CS Lymph Nodes--Breast: How is this field to be coded if the pathologist staged the case pN1a and the lymph node is stated to be negative on H&E, is .3 cm on IHC stain for pancytokeratin but on review of smears shows no malignant cells?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code CS Lymph Nodes as negative [00]. The positive stain for pancytokeratin is contradicted by the statement "malignant cells are not identified." See also sinq 20010055.
CS Tumor Size--Breast: How is this field coded for a 1.5 cm clinically palpable tumor that appeared to be a cyst with a papilloma when the partial mastectomy Path Micro stated the lesion was an "intraductal papilloma with focal noninvasive papillary carcinoma"? See Discussion.
Should the size be coded to 999 [unknown] because the noninvasive papillary carcinoma is described only as "focal" and is not measured and it is not known how much of the tumor is benign and how much is in situ. Or would the size be coded to the size of the palpable mass, 1.5 cm?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code CS tumor size as 999 [unknown]. Size of the focal noninvasive papillary carcinoma is not stated.
Reportability--Lung: Is sclerosing hemangioma of the lung with multiple regional lymph nodes metastases reportable?
No, it is not reportable. According to the WHO Classification of Lung Tumours, sclerosing hemangioma "behaves in a clinically benign fashion...Reported cases with hilar or mediastinal lymph node involvement do not have a worse prognosis."
CS Eval--Colon: Should 1 [No surgical resection done...] or 3 [Surgical resection performed...] be used to correctly reflect this field when a surgical observation is "adherent to duodenum" but the extension per the pathology is stated to be to the "subserosal tissue"? See Discussion.
7/2/04 Op Findings 5 cm mass in mid transverse colon involving also the right colon; mass was adherent to duodenum without obvious invasion. 7/2/04 Path: Rt & Transverse Colon: 6x5 cm mass, micro: MD Adenoca with invasion of subserosal tissue; margins neg. 17/17 colic LNs negative.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.For the case described above, code extension as 46 [Adherent to other organ...no microscopic tumor found in adhesion]. Code CS TS/Ext eval as 3 [Surgical resection performed...].
Surgery was performed for this case. The fact that the adherence to the duodenum was proven not to be tumor involvement should be coded as 3 in CS TS/Ext Eval. By using eval code 3, the case will map to a pathologic T indicating that the patient had resective surgery. Eval code 1 would map to a clinical T, incorrect for this case.
Priorities/CS Tumor Size--Breast: What is the priority order used in coding tumor size for this site when there is a larger 2 cm lesion noted on the PET scan and smaller sizes described in the pathology report as two malignant masses one measuring 0.8 cm and the second measuring 1.0 cm per the GROSS?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code CS Tumor Size as 1.0 cm. The pathology report is the highest priority source for coding tumor size. When multiple tumors are present, code the size of the largest tumor.
CS Tumor Size/CS Extension--Brain and CNS: How are these fields coded for a glioblastoma multiforme occurring in a 3.5 cm tumor in the parietal lobe and a 3.0 cm tumor in the occipital lobe?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
CS Extension code is 10 [confined to cerebral hemisphere]. Record the size of the largest lesion in CS Tumor Size. Both the occipital and parietal lobes are supratentorial and confined to the cerebral hemisphere with no mention of crossing midline or involvement of ventricles.
CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code CS Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes.
CS Eval--Colon: When the surgical resection occurs after radiation or chemo, how is the tumor size/extension evaluation field coded when there is no mention of the tumor size or extension in the surgical resection pathology report? See Discussion.
6/30/04 CT Scan abd/pelvis: 7.5x7.2 cm large rectal mass with l cm nodular densities in perirectal region probably adenopathy; irregularity of perirectal soft tissue which could be due to tumor infiltration. 7/26/04 Patient has radiation therapy and 5FU. 10/19/04 LAR: MD Adenoca rectum with regional node mets (3/8).
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Based on the information provided above, code CS Tumor Size and Extension from CT scan. Code CS TS/Ext eval 5 [Surgical resection performed with pre-surgical treatment...size based on clinical evidence].
Code CS lymph nodes using information from resection. Code CS Reg Nodes eval 6 [Regional LN removed...with pre-surgical treatment...based on pathologic evidence].
Histology--Lymphoma: How is "histiomonocytic lymphoma" coded?
For cases diagnosed prior to 1/1/2010:Assign code 9755 [Histiocytic sarcoma; True histiocytic lymphoma]. "Histiomonocytic" is not standard terminology, according to our expert consultant. However, 9755 is the best code to assign.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Chemotherapy/Radiation Therapy--Lymphoma: How is treatment coded when Rituxan is given in combination with the monoclonal antibody Zevalin conjugated to 90-Yttrium or the monoclonal antibody Bexxar conjugated to 131-Iodine in the treatment of NHL?
Code Rituxan as chemotherapy. Code 90-Yttrium as radioisotope. Code 131-Iodine as radioisotope when given with Rituxan as treatment for lymphoma.
Zevalin is a monoclonal antibody conjugated to Yttrium 90. Bexxar is a monoclonal antibody conjugated to Iodine 131. In both drugs, the monoclonal antibody is only the delivery agent for the radioisotope. Both drugs should be coded as radioisotopes. The one-two-three punch of Rituxan and zevalin followed by Rituxan and Bexxar should be coded as chemotherapy plus radioisotopes. Zevalin is also used by itself for people who have not responded to Rituxan.
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