Reportability: When a hospital pathologist sends the slides from an original biopsy to two or more outside reviewers and the reviewers differ on whether or not the case is reportable, is the case SEER reportable? Does the decision to treat the patient have any bearing on whether the case would be reportable?
Typically, the final diagnosis of the reviewing pathologist is the one used to determine whether the case is SEER reportable. If two or more reviewing pathologists disagree as to whether the case should be reportable, determine reportability based on the following priority order:
1) If the patient is treated for cancer, the case is reportable.
2) If the patient is not treated for cancer, use the amended diagnosis on the original pathology report if the hospital pathologist used the reviewing pathologists' opinions in establishing his new diagnosis.
3) If there is not an amended diagnosis for the original hospital pathology report, use the clinician's opinion regarding what the diagnosis is to determine whether the case is reportable.
First Course Treatment: What code is used to represent each treatment modality field when there is no indication that a particular modality of treatment was recommended or started?
Code the individual treatment fields to 0 or 00 [None] when the modality is not addressed in the treatment plan (or when a treatment plan is lacking) and there is no indication that a particular modality of treatment was recommended or started.
EOD-Extension--Lymphoma: What code is used to represent this field for a lymphoma that involves the spleen and lymph nodes above the diaphragm (e.g., involvement of only the spleen below the diaphragm and cervical lymph nodes above the diaphragm)?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 32 [30 + involvement of the spleen; III S]. The spleen is counted twice (once as the spleen and a second time as a lymph node region below the diaphragm). As a result, the EOD-Extension field is coded to reflect involvement of lymph node regions on both sides of the diaphragm plus involvement of the spleen. See Note 1 on the EOD scheme that states "Any lymphatic structure is to be coded the same as a lymph node region."
Histology (Pre-2007)/Behavior Code/Sequence Number-Central -- Ovary: How are these fields coded for a "serous tumor of low malignant potential" when lymph nodes are discovered to be involved?
For tumors diagnosed 2001-2006:
This ovarian tumor is not SEER reportable if diagnosed between 2001-2006. The histology and behavior codes are 8442/1 [serous cystadenoma, borderline malignancy]. Sequence is coded appropriately from 60-88 [non-malignant tumor or central registry-defined neoplasm].
The behavior code could be changed to /3 only when the pathologist states that the disease is malignant. Approximately 20% of serous tumors of low malignant potential have lymph node involvement, according to the WHO Classification of Ovarian Tumours. In ovarian serous tumors of low malignant potential, lymph node involvement is not always equivalent to metastasis and does not signify malignancy in these tumors unless definitely stated as such by the pathologist.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Diagnostic Confirmation--Prostate: How do we code this field when there is an elevated PSA, no other work-up and there is a clinical diagnosis of adenocarcinoma?
Code the Diagnostic Confirmation field to 5 [positive laboratory test/marker study] to indicate the diagnosis is based upon an abnormal PSA tumor marker if the physician uses the PSA as a basis for diagnosing prostate cancer.
Behavior--Breast: How is behavior coded when a biopsy shows in situ carcinoma with a focus suspicious for invasion and a subsequent excision/resection shows only in situ carcinoma?
Code this case as in situ. The specimen from the excision/resection is the more reliable source for determining behavior, compared to a biopsy, especially in this case where the behavior is ambiguous on the biopsy.
Grade, Differentiation--Prostate: Has SEER officially changed the conversion code for Gleason score 7 to grade 3 [poorly differentiated] for cases diagnosed in 2003 or later?
For prostate cases diagnosed in 2003 and forward: convert Gleason score 7 to grade 3 [poorly differentiated].
Other Therapy/Immunotherapy--Hematopoietic, NOS: How should erythropoietin be coded for leukemia or other hematopoietic diseases?
Do not code Erythropoietin as treatment, it is used as an ancillary drug for leukemias or other hematopoietic diseases. Record information about erythropoietin in the text field.
Terminology: Do focus, focal, foci and chips mean the same thing?
Focus, focal, and foci are variations of the same word. Focus (noun) describes an area or point of disease, either grossly or microscopically. Focal (adjective) relates to the area/focus of disease; an example is a prostate with focal adenocarcinoma. This means that the majority of the prostate is benign and the adenocarcinoma is confined to one small area/point. Foci (plural) describe more than one area/focus of disease. A prostate with foci of adenocarcinoma means the disease is multifocal (several areas/points of disease).
Chips are microscopic amounts of either tissue or tumor. A pathologist might examine several chips of prostate tissue, one of which contains a focus of adenocarcinoma.
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