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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20081106 | MP/H Rules--Breast: How many primaries for the following? Breast lumpectomy: Three foci of invasive ductal carcinoma. Tumor nodule #1 - Invasive ductal carcinoma. Tumor nodule #2 - Invasive ductal carcinoma with tubular features. Tumor nodule #3 - Invasive tubular carcinoma. See Discussion. |
According to the MP/H rules, this case is reportable as three primaries with histologies coded 8500, 8523 and 8211. However, our QC staff is having a problem accepting this. When the pathologist specifies that a ductal carcinoma has tubular features or is tubular type, isn't s/he saying that tubular is a type of duct? In addition, the first line of the FDx states, "Three foci of ductal carcinoma," which indicates that the pathologists interprets the three nodules to be ductal carcinoma. |
For cases diagnosed 2007 or later: These three tumors are three separate primaries. Rule M12 applies. According to the 2007 MP/H rules, tubular carcinoma is not a type of duct carcinoma. Among the paramount reasons for writing the MP/H rules are the non-standard usage of nomenclature by physicians and the inconsistency in interpretation of these non-standard phrases. The MP/H rules must be applied consistently by each cancer registrar in order for data to be comparable across registries. |
Breast | N/A | 2008 |
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20071123 | MP/H Rules/Reportability/Diagnostic Confirmation--Colon: Please clarify how to code diagnostic confirmation when there is no mention of a malignant polyp in the pathology report of a familial polyposis case given this statement: "Even if you have only one malignant polyp it is a single primary if there is a diagnosis of FAP. Even if there is no mention of a malignant polyp, if there is a diagnosis of FAP you will use this rule." |
For cases diagnosed 2007 or later:
In the very unlikely event of a FAP diagnosis with no malignancy, the case would not be reportable.
When FAP is diagnosed along with a colon malignancy, it is presumed that the malignancy originated in one of the numerous polyps, even if this is not explicitly stated. Use rule M3 for any colon malignancy (in a polyp, frank, or not stated) with a diagnosis of FAP and abstract as a single primary. |
Colon | N/A | 2007 | |
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20021048 | EOD-Lymph Nodes: If chemotherapy or radiation is given prior to the excision of an involved lymph node, should the size of the metastasis within the lymph node be coded from the subsequent surgical pathology report? See discussion. | For several sites, the size of the metastasis in an involved lymph node is integrated into the EOD-Lymph Node field. Should the size of the metastasis mentioned on the pathology report be ignored if the patient received radiation or chemotherapy prior to having the lymph node removed? | For cases diagnosed 1998-2003:
Record the size of a lymph node metastasis described in the pathology report for cases that had pre-surgical treatment. However, if both the pre-treatment and post-treatment size of the lymph node metastases are available, use the larger size when coding the EOD-Lymph Node field. |
N/A | N/A | 2002 |
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20021029 | Grade, Differentiation--Breast: Should the Bloom-Richardson (BR) grade (low, intermediate, high) have a higher priority than terminology (i.e., well differentiated)? See discussion. | 1. Grade of infiltrating carcinoma 1) Nuclear grade low; 2) Histological grade-intermediate; 3) Mitotic rate-low, 4) BR score 4.
2. Poorly differentiated but grade II/III. Microscopic comment: Slides show infiltrating ca which is P.D. in that it forms no tubules, but is grade 2 out of 3 in the modified BR scheme. It is ductal type with large moderately pleomorphic tumor cells displaying few mitoses.
3. Invasive moderately differentiated duct cell carcinoma with the following features: Modified BR grade: III/III (2+3+3=8). |
For cases diagnosed prior to 2004:
Code the example cases as follows:
1. Grade 2. Histologic grade terminology ("intermediate") has the highest priority.
2. Grade 3. Terminology ("poorly differentiated") has the highest priority.
3. Grade 2. Histologic grade terminology "moderately differentiated" has priority. |
Breast | N/A | 2002 |
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20091116 | MP/H Rules/Multiple primaries - - Colon: Is a colon tumor reported as "recurrent at the anastomotic junction" just over one year after the diagnosis of a T4 colon tumor to be counted as a new primary? See Discussion. | MP/H rules do not apply to metastasis. However, it has been our experience that pathologists and clinicians tend to use the terms metastatic and recurrence interchangeably. The term "recurrence" is not limited to a tumor recurrence in the same site as a previous malignancy. Sometimes it is obvious that the clinician is using the term recurrence to describe a metastatic lesion. When a "recurrence" is located in tissue that is very different from the original primary site, it is easy to recognize that the intended meaning of the term is metastasis.
Example: Patient with squamous cell carcinoma of the tongue with recurrence in the lung.
However, when the metastatic deposit occurs in similar tissue, it is more difficult to determine the number of primaries.
Example when the term "recurrence" is ambiguous: In April 2008 patient was diagnosed with adenocarcinoma of the ascending colon. At the time of hemicolectomy the tumor was noted to be plastered into the paraduodenal and peripancreatic area. Patient received one dose of adjuvant chemo and then discontinued treatment. In May 2009 the patient was found to have adenocarcinoma in the transverse colon. Per the pathology report the diagnosis for segmental resection at that time showed colonic adenocarcinoma. Tumor location: tumor appears recurrent at anastomotic junction. Abdominal wall mass showed metastatic adenocarcinoma.
One has to wonder if the pathologist found a metastatic nodule at the anastomotic site and called it "recurrent." It is unlikely that the pathologist will compare this specimen to the previous tumor, having already diagnosed it as "recurrent."
