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20210030 | Primary site--Breast: Patient was diagnosed with invasive ductal carcinoma of the left breast. Site of mass is 2:00 to 3:00. What is the correct site code, C504 upper outer quadrant (UOQ) or C50.8 (overlapping)? |
Assign C504, UOQ, for a left breast primary mass at 2:00 to 3:00. See the illustration in the SEER Coding Guidelines for breast, https://seer.cancer.gov/manuals/2021/AppendixC/Coding_Guidelines_Breast_2021.pdf |
2021 | |
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20210001 | SEER*RSA/Required data items--Melanoma: The site-specific data item, Ulceration, states it is required by "All" in SEER*RSA but in the NAACCR Data Dictionary table it states is it required by SEER, Commission on Cancer (CoC), and Canadian Cancer Registry (CCCR), not the National Program of Cancer Registries (NPCR). Does the definition of "All" in SEER*RSA not include NPCR? Also, please explain the difference between Required by: "All" and "Required by CCCR/Canada, COC, NPCR, SEER" (all listed out). |
Use the NAACCR Data Dictionary Required Status Table or refer to standard setter requirements. Do not use SEER*RSA to determine which data items are required to be collected or transmitted. Though "All" in SEER*RSA generally refers to the standard setters including CoC, NPCR, CCCR, and SEER, some items in SEER*RSA need updating; this is planned for 2022. |
2021 | |
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20210061 | First course treatment/Update to current manual: Should the instruction regarding expectant management in the 2021 (and 2022) SEER Manual include how to code for the patient’s decision to proceed with expectant management? See Discussion. |
Currently, First Course Therapy instruction for expectant management (also referred to as active surveillance, watchful waiting, etc.) instructs one to code 0 or 00 (not done) for all data items when the physician opts for expectant management. We find that the treatment decisions can be driven by the patient, physician, or combination of both patient and physician depending on the options presented. |
Instructions for First Course of Therapy include using the documented first course of therapy (treatment plan) from the medical record. While a patient may weigh in on the treatment decision, the physician is responsible for developing and managing the treatment plan including closely watching a patient’s condition but not giving treatment unless symptoms appear or change. We can add language to a future manual to clarify. |
2021 |
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20210066 | 2021 SEER Manual/Surgery of Primary Site--Lung: What is the correct surgery code for a left upper lobe (LUL) wedge resection (confirming adenocarcinoma) followed by a lingular-sparing LUL lobectomy and mediastinal lymph node dissection? Is the correct Surgery Code 22 since the lingula was not resected (not the whole LUL Lung)? Or should the appropriate surgery code be 33 (this surgery suffices to code to a lobectomy with the mediastinal lymph node dissection)? |
Assign code 22 for LUL wedge resection followed by a lingular-sparing LUL lobectomy and mediastinal lymph node dissection. Code the lymph node surgery in Scope of Regional Lymph Node Surgery. We obtained input from an expert who agrees with this code. He states a lingula-sparing lobectomy is best coded as a segmentectomy because it is the same as an apical trisegmentectomy. |
2021 | |
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20210056 | 2018 Solid Tumor Rules/Multiple Primaries--Breast: How many primaries should be reported when a left breast simple mastectomy identifies focal Paget disease of the nipple and 12 axillary nodes positive for metastatic lobular carcinoma (no primary lobular breast tumor identified)? |
Abstract two primaries, one lobular carcinoma (8520/3) and another one Paget disease of the breast (8540/3) using the 2018 Breast Solid Tumor Rules, Rule M9: Abstract multiple primaries when the diagnosis is Paget disease with underlying tumor which is NOT duct. Example: Paget disease of the nipple with underlying lobular carcinoma are multiple primaries. Additionally, Table 2, Histology Combination Codes, Note 2 states: Lobular carcinoma and Paget are separate primaries (see Lobular carcinoma and any histology in Table 3 with exception of duct carcinoma/carcinoma NST/DCIS (and subtypes/variants) 8500 and Paget disease, in situ and invasive). While not identified in the pathology of the mastectomy, the lobular carcinoma is likely underlying as it was identified in the axillary lymph nodes. The 2021 SEER Manual states: If the only pathologic specimen is from a metastatic site, code the appropriate histology code and the malignant behavior code (/3). The primary site and its metastatic site(s) have the same histology. |
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20210014 | Solid Tumor Rules (2018, 2021)/Multiple Primaries--Lung: How many primaries should be reported for a 4/2019 diagnosis of left upper lobe (LUL) adenosquamous carcinoma (left lingula mass biopsy: adenosquamous carcinoma; LUL lung biopsy: pulmonary adenocarcinoma, stated to be a collision tumor and single primary per the Tumor Board), treated with radiation followed by an enlarging LUL mass in 7/2020 found to be squamous cell carcinoma? See Discussion. |
