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Report Produced: 08/26/2025 18:08 PM

Report Question ID Question Discussion Answer Year
20190046

Tumor Size/Bladder: The 2018 SEER Coding and Staging Manual says to use imaging over physical exam as priority for determining tumor size. If a bladder tumor is 4 cm visualized on cystoscopy, and is 2.8 cm on CT scan, which should be used as the clinical size? Is cystoscopy (endoscopy) a clinical exam or imaging?

For the case described here, use the size from the CT scan. Physical exam includes what can be seen by a clinician either directly or through a scope. A tumor size obtained visually via cystoscopy is part of a physical exam. Therefore, the imaging (CT) tumor size is preferred. Use text fields to describe the details.

 2019
20190059

Solid Tumor Rules/Histology--Lung: What is the histology code and what H Rule applies for a diagnosis of well differentiated adenocarcinoma in situ (bronchioloalveolar carcinoma)? See Discussion.

There is no statement of mucinous or non-mucinous in this case, only adenocarcinoma in situ and an obsolete term bronchioloalveolar carcinoma (BAC) which used to be code 8250. However 8250 is now lepidic adenocarcinoma, and does not match this diagnosis.

Although the Histology Rules do include a general note indicating that the preferred term for BAC is now mucinous adenocarcinoma 8253, it is not listed as a synonym in Table 3. As a result it is unclear how to apply this statement in accordance with the H rules.

The ICD-O Histology Updates table also includes Bronchiolo-alveolar carcinoma, non-mucinous which seems to suggest that in order to apply histology code 8252 (non-mucinous) or 8253 (mucinous) one must also have a statement of mucinous or non-mucinous.

Code adenocarcinoma in situ as 8140/2 using the 2018 Lung Solid Tumor Rules, Rule H4 as this single histology is listed as a synonym for adenocarcinoma (8140) in Table 3 . Bronchiolalveolar carcinoma, a synonym for adenocarcinoma in situ, is an obsolete term according to WHO Classification of Tumors of the Lung, Pleura, Thymus and Heart, 4th edition; however, some pathologists add in the no longer preferred term to the diagnosis. When stated as non-mucinous adenocarcinoma in situ, code as 8250/2 for lung only (Rule H2) and mucinous adenocarcinoma in situ as 8253/2 (Rule H1).

Note: WHO published a corrected 4th Ed Lung blue book fixing the 8410 error.

 2019
20190074

First course treatment/Scope of Reg LN Surgery--Breast: How is Scope of Regional Lymph Node Surgery coded when there is a sentinel lymph node biopsy (SLNBx) and intra-mammary nodes removed for a single primary? See Discussion.

Example: Operative report documents a left breast skin sparing mastectomy and sentinel node biopsy procedure. Pathology report lists left axillary sentinel nodes in specimen A) with 0/2 nodes positive, and left breast mastectomy without axilla in specimen B) yielding an additional 0/2 intramammary nodes positive. Would the Scope of Regional Node Surgery be coded as 2 (SLN biopsy) to capture the intent of the sentinel node procedure only, or 6 (code 2 + 4) to capture the actual type and number of nodes removed?

SEER Coding and Staging Manual includes Scope of Regional Lymph Node Surgery instruction 4.b. which mentions assigning code 4 to intra-organ node removal. Similarly, there is instruction for coding SLN biopsy as code 2 and SLN biopsy with axillary dissection at the same time (code 6) or during separate procedures (code 7). However, it is not clear this combination code is how we should also capture an incidental intra-organ node removal.

Revised answer 07/11/2023

Assign code 6, Sentinel node biopsy and code 3, 4, or 5 at same time or timing not noted. There were two sentinel lymph nodes removed (code 2) plus two intramammary nodes removed in a separate specimen from the mastectomy (code 4). Assign code 6 when nodes are removed from a sentinel lymph node procedure at the same time as removal of intra-organ lymph nodes which were not part of the sentinel lymph node procedure.

 2019
20190092

First course Treatment/Lymph Nodes: When a Sentinel Lymph Node (SLN) biopsy ONLY is performed and SLNs are negative, are the SLNs included still counted in Regional Nodes (RNs) Examined and RNs Positive, or are the fields filled in: RLN Examined: 00 (No nodes examined) RLN Positive: 98 (No nodes examined) Date RLN Dissection: 00/00/0000 (No RLN dissection performed) or are the SLN included in the RLN Examined/Positive field but the Date RLN Dissection is 00/00/0000? See Discussion.

According to the 2018 SEER Manual, Sentinel Lymph Nodes (SLNs) Examined and SLNs Positive are included in Regional Nodes (RNs) Examined and RNs Positive when both a sentinel node biopsy procedure and a subsequent dissection procedure are performed or a sentinel node biopsy procedure is performed during the same procedure as the regional node dissection.

If a SLN biopsy is performed but no RLN dissection is performed, assign as follows.

Date of Regional Lymph Node Dissection: Leave blank as this field records the date non-sentinel regional node dissection was performed.

Date of Regional Lymph Node Dissection Flag: Assign code 11 (Not applicable: No proper value is applicable in this context (for example, no regional lymph node dissection was performed; autopsy only cases).

Regional Nodes Examined: Indicate the number of SLNs examined as this is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment.

Regional Nodes Positive: Indicate the number of SLNs positive as this is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment.

 2019
20190004

Systemic/Surgery Sequence: Does the Systemic/Surgery Sequence field apply to only the first surgery performed (Date of First Surgical Procedure) or does it apply to the most definitive surgery (Date Most Definitive Surgery) as well? See Discussion.

