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20150027 | Date of diagnosis--Diagnostic confirmation: How are the diagnosis date and diagnostic confirmation coded when the pathology (needle biopsy followed by resection) reports GIST, NOS and the physician subsequently states this is a malignant GIST and treats the patient for a malignancy? See Discussion. |
Pathologists rarely diagnose a GIST as a malignant tumor. Per the AJCC, GISTs encompass a continuum in terms of biologic potential, with larger more mitotically active tumors landing on the "histologically sarcomatous" or malignant end of the spectrum. Because the pathologists generally do not categorize these tumors as benign or malignant, the judgement is typically made by the clinician in light of all the clinical and pathologic findings. Unless there are obvious distant metastases, the clinician usually decides whether a GIST is malignant and treats the patient as such.
In the case above, the patient underwent a gastric biopsy on 04/10/2014 that showed GIST. The subsequent resection on 04/12/2014 showed a 4.5 cm GIST, spindle cell type with 6 mitoses/5 square mm. The resection pathology report does not indicate the GIST is malignant, but does identify a large tumor with mitotic activity. After reviewing the evidence in this case, the clinician calls this a malignant GIST on 04/29/2014 and starts the patient on Gleevec.
Although neither the biopsy nor the resection call this a malignant tumor, should the date the GIST was first diagnosed (biopsy on 04/10/2014) be used to code the diagnosis date, since this is the date the tumor (ultimately felt to be malignant) was diagnosed? If the diagnosis date is coded as the date malignant GIST was first mentioned (04/29/2014), this would exclude surgery as treatment for this tumor.
Would this be a histologic diagnosis because the tumor was histologically confirmed to be GIST? Or must this be a clinical diagnosis because the diagnosis of malignancy was only made clinically (by the clinician's review of the clinical and pathologic findings)? |
Code the diagnosis date for this case as 04/10/2014. Code the diagnostic confirmation as histologically confirmed. The clinician is using all of the information available to determine the diagnosis, including the biopsy and resection. |
2015 |
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20180037 | Date of Diagnosis--Colon: If a patient has a positive Cologuard test, is the date of diagnosis the date of the cologuard test or the date of the biopsy? |
Do not use the date of a positive Cologuard test as the date of diagnosis. |
2018 | |
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20200032 | Date of Diagnosis--Brain and CNS: How is the Date of Diagnosis coded when an MRI clinically diagnoses a borderline brain tumor on 4/4/2020, but the subsequent biopsy pathologically diagnoses a malignant brain tumor on 5/20/2020? See Discussion. |
Clinically, the patient was felt to have a pineocytoma (borderline tumor) on imaging, but the subsequent biopsy proved a pineal germinoma (malignant tumor). The Date of Diagnosis instructions state to code the month, day and year the tumor was first diagnosed, clinically or microscopically, by a recognized medical practitioner, but it does not indicate whether differences in behavior alter the diagnosis date. For brain and central nervous system tumors, should the diagnosis date be the first date a tumor is SEER reportable? Or should the diagnosis date for those tumors ultimately proven to be malignant, be the date the malignancy was diagnosed? |
This tumor was first diagnosed on 4/4/2020 according to the information provided. The pineocytoma was reportable based on a behavior of /1; it was later confirmed as a pineal germinoma; update both the histology and behavior on the abstract as better information was obtained, retaining the original date of diagnosis. |
2020 |
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20071044 | Date of Conclusive Terminology: Is there an applicable timeframe when coding this field? |
There is no strict timeframe for Date of Conclusive Terminology. The diagnosis using conclusive terminology could be made any time following the diagnostic work-up. The date of conclusive terminology is related to code 2 [ambiguous term followed by conclusive term] in the data item "Ambiguous terminology." Assign code 2 when a conclusive diagnosis is made 60 days or more after a diagnosis using ambiguous terminology. Record the date of the conclusive diagnosis in "Date of Conclusive Terminology." |
2007 | |
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20071058 | CS Tumor Size: Is a measured "area" equivalent to a tumor, mass or lesion size? See Discussion. |
Collaborative Stage manual, page 26 Rule 4a: "always code size of the primary tumor, not size of the polyp, ulcer, cyst or distant metastasis." Rule 4e: Additional rule for breast primaries: Example: Duct carcinoma in situ covering a 1.9 cm area with focal areas of invasive ductal carcinoma. Record the tumor size as 1.9 cm. |
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.In general, a measured area is not equivalent to a tumor size. Do not apply the rule related to the breast example to other primary sites. This example in the CS manual pertains to coding tumor size for breast primaries when the size of the invasive component is not stated. In the example, the area involved with duct carcinoma in situ is the only measurement available. The size of the invasive component was not given. |
2007 |
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20081001 | CS Tumor Size: Can an 'ulcerated mass' be used to code CS tumor size? See Discussion.
