Ambiguous Terminology: Should SEER's lists of ambiguous terminology be modified to reflect how pathologists and radiologists actually use these terms? See discussion.
Pathologists and radiologists say the term "suggestive" is used to describe a lesion that may be malignant, and the term "suspicious" is not used to describe lesions that may be malignant. According to the physician director of our Breast Center the FDA governs the use of terminology, and the term "highly suggestive" instead of "highly suspicious" must be used if there is a greater chance that a mass is malignant.
We recognize that the way clinicians and registrars speak is often different, and that the differences vary from region to region.
Our Medical Advisory Board reviewed the lists of ambiguous terminology before they were included in the third edition of the SEER EOD and the SEER Program Coding and Staging Manual 2004. Since that time, specific terminology has been mandated for describing mammography results. We know some of these terms are discrepant with our ambiguous terminology list.
As of 2007, the standard setters (CoC, NPCR, SEER and CCCR) all use the same ambiguous terminology list. Changes to the list must be approved by the NAACCR Uniform Data Standards Committee.
EOD-Clinical Extension/EOD-Lymph Nodes--Prostate: How do you code clinical extension and lymph nodes for path only prostate cases treated with a TURP? Would clinical extension be coded to unknown or localized, NOS?
For cases diagnosed 1998-2003: Code the EOD-Clinical Extension field to 30 [localized, NOS] and the EOD-Lymph Nodes field to 0 [no lymph node involvement]. Per Note 7: Use code 30 when there is insufficient information as to whether the tumor is clinically apparent or inapparent but the tumor is confined to the prostate. This is an example of a case where there is insufficient information as to whether the tumor is clinically apparent or inapparent. Assume the tumor is confined to the prostate.
EOD-Extension--Ovary: What code is used to represent this field for an ovarian primary presenting with "spread to the omentum"?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 75 [Peritoneal implants, NOS] because the size of the implants on the omentum is not known.
Note 6 was added to the EOD scheme which states that both direct extension and discontinuous metastasis to the omentum are coded in the range 70-75 depending on how the peritoneal implants are described.
Histology (Pre-2007)/Grade, Differentiation--Brain and CNS: What code is used to represent the histology and grade for "WHO-II astrocytoma, grade II" of the brain when the WHO-II classification is different from the classification systems previously used? See discussion.
According to the WHO-I classification system, this is a moderately anaplastic astrocytoma. According to the Duke criteria, this is an astrocytoma. By Dauma-Dupont criteria, this is a grade 2 astrocytoma.
For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 9401/34 [anaplastic astrocytoma].
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.
EOD-Extension--Lung: If a CT scan indicates that a patient has evidence of "long-standing pneumonia," is that synonymous with "pneumonitis" for the purposes of coding extension for lung primaries?
No. These terms are not synonymous. For cases diagnosed 1998-2003, disregard the pneumonia and use the other available information to code extension.
Surgery of Primary Site--Ovary: What code is used to represent this field when a patient has a history of a previous organ removal and has additional surgery/organ removal for a present cancer (e.g., History of a 1984 hysterectomy and in 2003 has ovarian primary treated with BSO)?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 52 [Bilateral salpingo-oophorectomy WITH hysterectomy].
Multiple Primaries (Pre-2007)--Breast: When a breast cancer is treated with less than a total mastectomy and more than 2 months later a tumor of the same histology is diagnosed in the same breast with no statement of "recurrence," is this a new primary?
For tumors diagnosed prior to 2007:
Count as 2 primaries when a subsequent malignant breast tumor is diagnosed more than 2 months later unless stated to be a recurrence. For cases diagnosed after 1/1/94, an in situ followed by an invasive breast cancer is counted as two primaries even if stated to be a recurrence.
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.
EOD-Extension--Lung: Should the phrase "some pleural fluid in both posterior gutters" be interpreted as pleural effusion for lung primaries? See discussion.
CT scan: "3 cm mass left upper lobe of lung. Some pleural fluid in both posterior gutters. Large matted hilar lymph nodes, left. Some narrowing left upper bronchus by this adenopathy. Squamous cell ca lung with mets to left hilar lymph nodes, most likely possibility." Would you code extension to 72 [malignant pleural effusion; pleural effusion, NOS]?
For cases diagnosed 1998-2003:
Yes. Code the EOD-Extension field to 72 [malignant pleural effusion, pleural effusion, NOS]. Pleural effusion is mentioned as being present.
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