Example: Bladder primary with transurethral resection of the bladder tumor (TURBT) on 2/17/2017 (Date of First Surgical Proc) followed by a second TURBT on 3/24/2017 (Date Most Definitive Surgery) with mitomycin C instilled on the second, most definitive TURB procedure.

There is an edit failure (IFX166) when Systemic/Surgery Sequence is coded 5 (intra-operative systemic) and Systemic Date does not match Date of First Surgical Procedure. How should we capture the intra-operative systemic treatment during the second, most definitive TURB? Is the correct Surgery/Systemic Sequence code 3 (systemic after surgery) for this case because (intra-operative) chemo was technically given after the first surgery?

Assign code 3 to Systemic/Surgery Sequence and document the intraoperative treatment in the text field. Surgery is defined as a Surgical Procedure to the Primary Site (codes 10-90), Scope of RLN Surgery (codes 1-7), or Surgical Procedure of Other Site (codes 1-5) in the 2018 SEER Manual. In this case, the treatment was after the first surgical procedure.

 2019
20190065

Update to current manual/EOD 2018/Summary Stage 2018--CLL/SLL: Can chronic lymphocytic leukemia (CLL) be staged when diagnosed by peripheral blood and no bone marrow biopsy, and observation is employed? See Discussion.

The physicians do not use the Lugano system as we are instructed to stage chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) as lymphomas. I had always been instructed that this qualifies as "bone marrow involvement," or "diffuse disease," and therefore is a Stage IV. Our experts advise that there is not enough information to code it to bone marrow, but do not elaborate as to whether you can actually code Extent of Disease (EOD), SEER Summary Stage, and AJCC Staging?

For EOD and Summary Stage: Peripheral blood involvement for CLL (or any lymphoma-but most commonly for CLL) can be coded. This is code 800 for 2018 EOD Primary Tumor, and code 7 for Summary Stage 2018. We have recently received confirmation that peripheral blood involvement only is not enough information to assign AJCC stage; assign code 99 for AJCC Stage Group. We will correct in the 2021 release of EOD so that peripheral blood involvement only will have its own code to derive the appropriate AJCC TNM Stage Group (99).

 2019
20190075

Sex: How should the sex field be coded for the newly allowable non-binary gender designation ? See Discussion.

Washington State added to birth certificates, which allows people to have their certificates changed to this non-binary gender designation. Gender X is defined as a gender that is not exclusively male or female, including, but not limited to: intersex, agender, amalgagender, androgynous, bigender, demigender, female-to-male, genderfluid, genderqueer, male-to-female, neutrois, nonbinary, pangender, third sex, transgender, transsexual, Two Spirit, and unspecified.

Code Gender X as 9 when that is the only information available. Use text fields to document the details.

Also refer to coding instruction #7.

When gender is not known

Assign code 1 when the primary site is C600 'C639

Assign code 2 when the primary site is C510 'C589

Assign code 9 for primary sites not included above

 2019
20190067

Reportability/Histology--Breast: Is a breast mastectomy showing mildly atypical cells within the nipple epidermis which are suspicious for Paget disease of the nipple a reportable malignancy? See Discussion.

Example: Left breast total mastectomy final diagnosis is incidental microscopic findings suspicious for early Paget disease of the nipple. The diagnosis comment states: The left breast mastectomy shows mildly atypical cells within the nipple epidermis which are suspicious for early Paget disease of the nipple. Additional sampling of the left breast was performed, and no evidence of atypical hyperplasia, in situ carcinoma, or invasive carcinoma within the left breast tissue was identified.

Would this case be non-reportable using rationale similar to an early/evolving melanoma per SINQ 20180029?

Code as 8540/3, Paget disease, based on the use of reportable ambiguous terminology (suspicious) listed in the 2018 SEER Coding Manual. In addition, Rule H8 of the 2018 Breast Solid Tumor Rules says to code Paget disease (8540/3) when the diagnosis is exactly Paget disease when a new tumor with no underlying tumor and the pathology documents invasive or unknown behavior.

When two ambiguous terms are used and one is on the reportable list (suspicious) and one is not (early), accept the reportable term and report the case. See #1.b.ii on page 12 in the SEER manual, https://seer.cancer.gov/manuals/2018/SPCSM_2018_maindoc.pdf

 2019
20190082

Primary site/Histology--Peritoneum: What is the correct primary site code for peritoneal mesothelioma in a female? When I use C482, it seems that the fields are all geared towards primary peritoneal carcinoma with FIGO staging, etc.

For mesothelioma, NOS (9050) and epithelioid mesothelioma (9052) of the peritoneum for females, assign C481, C482, or C488 as appropriate based on the site of origin in the medical documentation. The Primary Peritoneal Ca schema is assigned and you will need to complete the SSDIs for FIGO staging, CA-125 PreTx Interpretation, and Residual Tumor Volume Post Cytoreduction.

If the histology is 9051 or 9053 with primary site of C481, C482, or C488 for females, the Retroperitoneum schema is assigned. The only SSDI for this schema is Bone Invasion.

 2019
20190048

Reportability/Histology--Skin: Is malignant hidroacanthoma simplex of the scalp reportable? If so, what is the histology?

Malignant hidroacanthoma simplex of the scalp is reportable. Malignant hidroacanthoma simplex is a synonym for porocarcinoma, 8409/3.

 2019