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20250009 | Sequence Number--Central/Reportability--Heme & Lymphoid Neoplasms: Is a hematolymphoid disease included in the sequencing if it was not reportable at the time of diagnosis? |
Do not include the disease in the sequencing if the original hematolymphoid disease was not reportable at time of diagnosis.
The 2025 SEER Manual Sequence Number--Central Coding Instruction 1.a advises: A ‘reportable’ primary refers to the site/histology/behavior of the tumor and the years when reporting was required. Review of the reportability requirements in effect during the diagnosis year will be needed. |
2025 | |
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20250012 | Solid Tumor Rules/Histology--Lung: How is histology coded and which H Rule applies for a lung adenocarcinoma when the greatest percentage of the adenocarcinoma is stated to be, "solid; complex glands (cribriform and fused glands) (50%)"? See Discussion. |
In 01/2023, right lower lobectomy final diagnosis proved a single adenocarcinoma tumor with the histological patterns described as acinar (20%), papillary (30%) and solid; complex glands (cribriform and fused glands) (50%). There is no H Rule applicable to a complex glandular pattern adenocarcinoma. Is this equivalent to a solid predominant adenocarcinoma (8230) per Rule H7? Or is the predominant adenocarcinoma a mixed subtype coded as 8255 per Rule H9? |
Histology code 8255/3 best identifies this histology. Complex glands in lung tumors are often associated with a poor prognosis and represent a high-grade pattern in lung cancer grading systems. This histology is not currently recognized as a variant by WHO. |
2025 |
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20250011 | Reportability--Liver: Is a 2023 cholangiocarcinoma case with Liver Imaging Reporting And Data System (LI-RADS) M (LR-M) lesion on imaging reportable? |
Report LR-M unless there is information to the contrary. The American College of Radiology defines LR-M as "probably or definitely malignant, not necessarily hepatocellular carcinoma (HCC)." |
2025 | |
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20250008 | Diagnostic Confirmation--Heme & Lymphoid Neoplasms: How is Diagnostic Confirmation coded for hematopoietic and lymphoid neoplasms (heme) when immunophenotyping, genetics, etc. confirm the diagnosis. |
Assign Code 3 (Positive histology PLUS positive immunophenotyping or genetic testing) for 1. Cases with positive histology for the neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis), AND
2. A not otherwise specified (NOS) histology diagnosed and not a provisional diagnosis, AND genetic/immunophenotyping was performed and positive Refer to the current version of the Heme Manual for specific notes and examples when coding Diagnostic Confirmation. |
2025 | |
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20250019 | SEER Manual/Tumor Size Summary--Breast: Can the size of a non-mass enhancement (NME) be used if it represents the largest size within the appropriate time frame to code tumor size summary when neoadjuvant therapy is administered? Clinical and pathologic tumor sizes are no longer collected for 2024 and 2025 cases. See Discussion. |
In the SEER Program Coding and Staging Manual 2023, under clinical tumor size (page 115, item #12), it states: “For breast tumors, clinical size may be recorded based on the size of a non-mass enhancement (NME). NME is defined as an enhancing abnormality that is not associated with the three-dimensional volume of a mass, shape, and outlining, and it is separate from Background Parenchymal Enhancement (BPE).” This guidance does not appear to have been carried forward into the Tumor Size Summary coding instructions. |
Do not use the NME size from magnetic resonance imaging (MRI) to code tumor size when both tumor size and NME size are stated or if NME is the only size available. The size of the solid tumor mass takes priority over the size of the NME when provided separately and the NME is larger. The American College of Radiology, Breast Imaging Reporting and Data System (BI-RADS) defines NME as an area of enhancement on MRI that does not belong to a 3D mass or have distinct features of a mass. It is a separate descriptor from size that includes modifiers describing enhancement patterns with a specific MRI pattern. |
2025 |
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20250020 | Solid Tumor Rules/Histology--Vulva: Can instructions and descriptions from registry manuals be used to determine p16 status for the human papillomavirus (HPV)-related histology codes in the Solid Tumor Rules (STR)? Does it have to state that p16 is “positive” or “over-expressed” only? See Discussion. |
The STR states that p16 can be used to code HPV-associated and HPV-independent histologies for selected sites depending on diagnosis year but contains no instructions about how to interpret p16 staining results on pathology reports. These are often stated in various ways in our area, depending on the pathology lab and different pathologists. The SSDI Manual and SEER Coding and Staging Manual each have some instructions and code definitions for p16, including: - Code 0 for p16 expression of weak intensity or limited distribution - Code 0: p16 Negative; Nonreactive - Code 1: p16 Positive; Diffuse, Strong reactivity - IHC for p16 expression is a surrogate marker for HPV infection Example: 2023 squamous cell carcinoma of the vulva, partial vulvectomy; pathology states vulvar intraepithelial neoplasia-3, p16 immunohistochemistry demonstrates block-like expression, which supports the diagnosis. The next path report states invasive squamous cell carcinoma, stain for p16 is strong and diffuse in the lesion, supporting the above diagnosis. Neither path report specifically states "HPV-related," so are p16 "expression" and "strong and diffuse" staining enough to code the histology as 8085/3 for this case? |
