EOD 2018/EOD Regional Nodes--Melanoma: Can central cancer registries code Extent of Disease (EOD) Regional Nodes as 000 based on Breslow’s depth and/or Clark’s Level (per EOD and/or Summary Stage) from a melanoma pathology only report with a localized tumor and no information on regional lymph nodes or mets. See Discussion.
Based on the EOD General instructions for accessible sites, the following three requirements must be met
a. There is no mention of regional lymph node involvement in the physical examination, pre-treatment diagnostic testing, or surgical exploration;
b. The patient has localized disease;
c. The patient receives what would be the standard treatment to the primary site (treatment appropriate to the stage of disease as determined by the physician), or patient is offered usual treatment but refuses it.
As a central registry, we receive a lot of melanoma path reports but never receive an abstract since the patients are seen at a dermatology office that does not report to the central registry. In these scenarios, we have both the diagnosis and wide excision or Mohs surgery from which we create a consolidated record. It is not often that lymph nodes are removed which indicates there were no palpable nodes.
Since the Breslow’s and Clark’s level allow for summary staging, is it possible to have central registry guidelines that allow for coding lymph nodes other than 999? The path reports meet two of the three criteria. Is there any new literature that supports coding lymph nodes 000 based on a Clark’s level or Breslow measure providing the patient has a wide excision?
Assign 000 for EOD Regional Nodes when you have a pathology only report with a localized tumor based on Breslow’s depth and/or Clark’s Level (per EOD and/or Summary Stage) and no information on regional lymph nodes or mets. When the tumor is noted to be regional or distant based on Breslow’s Depth and/or Clark’s based on the definitions in EOD and/or Summary Stage, do not assume that the nodes are negative and assign 999. Clarification will be added to the EOD manual.
Reportability--Prostate: According to the 2018 SEER Program Manual, a prostatic intraepithelial neoplasia (PIN) III is not reportable, but is an atypical small acinar proliferation (ASAP) PIN 4 reportable?
ASAP is not reportable. Patients with ASAP found on needle biopsy will likely undergo another biopsy.
Primary Site--Bladder: What subsite is used for fundus of the bladder?
As of November 2005, Code fundus of bladder to C678 [overlapping lesion of bladder]. Opinions vary regarding the definition of bladder "fundus." However, according to our pathologist consultant, fundus includes posterior, anterior and lateral walls and dome. Fundus does not include the trigone.
A correction to page C-595 of the 2004 SEER manual will be included in the next errata.
Reportability--Thyroid: Is a final diagnosis of "non-invasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) reportable when the diagnosis comment states this tumor was historically classified as encapsulated follicular variant of papillary thyroid carcinoma? See Discussion.
The term "non-invasive follicular thyroid neoplasm with papillary-like nuclear features" is now being used, instead of the previous classification of an encapsulated malignant thyroid tumor. Recent evidence supports a very minimal risk of aggressive behavior for these tumors, and pathologists in our area are no longer classifying these as malignant in the final diagnosis.
As of January 1, 2021
Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) C739 is no longer reportable for cases diagnosed 1/1/2021 forward. See the ICD-O-3.2 material on the NAACCR website,https://www.naaccr.org/icdo3/#1582820761121-27c484fc-46a7
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Answer for cases diagnosed 1-1-2017 to 12/31/2020
Report NIFTP and assign ICD-O-3 morphology code 8343/2. See the NAACCR document, page 3, https://20tqtx36s1la18rvn82wcmpn-wpengine.netdna-ssl.com/wp-content/uploads/2017/01/What-You-Need-to-Know-for-2017.pdf
MP/H Rules/Histology--Testis: Which MP/H rule applies in coding the histology described as a "malignant mixed germ cell tumor with the following features: Histologic type: embryonal carcinoma (97%) and yolk sac tumor (3%)"? See Discussion.
Per MP/H rule H16, code the appropriate combination/mixed code (Table 2) when there are multiple specific histologies or when there is a non-specific histology with multiple specific histologies. The combination embryonal carcinoma and yolk sac tumor is not listed in Table 2, even though the pathology report indicates this is a mixed germ cell tumor.
Should rule H17 be applied and the numerically higher histology code be used?
As of 2016: Code histology to 9085/3 [mixed germ cell tumor]. Combine 9065 and 9085 for analysis purposes.
Reportability/Melanoma: Is evolving melanoma reportable with a Clark's level and Breslow's thickness are cited in the pathology report? See Discussion.
How do we interpret the reportability of the following: The histological and immunohistochemical findings are most consistent with an early-evolving malignant melanoma, superficial spreading type, with Clark's level II and maximal Breslow thickness 0.33 mm, arising in association with an atypical nevus. Since a Clark's level and Breslow's thickness are included, is this reportable? Is this really an evolving melanoma?
As of 01/01/2021, early or evolving melanoma in situ, or any other early or evolving melanoma, is reportable.
Primary site: Is there a physician priority list for coding primary site? For example, the surgeon states during a pancreatectomy that the primary is in body while the pathologist states in their synopitc report that primary is neck; neither is in agreement, or neither is available for confirmation.
As a general rule, the surgeon is usually in a better position to determine the site of origin compared to the pathologist. The surgeon sees the tumor in its anatomic location, while the pathologist is often using information given to him/her by the surgeon and looking at a specimen removed from the anatomic landmarks. However, when a pathologist is looking at an entire organ, such as the pancreas, he/she may be able to pinpoint the site of origin within that organ.
In the case of pancreas body vs. neck, the neck is a thin section of the pancreas located between the head and the body. It may be a matter of opinion whether a tumor is located in the "body" vs. the "neck." In the situation you describe, we would give preference to the surgeon and assign the code for body of pancreas, C251.
First course treatment--Corpus Uteri: Should Arimidex be coded as hormone therapy for an endometrioid adenocarcinoma? See Discussion.
Per the SEER Manual, endometrial cancers may be treated with progesterone which is coded as hormone therapy for these primaries. As endometrioid adenocarcinomas are hormonally-dependent carcinomas, should an aromatase inhibitor or anti-estrogen agent also be coded as hormone therapy?
Arimidex has not been approved to treat endometrial cancer. It is not prescribed for pre-menopausal women. Clarify with the physician why the drug was being used. If the physician states Arimidex was given to reduce tumor burden, code as hormone therapy.
MP/H/Histology--Breast: What MP/H Rule, histology, and behavior code for a breast primary apply to the following?
2 foci DCIS, solid, high grade (Grade 3) w/microca++
Apply the Multiple Primaries/Histology, Breast Rule H3: DCIS and a more specific in situ are coded to the more specific histology term which in this case is solid. Code the histology to ductal carcinoma in situ, solid type (8230/2). Based on the information provided, there is no invasive component. The term "microca ++" means micro-calcifications are present, not micro carcinoma.
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