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The CS Manual (p. 26, 4.a.) states do not code the size of the polyp, ulcer or cyst. However it states that a 'cystic mass' can be used to code TS if it is the only size given. Scopes Text: 'ulcerated' mass based at anal verge & ext 3-4 cm up into rectum. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Do not code CS Tumor size using the size of an ulcerated mass.
Answer from:
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2008 |
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20041046 | CS Tumor Size--Breast: When the diagnosis is inflammatory carcinoma of the breast, must the CS tumor size always be 998? See Discussion. |
I have no specific example of a situation; I am writing an edit check and wondering if there would be any exceptions to this rule. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.No. For inflammatory carcinoma, code the size of the tumor in CS tumor size. Use code 998 [diffuse] when the tumor is stated to be "diffuse." Page 27 in Part I of the CS manual will be corrected to define code 998 for breast as only "diffuse." The errata should be distributed in July 2004. |
2004 |
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20051066 | CS Site Specific Factor--Prostate: Explain the difference among SSF4 prostate codes 150 [No clinical involvement of prostatic apex & prostatectomy apex extension unknown], 510 [Clinical involvement of prostatic apex unknown & No prostatectomy apex extension], and 550 [Clinical involvement of prostatic apex unknown & prostatectomy apex extension unknown]. |
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Site Specific Factor 4 captures the status of clinical apex involvement and prostatectomy apex involvement. The first digit in codes 110-550 indicates the clinical status of apex involvement. The second digit indicates apex involvement found at prostatectomy. The third digit is always zero. For both first and second digits, the codes and definitions are the same: 1 - No involvement of prostatic apex 2 - Into prostatic apex/arising in prostatic apex, NOS 3 - Arising into prostatic apex 4 - Extension into prostatic apex 5 - Apex extension unknown Code 150 = No clinical involvement of prostatic apex & prostatectomy apex extension unknown Code 510 = Clinical involvement of prostatic apex unknown & No prostatectomy apex extension Code 550 = Clinical involvement of prostatic apex unknown & prostatectomy apex extension unknown |
2005 | |
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20061058 | CS Site Specific Factor--Prostate: Can autopsy results also be used when coding SSF3, pathologic extension, given that the instructions only address the use of prostatectomy findings when coding this field? |
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. If the prostate cancer was diagnosed on autopsy, or the autopsy was performed within the staging timeframe (See 2004 SEER Manual, page 112), code SSF3 using the autopsy information. |
2006 | |
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20170010 | CS Site Specific Factor--Breast: What estrogen receptor/progesterone receptor (ER/PR) values should be coded in a case with two separate tumors (1 ductal, 1 lobular) diagnosed simultaneously in the same breast (single primary) with differing ER/PR values for each tumor? One is ER/PR positive; the other is ER/PR negative. |
In cases where ER (or PR) is reported on more than one tumor specimen, record the highest value. If any sample is positive, record as positive. Guidance on Collaborative Stage (CS) site-specific factors (SSFs) in the breast schema can be found in the SEER Registrar Staging Assistant (SEER*RSA): SSF1-Estrogen Receptor (ER) Assay and SSF2-Progesterone Receptor (PR) Assay. The SEER* RSA breast schema is found at: https://staging.seer.cancer.gov/cs/schema/02.05.50/breast/?breadcrumbs=(~schema_list~) |
2017 |
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