Refer to the College of American Pathologists (CAP) protocols to determine how to interpret p16 staining results on pathology reports. Per the Vulva CAP Protocol, p16 positive is defined as diffuse or block-like expression. Since the pathology report states "block-like expression," code the histology as 8085/3 (invasive squamous cell carcinoma, HPV-associated). |
2025 |
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20250030 | First Course of Therapy/Hormone Therapy--Meningioma: Should Sandostatin be coded as treatment for a Grade 1 meningioma? Patient had surgery and was somatostatin receptor 2 (SSTR2) positive by immunohistochemistry. |
Code Sandostatin (octreotide acetate) as hormonal therapy when given including: · SSTR 2 positive meningioma (NCCN, 2025: smaller studies support the use of targeted therapy including somatostatin) · Neuroendocrine tumor (NET) (NCCN, 2025: Tumor control: antitumor effect is supported by studies for well-differentiated G1/G2 gastro-entero-pancreatic NET. In lung/thymic NET, somatostatin analogues may be considered if metastatic or SSTR positive). The SEER*Rx entry for Octreotide Acetate was updated as studies showed somatostatin analogs may shrink tumors or inhibit further growth. |
2025 | |
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20250017 | SEER Manual/First Course Therapy--Neoadjuvant Therapy: How is Neoadjuvant Therapy--Treatment Effect coded for bladder cancers? The College of American Pathologists (CAP) Protocol for the Examination of Cystectomy Specimens From Patients With Carcinoma of the Urinary Bladder does not provide a clear distinction between the SEER site-specific codes for Neoadjuvant Therapy Treatment Effect for All Other Schemas, codes 2, 3, and 4, as compared to the CAP Treatment Effect Post Neoadjuvant Chemotherapy (BCG not included) categories. See Discussion. |
CAP Protocol for the Examination of Cystectomy Specimens From Patients With Carcinoma of the Urinary Bladder/Treatment Effect Post Neoadjuvant Chemotherapy (BCG not included) selections o No known presurgical neoadjuvant therapy o Complete response: Absence of histologically identifiable residual cancer cells and extensive fibrosis of the tumor bed after presurgical neoadjuvant therapy (TRG1) o Strong response: Predominant fibrosis of the tumor bed, with residual cancer cells occupying less than 50% of this area (TRG2) o Weak or no response: Residual cancer cells occupying ≥50% of the tumor bed or absence of regressive changes (TRG3) o Other (specify): _________________ SEER Coding Instruction for Site-Specific Codes for Neoadjuvant Therapy Treatment Effect - Schemas: All Other Schemas selections 0 Neoadjuvant therapy not given/no known presurgical therapy 1 Complete pathological response Present: No viable cancer cells/no residual invasive carcinoma identified Residual in situ carcinoma only 2 Near complete pathological response Present: Single cells or rare small groups of invasive cancer cells 3 Partial or minimal pathological response Present: Residual invasive cancer with evident tumor regression, but more than single cells or rare small groups of cancer cells 4 Poor or no pathological response Absent: Extensive residual cancer with no evident tumor regression 6 Neoadjuvant therapy completed and surgical resection performed, response not documented or unknown Cannot be determined 7 Neoadjuvant therapy completed and planned surgical resection not performed 9 Unknown if neoadjuvant therapy performed Unknown if planned surgical procedure performed after completion of neoadjuvant therapy
Death Certificate only (DCO) |
Code Neoadjuvant Therapy--Treatment Effect using the surgical pathology report only. Carefully review the pathology report gross description and comments to assist with assignment of codes. Review of neoadjuvant therapy data items is currently underway. |
2025 |
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20250010 | Immunotherapy/Other Therapy--Heme & Lymphoid Neoplasms: Is the elimination of immunosuppression treatment coded as other treatment? An example is when a post-transplant patient develops a malignant myeloproliferative neoplasm that subsides when immunosuppression drugs are stopped. |
Do not code as a treatment. Record the cessation of immunosuppressive drug treatment in text to explain the patient’s change in disease status. |
2025 | |
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20250013 | Solid Tumor Rules/Multiple Primaries--Testis: How many primaries and what M Rule applies when metastatic seminoma is diagnosed greater than 40 years after a left testicular teratoma with yolk sac tumor and embryonal carcinoma? See Discussion. |
The patient was diagnosed with a left testis primary in the early 1980s that did not include a seminoma component per the information available. The slides were not available for review. In 2024, the patient was found to have a metastatic seminoma involving multiple pelvic lymph nodes and the prostate. The right testicular ultrasound was negative. The managing physician noted this was both a "relapsed seminoma" and a "Stage IIC seminoma." Should the new diagnosis of metastatic seminoma be accessioned as a new primary based on the histology differences? Or is this situation similar to SINQ 20160073 in which this is a single primary even though the metastases are a distinctly different histology? |
Without evidence of a new testicular tumor, record this as a single primary now with metastatic disease (seminoma). The seminoma may not have been identified in the original tumor and treatment was based on the histologies found. This allowed the seminoma to metastasize. |
2025 |
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