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Patient was diagnosed March 2024 with high grade dysplasia of the gallbladder during excision for clinical history of acute cholecystitis and obstruction.

Per the STR, Table 10 for Gallbladder and Extrahepatic Bile Duct Histologies shows Biliary intraepithelial neoplasia, high grade as code 8148/2. High grade glandular intraepithelial neoplasia of the biliary tract is also code 8148/2.

Recent SINQ 20240021 (GI specific) indicates high grade dysplasia is reportable as high grade glandular intraepithelial neoplasia (8148/2) for stomach, small intestine, and esophagus. Does the same hold true for gallbladder? If so, then it appears there is a conflict between STR and Appendix E2.

However, using the logic of SINQ 20240021 for this site would appear to contradict Appendix E2 which indicates high grade dysplasia in sites other than stomach, intestine, and esophageal sites is not reportable.

If we can code high grade dysplasia of GI sites to 8148/2, should we accession high grade dysplasia of the gallbladder and other biliary sites in a similar manner? If so, then Appendix E needs to be modified.

SEER Program Coding and Staging Manual: Reportability – Reportable Diagnosis List indicates pancreatic intraepithelial neoplasia (PanIN II) (C250-C259) is reportable.

However, the ICD-O-3.2 lists “Glandular intraepithelial neoplasia, grade II” and “Glandular intraepithelial neoplasia, low grade” as histology code 8148 with behavior of /0 (benign).

A 17 year old exchange student was brought into the hospital with appendicitis.  The patient had an appendectomy; there was no follow up treatment.  5/27/2006 pathology report of vermiform appendix:  Adenocarcinoid appendix <5 mm tumor limited to appendix.

The patient has no record in Lexis Nexus and no social security number.  The address is a post office box; additionally, the patient’s birthplace is Switzerland and is lost to follow up.

Example: Lung resection final diagnosis is Lung adenocarcinoma, see Summary Cancer Data, and the Summary Cancer Data (CAP Synoptic Report) states Histologic type: Invasive adenocarcinoma, solid predominant. Other Subtypes Present: 20% acinar and <5% micropapillary components.

Instruction 1B and Note 1 for Coding Multiple Histologies (Lung Histology Rules) indicates type, subtype, component, and predominantly are all terms that may be used to code the most specific histology. In this case, the multiple specific histologies were documented using all of those terms.

Note 2 for instruction 1B states predominantly describes the greatest amount of tumor and when it is used for the listed subtypes of adenocarcinoma, that subtype should be coded. However, Note 2 does not indicate that the other subtypes are ignored when one is identified to be predominant and the others are identified as subtype or component only.

Now that there are specific surgery codes for shave and punch biopsies, are these biopsies always the Date of First Surgical Procedure (NAACCR Item #1200)? Or should we still be applying the Surgery of Primary Site 2023 instruction in the SEER Manual that states shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed?

Example: On 01/01/2023, patient has a frontal scalp shave biopsy showing melanoma, margins involved. On 02/01/2023, frontal scalp excision shows residual melanoma. Surgery code is assigned B520 (shave followed by wide excision). How is Date of First Surgical Procedure coded now that there is an additional surgery code for the shave biopsy?

Now that there are specific surgery codes for shave and punch biopsies, are these biopsies always the Date of First Surgical Procedure (NAACCR Item #1200)? Or should we still be applying the Surgery of Primary Site 2023 instruction in the SEER Manual that states shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed?

We are aware of the instruction for melanoma cases outlined in SINQ 20230034; however, it is unclear if this should also apply to cutaneous lymphomas and Kaposi sarcomas, or if the intent of the procedure is used for these specific types of skin cases that typically present with multifocal involvement.

Example 1: Patient is diagnosed March 2023 with primary cutaneous T-cell lymphoma presenting as pink, tan patches on the trunk. Punch biopsy diagnosed CTCL and treatment was given via narrow band UVB phototherapy.

Example 2: Patient is diagnosed February 2023 with Kaposi sarcoma presenting as widespread violaceous macules, papules, plaques on the torso, bilateral extremities, and abdomen. Punch biopsy diagnosed Kaposi sarcoma.

1) Is the operative report only used for margins when the wide excision states no residual disease and no margins are stated on path report? Or do you use the operative report too for margins when the wide excision has residual melanoma and margins are negative but distance is not stated on path report? Does it matter if there was residual melanoma on the wide excision or not as far as using the operative report for margins?

2) Do these rules only apply to melanoma cases or do they also apply to Merkel cell?

3) Did CoC and SEER both agree on this? Are they going to send out an update because this is not how I interpret what is in the STORE manual/SEER manual under the surgery codes. It might be good to send out an official update to the surgical coding rules if this is how we are to code now.

Example 4:  Esophageal biopsy with diagnosis of “focal areas suspicious for adenocarcinoma in situ.” Diagnosis on partial esophagectomy specimen “with foci of high grade dysplasia; no invasive carcinoma identified.” Do not accession the case. The esophagectomy proved that the suspicious biopsy result was false.

Appendix E2 #32 of the SEER Manual states high grade dysplasia in site other than stomach, small intestines, and esophageal primary sites are not reportable. Does this mean high grade dysplasia is reportable for esophagus primaries?