| Report | Question ID | Question | Discussion | Answer | Year |
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20031076 | EOD-Size of Primary Tumor--Prostate: Is this field coded to the size of a hypoechoic mass identified on a TRUS when there is no tumor size from the prostatectomy specimen? | For cases diagnosed 1998-2003: Ultrasound measurement of a malignancy can be used to code EOD-Size of Primary Tumor. Information on tumor size taken from imaging/radiographic techniques has low priority, just above physical examination. | 2003 | |
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20031007 | EOD Extension--Lung: Do we ignore pericardial effusion seen on a CXR if a subsequent lobectomy reveals only a localized tumor? See discussion. | Note 6 in the lung EOD scheme instructs us to assume that a pleural effusion is negative if a resection is done. Does this also apply to a pericardial effusion? For example, if a pericardial effusion is seen on CXR, and a subsequent lobectomy reveals only a localized tumor, should the effusion be ignored? | For cases diagnosed 1998-2003: Ignore pericardial effusion which is negative for tumor. Assume that a pericardial effusion is negative if a resection is done and the tumor is pathologically confirmed to be localized. | 2003 |
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20031091 | EOD-Pathologic Extension--Prostate/Lymphoma: How is this field coded for a prostatic lymphoma? | For cases diagnosed 1998-2003: Do not code the prostate pathologic extent of disease field for prostatic lymphoma. Leave the path extension for prostate field blank. Code the extent of disease using the lymphoma scheme. Use ONLY the lymphoma scheme - do NOT try to code both lymphoma and prostate extension fields for prostatic lymphoma. | 2003 | |
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20031165 | Behavior Code/EOD-Extension--Colon: Are extension codes 10 [Mucosa, NOS (incl. Intramucosal, NOS)] and 11 [Lamina propria] in situ, in accordance with AJCC stage for this site? |
For cases diagnosed 1998-2003: EOD codes 10 and 11 are invasive. SEER, to be compatible with Summary Stage 77 and 2000, calls EOD extension codes 10 and 11 invasive because invasion of the lamina propria is invasion through the lamina propria/basement membrane and therefore invasive. According to AJCC, the survivial rates for tumors that invade only the mucosa or lamina propria are similar to Tis tumors, so the AJCC classifies them as Tis. |
2003 | |
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20031152 | Ambiguous Terminology/Histology (Pre-2007): How do we code histology when there is a difference between the histology mentioned on a suspicious cytology and the clinical diagnosis by the treating physician? See Description. | An FNA of pancreas is stated as "highly atypical cells present, suspicious for pancreatic ductal carcinoma." The attending physician states the patient has pancreatic carcinoma. Can histology be coded 8500/3 [infiltrating duct carcinoma, NOS] or should it be 8010/3 [carcinoma, NOS]? | For tumors diagnosed prior to 2007:
Code the histology from a suspicious cytology when this histology is supported by the clinical diagnosis. Code the example above to 8010/3 [Carcinoma, NOS].
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. |
2003 |
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20031012 | EOD-Lymph Nodes/Extension: How does one code these fields if the clinical level of disease extension prior to neoadjuvant treatment is greater than demonstrated on pathology at time of resection? See discussion. | Breast case described clinically as a "breast mass and nodal metastases" which is treated with neoadjuvant chemotherapy and at surgery the lymph nodes are pathologically negative. | For cases diagnosed 1998-2003:
Use the combination of clinical and pathologic information to code EOD for primary site, extension and lymph nodes. Code the more extensive disease. If lymph nodes are positive clinically and not positive after neoadjuvant treatment, code lymph node involvement. If lymph nodes are negative clinically and positive on path, code lymph node involvement. When neoadjuvant treatment is administered because of a clinical statement of stage or involvement, code EOD based on this clinical information, even if later pathologic information would lead to a lesser EOD. General guideline number 6 (page 1 of SEER EOD-88 3rd ed.) points out that clinical information must be considered when coding EOD. However, do not code EOD based on clinical information disproved by pathologic findings in the absence of intervening treatment. The scenario above: The clinical involvement of the nodes justifies the neoadjuvant chemotherapy. Therefore, code EOD based on the clinical lymph node involvement. |
2003 |
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20031034 | Histology (Pre-2007)--Kidney, renal pelvis: What codes are used to represent the histologies of 1) "renal papillary (chromophil) carcinoma" and 2) "chromophil renal cell carcinoma?" |
For tumors diagnosed prior to 2007: Code "chromophil" to 8260 [papillary renal cell]. According to our pathologist consultant, in the case of chromophil, most authors regard this as more or less synonymous with papillary renal cell [8260]. "More or less" because papillary is an old term descriptive of the microscopic structure, while chromophil is newer and based on the cytology; because most of the latter are papillary the current usage assumes them to be equivalent. 1) The diagnosis "renal papillary (chromophil) carcinoma" tells us that the pathologist who wrote it was seeing both pattern and cytologic features, and is regarding papillary equivalent to chromophil; thus, code to 8260. 2) Code "chromophil renal cell carcinoma" to 8260. 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. |
2003 | |
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20031001 | EOD-Extension/EOD-Lymph Nodes--Cervix: How do you code these fields when the cancer extended to the pelvic wall and there are periaortic LN metastases? | For cases diagnosed 1998-2003: Assign extension code 65 for contiguous (direct) extension of tumor from the cervix to the pelvic wall. Assign extension code 85 only if the pelvic wall is involved with discontinuous extension from the cervix; i.e., the cervical tumor spread indirectly (through lymph or vascular channels) to the pelvic wall. Code the pelvic wall involvement in the Extension field and the periaortic lymph node involvement in the Lymph Node field. When the computer does the algorithm, it will look at the periaortic lymph nodes and report the summary stage as distant and the TNM stage group as IV because periarotic nodes are M1. Do not code the periaortic lymph nodes in both fields. This is stage IV, distant disease, due to the periaortic lymph node involvement (EOD lymph nodes code 6). |
2003 | |
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20031176 | EOD-Patholgic Review of Number of Regional Lymph Nodes Examined: How is this field coded when there is no lymph node count in the final pathology diagnosis and the gross description states "four possible lymph nodes are dissected"? See Description. | Patient with kidney cancer underwent nephrectomy and lymph node removal. Final path diagnosis was Lymph nodes, pericaval biopsy, lymph nodes with no evidence of carcinoma. Per Gross description: Received in formalin as pericaval lymph node is 2.5 cm piece of fibrofatty tissue, from which four possible lymph nodes are dissected. | For cases diagnosed 1998-2003: Code the number of regional lymph nodes examined as 04. This is as accurate as possible for this situation. | 2003 |
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20031116 | EOD-Size of Primary Tumor: Can the term "filling defect" be used to code tumor size? See Description. |
Site: Bladder CT abd/pelvis: 4 cm filling defect of the bladder encasing jetstream of distal ureter. 2-3 cm lesion may be extension to bladder. KUB: 3-4 cm filling defect within bladder. Cystoscopy: large bladder tumor with small tumor extending out of the large tumor. OP Findings: Large tumor on right of bladder extending from bladder neck lateral and posterior Pathology: TURB: High grade TCC, Grade III with focal lamina propria invasion. |
For tumors diagnosed 1998-2003:
Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, just above a physical exam. The term "filling defect" from a CT or KUB may be used to code tumor size for bladder in the absence of more reliable size information from path, operative or endoscopic reports. |
2003 |
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