sources.", "Help clinicians find records and guidance they are authorized to access.", "Point families to support and specialist services." ], "must_not": [ "Diagnose or rule out the condition in a specific fetus or child.", "Advise on pregnancy decisions or surgery.", "Share a family's prenatal or medical records without consent.", "Present prognosis figures as certain for an individual case." ], "requires_human": [ "Telling families about a diagnosis.", "Any decision about delivery, surgery or follow-up." ] }, "ethics": { "considerations": [ "Prenatal findings create hard choices for families who need accurate, compassionate information.", "Many cases have good outcomes; overstating risk causes needless distress." ], "affected_parties": [ "Children and fetuses", "Parents", "Clinicians" ] }, "owners": { "steward": "The treating clinicians; the family holds the right to the child's health information.", "master_systems": [ "Patient health records", "Congenital anomaly registers" ] }, "failure_modes_and_hazards": [ "Breathing difficulty in newborns with large lesions.", "Repeated chest infections if untreated." ], "what_it_is_for": [ "This condition is encountered in prenatal imaging, neonatal assessment and investigations of respiratory symptoms or recurrent lung infection.", "The term supports communication among imaging, paediatric, surgical and pathology specialists about abnormal lung development and lesion-specific findings." ], "standards_and_regulation": [ "The International Classification of Diseases, Tenth Revision, issued by the World Health Organization, includes congenital cystic lung under category Q33.0." ], "visual_identification": [ "Imaging may show multiple air-filled or fluid-filled cystic spaces grouped within a lung region.", "Some lesions appear predominantly solid on prenatal ultrasound because their cysts are too small to resolve individually.", "Larger lesions may compress adjacent lung and displace central chest structures, although these features are not specific to this condition.", "Overlapping appearances with other congenital lung lesions mean visual findings alone do not establish the diagnosis." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q246040: congenital cystic adenomatoid malformation", "url": "https://www.wikidata.org/wiki/Q246040", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Congenital pulmonary airway malformation", "url": "https://en.wikipedia.org/wiki/Congenital_pulmonary_airway_malformation", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "diagnostic-identity", "name": "Diagnostic identity", "description": "Establish what the CCAM label means in this record and how strongly the lesion has been identified.", "rationale": "Historical terminology and provisional prenatal diagnoses can conceal different levels of diagnostic certainty.", "layers": [ { "id": "terminology-and-evidence", "name": "Terminology and evidence", "description": "Connect the recorded name to the clinician's intended concept and supporting observations.", "findings": [ { "id": "ccam-cpam-mapping", "name": "CCAM CPAM mapping", "description": "Retain the original term and document whether its use corresponds to contemporary CPAM terminology, including any unresolved scope difference.", "questions": [ { "text": "What anatomical abnormality does the author mean by CCAM or CPAM in this record?", "kind": "definition", "id": "ccam-cpam-mapping-q01" }, { "text": "Which dated imaging interpretation or pathology report supports the diagnosis, and who issued it?", "kind": "provenance", "id": "ccam-cpam-mapping-q02" } ] } ] }, { "id": "competing-lesion-identities", "name": "Competing lesion identities", "description": "Make alternative diagnoses and reasons for retaining or excluding them explicit.", "findings": [ { "id": "differential-resolution", "name": "Differential resolution", "description": "Maintain a case-specific differential covering sequestration, hybrid lesions, other congenital thoracic abnormalities and relevant cystic neoplasms.", "questions": [ { "text": "Which observations favour CCAM over sequestration, a bronchogenic cyst, lobar overinflation or diaphragmatic hernia?", "kind": "boundary", "id": "differential-resolution-q01" }, { "text": "What unresolved imaging, tissue or family-history findings require specialist review for pleuropulmonary blastoma?", "kind": "action", "id": "differential-resolution-q02" } ] } ] } ] }, { "id": "lesion-anatomy-and-classification", "name": "Lesion anatomy and classification", "description": "Describe the pulmonary lesion in terms that remain traceable across imaging, surgery and pathology.", "rationale": "Location, cyst architecture and vascular connections affect both diagnostic interpretation and procedural planning.", "layers": [ { "id": "pulmonary-and-vascular-map", "name": "Pulmonary and vascular map", "description": "Locate the lesion and establish its relationships to functioning lung, vessels and adjacent structures.", "findings": [ { "id": "extent-and-connections", "name": "Extent and connections", "description": "Record affected lobes, lesion boundaries, arterial supply, venous drainage and any demonstrated