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For cases diagnosed 2007 or later, Rule M4 applies to the example of adenocarcinoma of ascending colon diagnosed in 2008 followed by adenocarcinoma of transverse colon diagnosed in 2009. When a colon resection has taken place, the original primary site is no longer present. A colon resection usually includes a portion of uninvolved colon on either side of the tumor. A tumor diagnosed at the anastomotic junction cannot be located in the same site as the previous tumor. Use of the term "recurrent" in this case is not synonymous with "metastatic." Apply the MP/H rules. | Colon | N/A | 2009 |
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20021023 | EOD-Size of Primary Tumor/EOD-Extension--Breast: How do you code extension when the tumor in the breast is in situ and the regional axillary lymph nodes are positive? See discussion. |
For example, what extension code is used for a 4.5 cm DCIS (no invasive ca found in excisional biopsy or mastectomy specimen) with mets to 01/07 LNs? |
For cases diagnosed 1998-2003: Code the EOD-Size of Primary Tumor field to 045 [4.5 cm]. Document how the size was determined in the EOD-Extension field. Code the EOD-Extension field to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) AND proportions of in situ and invasive not known]. By virtue of the lymph node metastasis, this must be an invasive breast carcinoma. The size of the invasive component is unknown. |
Breast | N/A | 2002 |
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20150066 | Grade--Breast: Do you take grade from the most representative specimen along with the histology? What is the correct histology/grade combination? See discussion.
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Breast biopsy (from hospital A): DCIS, solid, cribriform, comedo type, high nuclear grade
Breast Lumpectomy (from hospital B): DCIS, cribriform type, nuclear grade 1, tumor 2.5cm |
Assign 8201/2 for this case.
MP/H rules are to code histology based on the specimen with the most tumor tissue. That would be the lumpectomy in this case. The histology is DCIS, cribriform type.
Reference: http://seer.cancer.gov/tools/mphrules/mphrules_instructions.pdf
The general rule for grade is to code the highest grade specified within the applicable grading system. For the case information provided, follow instruction #5, nuclear grade: use Coding for Solid Tumors #7: 2-, 3-, or 4- grade system. High nuclear grade (grade code 3 for breast) is higher than nuclear grade 1 (grade code 1).
Reference: http://seer.cancer.gov/tools/grade/ |
Breast | N/A | 2015 |
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20020030 | EOD-Size of Primary Tumor: 1) Can we add "Imaging studies" to those EOD schemes that currently do not include this on their priority list for coding size? 2) When an EOD scheme already lists specific types of imaging studies, are we limited to only those types of procedures or can any imaging study be used to code size? See discussion. | How do we determine where to add "imaging studies" to the priority listing? Currently the hierarchy differs for primaries that currently include imaging studies on their EOD schemes. For example, on the breast EOD imaging ranks lower than the physical exam while on the thyroid EOD imaging ranks higher than the physical exam. | For cases diagnosed 1998-2003:
1) You may add "Imaging" to the size priority list for all EOD schemes that currently do not include it. Prioritize it just above the physical exam for these sites.
2) You may use the information from any imaging technique to code tumor size, even for those sites such as breast and bladder where specific imaging tests are mentioned. |
N/A | N/A | 2002 |
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20110077 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be reported if different recurrence scores are found on the Oncotype Dx studies performed for multiple tumors in the same breast if the clinician states the patient has two primaries but the pathologist does not address the issue? See Discussion. | A patient has two separate lesions in the same quadrant with the same histology. According to the MP/H rules this is a single primary. However, Oncotype Dx studies were performed on both tumors and the DX recurrence was different for each tumor. The medical oncologist states the patient has two primaries. The pathologist does not indicate the number of primaries. | This is a single primary. The only rules used to determine the number of primaries are the MP/H rules for cases diagnosed 2007 or later. Do not use other information such as Oncotype Dx to determine the number of primaries for a patient. Oncotype is used to determine whether the cancer is likely to recur AND whether the cancer would benefit from chemotherapy.
The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Breast MP rules under one of the three formats (i.e., flowchart, matrix or text).
Start with the MULTIPLE TUMORS module, Rule M4. The rules are intended to be reviewed in consecutive order within the module from Rule M4 to Rule M13. You stop at the first rule that applies to the case you are processing.
The patient has two tumors in the same breast with the same histology. Abstract a single primary for this patient. |
Breast | N/A | 2011 |
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20220049 | Solid Tumor Rules/Multiple Primaries--Lung: How many cases should be abstracted for a patient with 2022 wedge biopsy of right upper lobe acinar predominant lung adenocarcinoma and wedge biopsy of right lower lobe lepidic predominant adenocarcinoma if there is concern for diffuse spread throughout the lungs secondary to the lymphangitic carcinomatosis and possible diffuse pneumonic type of adenocarcinoma? See Discussion. |
Acinar predominant adenocarcinoma measures at least 12 mm and involves wedge biopsy margins, while the lepidic predominant adenocarcinoma measures 11 mm and does not involve the margins of that separate specimen. Pathologist also notes, “CT findings of diffuse coarse reticular nodular opacity, these findings may represent pneumonic type adenocarcinoma/diffuse pulmonary involvement or intrapulmonary metastasis. Both of these scenarios have the corresponding stages of pT4 (if thought to be ipsilateral) or M1a (if thought to also involve the contralateral lobe).” Patient declined any further treatment and transitioned to hospice before expiring less than 1 month after wedge biopsies. It is unclear if Rule M6 would apply to these two specimens with different subtypes since this scenario is not specifically addressed in the M rule definitions. |
Abstract two separate primaries when separate/non-contiguous tumors are two or more different subtypes/variants in Column 3 of Table 3 using Rule M6 in the Solid Tumor Rules (September 2021 Update). They represent two subtypes/variants of the same NOS histology. When coding histology, tissue from pathology takes precedence over imaging, including when stated as differential diagnoses based on the CT scan, as noted by the pathologist in this example. |
Lung | N/A | 2022 |
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