The physician stated the prior LUL adenosquamous carcinoma was PD-L1 negative and the LUL squamous cell carcinoma is PD-L1 positive and is calling it a new primary. 5/22-7/3/19 6000x30 IMRT Photons LUL lung Chemo refused Not a Surg candidate 10/01/2019 CT Chest: IMP: In comparison to CT chest 03/06/2019 and PET/CT 03/21/2019, left lingular mass has mildly decreased in size. Left apical anterior and posterior lung lesions more anterior lesion appears slightly increased in size, the other slight decreased in size, with adjacent areas of atelectasis and scarring. 06/23/2020 CT Chest: MP: In comparison to CT chest 10/1/2019, left lingular mass has increased in size concerning for increasing tumor with adjacent thicker focal pleural thickening involving the chest wall, concerning for possible chest wall invasion. Left apical anterior and posterior lung lesions appears more solid in appearance, representing known adeno CA, given that the appearance has changed, is concerning for residual tumor. 07/06/2020 PET: Hypermetabolic lingular mass and peripheral nodularity has increased in size and FDG avidity on the prior PET/CT. Left apical nodular opacity is difficult to separate from fairly uniform mild left apical pleural hypermetabolism which may be treatment related and/or neoplastic. |
Abstract two primaries: 8560 and 8140 using rule M6. One of the original tumors with adenosquamous now shows only residual SCC following XRT. PD-L-1 is not used to determine multiple primaries. Assuming three tumors (the post-XRT SCC is not a new tumor but residual from one of the adenosquamous tumors) there are two primaries: 8560 and 8140 per M6. For collision tumors, each histology identified in the tumor is used to determine multiple primaries. |
2021 |
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20210033 | Reportability--Liver: Is a diagnosis of Liver Imaging Reporting and Data System (LI-RADS)-Treatment Response (LR-TR) viable nodule seen on imaging and treated with Y-90 radiotherapy reportable? See Discussion. |
Patient was initially diagnosed in 2017 with LR-5 lesions in segments 3 and 7 of liver and treated with radiofrequency ablation (RFA). Routine scans in 2019 show no evidence of residual or recurrent disease. Surveillance imaging in 2020 identifies LR-TR viable segment 3 treatment zone with slowly growing arterially-enhancing nodule as well as increasing arterial enhancement in the neighboring parenchyma. No new LR-4 or LR-5 observations. Patient is not a surgical candidate but is treated with Y-90 radiotherapy. Per Rule M10, tumors diagnosed more than 1 year apart are multiple primaries. However, there is no clear clinical statement of malignancy in this case. |
Do not report LR-TR viable as a new primary. LR-TR viable is a component of the Li-RADS Treatment Response algorithm designed to assess response for path-proven or presumed (e.g., LR-4, LR-5, LR-M) malignancy after locoregional treatment for hepatocellular cancer. LR-TR viable indicates it met the criteria as a viable tumor. |
2021 |
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20210035 | Update to current manual/Lymphovacular invasion--Thyroid: Are psammoma bodies only recorded as vascular invasion in papillary thyroid cancer cases? See Discussion. |
For example, total thyroidectomy specimen shows right lobe papillary thyroid carcinoma, 4.2 cm, unencapsulated, with numerous psammoma bodies in non-tumoral thyroid parenchyma, without angioinvasion; left lobe with papillary thyroid carcinoma, 0.6 cm, encapsulated, with capsular invasion, with intralymphatic psammoma bodies in non-tumoral thyroid parenchyma, without angioinvasion. The synoptic summary documents vascular invasion present (psammoma bodies only). |
If you are collecting lymphovascular invasion (LVI) for thyroid cases, record "vascular invasion present (psammoma bodies only)" as vascular invasion (code 1, Lymphovascular Invasion Present/Identified) in the LVI data item. Use a text field to specify that this is vascular invasion by psammoma bodies. |
2021 |
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20210041 | Reportability/Behavior--Paraganglia: Is a 2021+ diagnosis of paraganglioma reportable if the grading of adrenal pheochromocytoma and paraganglioma (GAPP) score falls outside the stated requirements for malignancy? See Discussion. |
Patient was diagnosed with a retroperitoneal paraganglioma on April 2021 mass resection. Final diagnosis included the comment: Based on the modified grading of adrenal pheochromocytoma and paraganglioma (GAPP), the GAPP score is 1. Scores greater than or equal to 3 are malignant. We are aware that paraganglioma is classified as malignant for cases diagnosed in 2021+, however it is unclear how the pathologist's interpretation of the GAPP score may affect the behavior of this case. |
Report retroperitoneal paraganglioma based on ICD-O-3.2 histology/behavior that lists paraganglioma, NOS as 8680/3 for cases diagnosed 2021 and forward. While GAPP is a predictor of metastatic potential, it does not factor into behavior, thus reportability. |
2021 |
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20210038 | Update to current manual/First course treatment--Neoadjuvant treatment: How are the 2021 neoadjuvant therapy fields coded when neoadjuvant therapy and surgery were part of first course plans but treatment was never completed. See Discussion. |
Example: Breast case where first course treatment plan is neoadjuvant therapy and surgery after. The patient was hospitalized during neoadjuvant therapy, elected hospice, and later died, so the neoadjuvant therapy was never completed, surgery not done. How are the 2021 neoadjuvant therapy fields coded in this situation as neoadjuvant therapy and surgery were part of first course plans. I coded neoadjuvant therapy to 2 - started but not completed, but there are no codes to properly explain the clinical response and therapy treatment effect as the patient did not complete neoadjuvant therapy. Should I use code 9 for clinical response and treatment effect or should this be left blank for this particular case? |
Assign code 8 for Neoadjuvant Therapy--Clinical Response in this case. We will update the SEER manual to allow code 2, in addition to code 1, in Neoadjuvant therapy when Clinical Response is coded 8. We will also add instructions covering a case such as this one. Assign code 7 for Neoadjuvant Therapy--Treatment Effect and use text fields to record the details. We will add instructions to the manual for this scenario. |
2021 |
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