airway relationship.", "questions": [ { "text": "Which lobes are involved, and what are the lesion dimensions on the latest adequately documented study?", "kind": "measurement", "id": "extent-and-connections-q01" }, { "text": "Does demonstrated systemic arterial supply support a sequestration component, and what vascular anatomy remains unresolved?", "kind": "boundary", "id": "extent-and-connections-q02" } ] } ] }, { "id": "imaging-and-tissue-phenotype", "name": "Imaging and tissue phenotype", "description": "Keep visible cyst morphology distinct from classification based on sampled tissue.", "findings": [ { "id": "phenotype-classification-concordance", "name": "Phenotype classification concordance", "description": "Record the imaging category and any histological subtype independently, with their methods and disagreements.", "questions": [ { "text": "What cyst-size convention and measurements support the reported macrocystic, microcystic or mixed appearance?", "kind": "measurement", "id": "phenotype-classification-concordance-q01" }, { "text": "Which specimen and pathology report establish the subtype, and does that interpretation agree with the imaging diagnosis?", "kind": "provenance", "id": "phenotype-classification-concordance-q02" } ] } ] } ] }, { "id": "prenatal-course-and-birth-transition", "name": "Prenatal course and birth transition", "description": "Track fetal lesion behaviour and the evidence needed to plan assessment around delivery.", "rationale": "A single prenatal image cannot represent the lesion's trajectory or the infant's eventual respiratory state.", "layers": [ { "id": "serial-fetal-assessment", "name": "Serial fetal assessment", "description": "Compare dated lesion measurements alongside documented effects on the fetus.", "findings": [ { "id": "growth-and-fetal-compromise", "name": "Growth and fetal compromise", "description": "Record lesion growth, reported CVR, dominant cyst behaviour and assessments of hydrops or thoracic compression without assigning an unsupported universal intervention threshold.", "questions": [ { "text": "How have lesion dimensions and CVR changed with gestational age, and are the measurement methods comparable?", "kind": "measurement", "id": "growth-and-fetal-compromise-q01" }, { "text": "What evidence of hydrops or worsening compression has the fetal team documented, and what review does its protocol require?", "kind": "action", "id": "growth-and-fetal-compromise-q02" } ] } ] }, { "id": "delivery-and-neonatal-reassessment", "name": "Delivery and neonatal reassessment", "description": "Carry prenatal uncertainty and lesion-specific concerns into neonatal evaluation.", "findings": [ { "id": "birth-handover-and-confirmation", "name": "Birth handover and confirmation", "description": "Connect the delivery plan, initial respiratory assessment and planned postnatal lesion characterisation.", "questions": [ { "text": "What delivery setting and neonatal assessment have the responsible teams selected from the fetal findings?", "kind": "action", "id": "birth-handover-and-confirmation-q01" }, { "text": "If the lesion becomes less visible prenatally, what postnatal evidence is required before recording anatomical resolution?", "kind": "boundary", "id": "birth-handover-and-confirmation-q02" } ] } ] } ] }, { "id": "postnatal-decisions-and-outcomes", "name": "Postnatal decisions and outcomes", "description": "Relate symptoms and diagnostic confidence to specialist decisions and subsequent lesion status.", "rationale": "The model must support explicit decisions for both symptomatic and incidentally identified lesions while preserving uncertainty about observation and elective treatment.", "layers": [ { "id": "clinical-burden-and-treatment-choice", "name": "Clinical burden and treatment choice", "description": "Separate symptoms attributed to the lesion from coincidental illness and document the management rationale.", "findings": [ { "id": "observation-or-intervention", "name": "Observation or intervention", "description": "Record respiratory burden, infection history, pneumothorax and diagnostic concerns alongside the specialist's assessment of observation and intervention.", "questions": [ { "text": "Which respiratory symptoms or complications are attributed to this lesion, and what evidence supports that attribution?", "kind": "boundary", "id": "observation-or-intervention-q01" }, { "text": "Why was surveillance or intervention selected, and which changes would trigger reconsideration?", "kind": "action", "id": "observation-or-intervention-q02" } ] } ] }, { "id": "residual-lesion-and-follow-up", "name": "Residual lesion and follow-up", "description": "Reconcile treatment results, final diagnosis and the continuing need for assessment.", "findings": [ { "id": "anatomical-and-diagnostic-outcome", "name": "Anatomical and diagnostic outcome", "description": "Track residual abnormalities, pathology-driven reclassification and follow-up responsibility after either observation or treatment.", "questions": [ { "text": "What imaging, operative or pathology evidence establishes persistent, removed or reclassified lesion status?", "kind": "provenance", "id": "anatomical-and-diagnostic-outcome-q01" }, { "text": "Who owns the next review, what will it assess, and what criteria justify continuing or ending surveillance?", "kind": "action", "id": "anatomical-and-diagnostic-outcome-q02" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is recalled knowledge, not a source-verified account; confirm coding against the applicable ICD edition and national modification.", "Stocker categories are histopathological and cannot be assigned reliably from prenatal cyst size alone.", "The boundaries of types 0 and 4, malignancy risk estimates and management of asymptomatic lesions require specialist source review." