Report | Question ID | Question | Discussion | Answer | Year |
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20041080 | Behavior Code/CS Extension--Brain and CNS: How are these fields coded when the final diagnosis on pathology indicates that an atypical meningioma invades the brain and the bone flap specimen indicates extensive invasion through the full thickness of the calvarium? See Discussion. |
FDx on the path is: A. Rt frontotemporal brain tumor: Atypical meningioma, WHO grade II (out of III). B. Arachnoid tissue: Atypical meningioma with small focus of invasion into superficial brain and focal perivascular spread. C. Bone flap: Atypical meningioma with extensive invasion through full thickness of the calvarium. Comment: Although this tumor shows a small focus of brain invasion, it should be considered a grade II (out of III) meningioma based on its histologic atypia (cellularity, sheeting of tumor cells and prominent nucleoli), elevated Ki-67 index and low mitotic rate. |
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 tumors diagnosed prior to 2004, the example above is a benign meningioma and not reportable to SEER. For tumors diagnosed 2004 or later, code the behavior as 1 [Borderline malignancy]. Code CS Extension as 05 [Benign or borderline brain tumors]. According to expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant. |
2004 |
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20041016 | CS Site Specific Factor 4--Prostate: If PAP is not mentioned in the chart, should Site Specific Factor 4 be coded to 999 [unknown or no information] or 000 [test not done]? | 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 tumors diagnosed 2004 only:
Code the CS Site Specific Factor 4 to 999 [Unknown or no information; Not documented in patient record]. If there is no report of a lab test in the health record, code as 999.
Code this field to 000 [Test not done] when there is a statement in the record that a test was not performed.
Tumors diagnosed 1/1/2005 forward no longer have PAP coded in the Site Specific Factor 4 field. |
2004 | |
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20051070 | CS Lymph Nodes--Breast: Which category has priority when both apply, "Regional lymph nodes, NOS" or "Stated as N_, NOS"? See Discussion. | Example: When there is a clinical diagnosis of axillary lymph node metastasis for a breast primary on a physical exam "Enlarged axillary lymph nodes suspicious for metastatic involvement", as well as a clinical N1 designation, do we code as 60 [Axillary LNS, NOS] or 26 [Stated as N1, NOS]? | 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 example provided, assign code 25 [Movable axillary lymph node(s)...] for "Enlarged axillary lymph nodes suspicious for metastatic involvement." Code 60 [Axillary/regional lymph node(s), NOS] is the least specific and would not be used in this case because axillary nodes are defined in code 25. Code 26 is for cases in which "N1, NOS" documented by the physician is the only information available. |
2005 |
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20051044 | CS Reg LN Pos/Exam--Colon: For a patient with both a prostate and colon primary, if the pathology report indicates that 2 of the 3 regional lymph nodes to the colon are positive for a prostate malignancy, how should these fields be coded for the colon primary? | 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 colon primary, code Reg LN Pos 00 [all nodes negative]. Code Reg LN Exam 03 [three nodes examined]. Three lymph nodes were examined and found to be negative for metastatic colon cancer. |
2005 | |
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20051120 | 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. |
2005 |
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20051122 | CS Lymph Nodes--Prostate: How is this field coded when no scan, scope or surgical evaluation of regional lymph nodes is performed for a case with localized disease in the primary site? See Discussion. | Prior to initiation of collaborative stage, SEER prostate guidelines instructed us to code lymph node involvement as negative when clinical or pathologic extension was coded 10-34 and there was no lymph node information. Is this guideline still in effect, or do we follow the collaborative stage rules which require lymph node information or, in absence of node info, usual treatment for localized 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.For prostate and other "inaccessible sites" with localized disease, code the regional lymph nodes as clinically negative when not mentioned on imaging or exploratory surgery. |
2005 |
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20061109 | CS Tumor Size--Lung/Breast: Explain why the SEER instructions differ from the CS Manual regarding priority order of sources to code tumor size? See Discussion. | Regarding the 2004 SEER Manual, Appendix C, Site Specific Coding Modules, Lung and Breast. The priority of sources for coding tumor size is Pathology, Operative Report, PE, imaging for breast and pathology, operative, endoscopic, and imaging for lung. This differs from the CS Manual instructions. | 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 cases diagnosed in 2007 and forward, follow the instructions in the 2007 SEER manual and the CS manual. |
2006 |
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20031155 | CS Site Specific Factor--Prostate: Does perineural invasion affect the coding of SSF3, pathologic extension? See Description. | "Adenoca scattered over a 2.5 cm region bilaterally toward the apex. Perineural invasion is identified, including within the right apex." Does this mean that there is extension into the apex? | 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 cases diagnosed 2004 and forward: Presence or absence of perineural invasion does not affect pathologic extension. Most likely perineural invasion is still localized. It means that there is tumor found along the track of the nerves in the prostate. Where the nerves enter the prostate, the capsule is thinner than in other areas; thus pathologists make note of the potential for extracapsular extension. The CAP Cancer Protocol for Prostate states that perineural invasion "has been associated with a high risk of extraprostatic extension...although the exact prognostic significance remains to be determined." Based on the available information, code the case example to 023 [Involves both lobes]. |
2003 |
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20081037 | Extension/CS Extension--Prostate: Do the prostate guidelines used for EOD still apply to cases diagnosed 2004 forward? | 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 cases diagnosed 2004 and forward, refer to the Collaborative Staging manual. The 2004 CS guidelines have been agreed upon by all standard setters and have been reviewed by the COC/AJCC urologists.
Note: Do not use the SEER EOD guidelines with Collaborative Staging. |
2008 | |
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20061088 | CS Extension--Lymphoma: If bilateral tonsils are involved with lymphoma, is it one or two regions of involvement and how is extension coded? |
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 cases diagnosed 1-1-08 and later: Assign CS extension code 10 [involvement of a single lymph node region]. Bilateral tonsils are one organ/site. See Note 1 under CS Extension. Tonsil is coded the same as a lymph node region. |
2006 |