Collaborative Staging--Lung: Given that the AJCC lung TNM is not applicable for a high grade sarcoma of this site, how do we code Collaborative Stage for this site/histo combination when the pathologist indicates a TNM stage of T2bN0M0=stage III, using AJCC Soft Tissue Sarcoma schema?
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.
Use the lung schema to code CS for sarcoma of the lung. Complete the CS information as best you can from the medical record WITHOUT using the TNM Soft Tissue Sarcoma staging form. Visceral sarcomas are specifically excluded from soft tissue sarcoma TNM staging and sarcomas are excluded from the TNM staging for lung.
Sarcoma is listed on the Histology Exclusion Table for lung. When a case is coded in Collaborative Staging and the histology is on the exclusion list, SEER Summary Stage 1977 and 2000 can be assigned. For these cases, TNM will not be calculated and displayed results will be "T NA N NA M NA and Stage Group NA".
Reportability--Brain and CNS: Is Langerhans cell histiocytosis [9751/1] of the meninges [C709] reportable?
For cases diagnosed prior to 1/1/2010:Yes. The criteria for reportable benign/borderline CNS tumors is based on location (site) and behavior (benign/borderline). There is no caveat for histologic type. Therefore, this would be reportable as these tumors have been reported arising from the meninges or choroid plexus.
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.
Reportability--Ovary: Is an "aggressive adult granulosa cell tumor with one of two lymph nodes positive for metastatic granulosa cell tumor" reportable?
Malignant granulosa cell tumor is reportable. The case described above is malignant as proven by metastasis to the lymph node.
CS Tumor Size--Breast: Should this field be coded to 999 [Unknown] or 008 [0.8 cm tumor] when the tumor size is not provided on a stereomammotomy biopsy for an in situ malignancy and a subsequent excision demonstrates 0.8 cm tumor of residual in situ disease?
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 008 [0.8cm]. A mammotomy specimen is very small, so for this case, the residual tumor size is quite accurate. Size is not a critical data element for in situ breast cancer.
Behavior--Head & Neck: Should the SEER IF_Morph_3 edit be modified because it does not allow a behavior code 2 with histology 8941 [carcinoma in a pleomorphic adenoma] for a parotid primary?
Code the behavior as 2 and over-ride the edit. The edit is there to flag unusual combinations. Once you have verified that the behavior is coded correctly, over-ride the edit.
The surgeon stage of T2 is based on size of tumor, the TIS is based on behavior. Code according to pathologically confirmed TIS.
Histology (Pre-2007)--Head & Neck: How is a "sinonasal undifferentiated carcinoma (SNUC)" coded?
For tumors diagnosed prior to 2007:
Code histology to 8020 [carcinoma, undifferentiated]. "Sinonasal" refers to anatomic location of primary site not histology.
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.
CS Lymph Nodes--Breast: Clarify the use of code 25 [Movable axillary lymph node(s), ipsilateral, positive with more than micrometastasis (i.e., at least one metastasis greater than 2 mm)] vs code 60 [Axillary/regional lymph node(s), NOS; Lymph nodes NOS] when surgically removed lymph nodes are positive but the size of the metastasis is not stated. See Discussion.
Note 2 in CS manual states: "If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2mm and code LNs as positive in this field. Use code 60 in the absence of other information about regional nodes."
1. If the LNs are known to be axillary LNs, note 2 seems to imply the size can be assumed to be greater than 0.2mm. Would you code 25 or 60?
2. Both codes 25 and 60 map to N1, node involvement. Do they each mean something else in the evaluation process?
3. What would constitute "absence of other information"?
4. Is the use of 60 over 25 specific to SEER registries or all users?
5. Abstractors are trained to assume LNs are mobile if there is no contrary information. Is this appropriate?
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.
Assign CS Lymph Nodes code 25 for breast when there are positive axillary nodes without internal mammary nodes. Code 25 is used in a couple of situations: a. when you know the lymph nodes are clinically movable and only the axillary nodes are involved; b. when you know the size of the metastasis in an axillary lymph node is more than a micrometastasis (i.e., > 2 mm). Code 60 can be used for any regional lymph node (internal mammary, infra- or supraclavicular, as well as axillary. So you can code to 25 if you have "regular" metastases in axillary lymph nodes only. If you don't know whether the mets are micro or regular, use code 60. Assign code 60 when there are positive regional nodes not further described.
1. Assign code 25 for positive axillary lymph nodes.
2. Codes 25 and 60 may map to N1, N1a, N2a or N3a depending on the coding of SSF3.
3. Assign code 60 when there is not enough information to assign a code from 13 to 50.
4. CS instructions are the same for all users. There are no CS instructions specific to SEER registries.
5. Yes, assume lymph nodes are moveable (not matted, not fixed) when there is no information to the contrary.
CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]?
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 vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability.
Reportability/Behavior--Skin: Is an "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" with an ICDO-3 histology code of 8830 reportable with a behavior code of 3 or is it nonreportable with a behavior code of 1?
Yes, "atypical fibroxanthoma (superficial malignant fibrous histiocytoma)" is reportable. The information in parentheses provides more detail and confirms a reportable malignancy.
First Course Treatment: If an "aromatase inhibitor" used as a complement to Tamoxifen is treatment, how should it be coded?
When an aromatase inhibitor is part of the planned first course of therapy, code it under hormone treatment.
When a change of drug is PLANNED, it is part of the same course even if subcategories change. This is the usual situation with Tamoxifen and aromatase inhibitor (for example: Femara). The switch to Femara is planned, so it is not a new course. When a drug change happens that is not planned, it is still the same course if both drugs are in the same category and subcategory. An unplanned drug change to a different subcategory would be a new course.
An official website of the United States government
Home