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of congenital cystic adenomatoid malformation this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Stocker type 0: rare malformation resembling proximal tracheobronchial airways", "Stocker type 1: predominantly large cysts with bronchial or bronchiolar differentiation", "Stocker type 2: multiple smaller cysts resembling bronchioles", "Stocker type 3: predominantly solid-appearing lesion composed of microscopic airway spaces", "Stocker type 4: peripheral, thin-walled cysts with distal acinar differentiation" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of congenital cystic adenomatoid malformation this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10", "value_or_pattern": "Q33.0", "note": "WHO category for congenital cystic lung; broader than CCAM/CPAM alone." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of congenital cystic adenomatoid malformation this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Prenatal diagnosis supports surveillance of lesion growth, fetal hydrops and compression of adjacent structures.", "Assessment helps plan delivery location and neonatal respiratory support.", "Postnatal imaging characterizes the lesion and its blood supply.", "Histopathological examination classifies resected lesions and evaluates alternative diagnoses." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of congenital cystic adenomatoid malformation this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "CPAM volume ratio (CVR)", "typical_range": "No single normal range; used to assess fetal lesion burden and hydrops risk.", "unit": "cm² when estimated lesion volume in cm³ is divided by fetal head circumference in cm; commonly reported without a unit" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of congenital cystic adenomatoid malformation this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Large fetal lesions can cause mediastinal displacement, impaired venous return and hydrops.", "Compression of developing lung can contribute to pulmonary hypoplasia and neonatal respiratory distress.", "Persistent lesions may become infected.", "Cyst rupture can cause pneumothorax.", "Some lesions have associated neoplastic concerns, and cystic pleuropulmonary blastoma can be mistaken for CPAM." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of congenital cystic adenomatoid malformation this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Congenital pulmonary airway malformation", "difference": "This is the modern, broader terminology for substantially the same diagnostic family; CCAM emphasizes cystic and adenomatoid features that are not present in every subtype." }, { "name": "Bronchopulmonary sequestration", "difference": "Sequestration is defined by abnormal lung tissue with systemic arterial supply and typically no normal airway connection; hybrid lesions can combine sequestration and CPAM features." }, { "name": "Bronchogenic cyst", "difference": "Usually a discrete foregut-derived cyst with bronchial wall elements, rather than a region of malformed pulmonary airways." }, { "name": "Congenital lobar overinflation", "difference": "The affected lobe is overexpanded by air trapping rather than replaced by a cystic airway malformation." }, { "name": "Pleuropulmonary blastoma", "difference": "A neoplasm that can initially be purely cystic; imaging overlap may require pathological and genetic evaluation to distinguish it from CPAM." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of congenital cystic adenomatoid malformation this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Does the registry intend historical CCAM to encompass the full contemporary CPAM category, and does an existing world model already own that concept?", "Which imaging morphology and histopathological classification conventions should this model adopt, including how it should represent disputed subtype boundaries?", "Which prenatal measurements, trajectories and fetal findings support intervention decisions across gestational ages and treatment centres?", "For asymptomatic postnatal lesions, what comparative evidence supports surveillance versus elective resection, and what follow-up duration is justified?", "Which findings should prompt expert pathology review or DICER1 evaluation, and how should the model distinguish initial misclassification as CPAM from evidence of subsequent neoplastic change?" ], "statistics": { "bundles": 5, "layers": 9, "findings": 15, "questions": 23 } }