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Report Produced: 02/12/2026 10:52 AM

Report Question ID Question Discussion Answer Year
20091093

Race--How and when is Appendix D, Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics, to be used? See Discussion.

For example, if race is recorded as unknown on the facesheet of a hardcopy medical record or in the race field of an electronic medical record, how should race be coded for the following descriptions found in the history and physical or consultation reports submitted by clinicians?

1) Patient is Czechoslovakian

2) Patient is born in Czechoslovakia

3) Patient is Ethiopian

4) Patient is born in Ethiopia

5) Patient is Japanese

6) Patient is born in Japan

7) Patient is Brazilian

8) Patient is born in Brazil

Would you code these cases any differently if these descriptions were actually used in the race fields in the medical record or on a death certificate?

Code the patient's stated race when possible. Refer to Appendix D, Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics, for guidance.

Use the lists in Appendix D when race is not stated but other information is provided in the medical record. The cases you provide are good examples of the use of Appendix D. They would be coded the same if the descriptions were used in the medical record or death certificate race fields.

 2009
20200029

Systemic/Surgery Sequence: The note associated with code 4 in Systemic Treatment/Surgery Sequence in the 2018 SEER Manual says: Code 4 is intended for situations with at least two episodes or courses of systemic therapy. Does this mean two different types of systemic therapy before and after surgery? See Discussion.

For example, chemotherapy and immunotherapy administered first, followed by surgery, then immunotherapy and hormone therapy after surgery. Or is code 4 used for two administrations of chemotherapy before surgery and two more courses after surgery?

Assign code 4 for the example you describe. Code 4 also applies to cases with one course of chemotherapy before surgery and another course after surgery.

 2020
20021058

Multiple Primaries (Pre-2007)--Breast: When simultaneously diagnosed breast tumors of the same histology in the same breast are stated by the pathologist and/or clinician to be more than one primary, should these be reported as multiple primaries? See discussion.

For example, based on special pathology studies that showed a difference in appearance between tumors, a pathologist may state that two ductal, NOS tumors diagnosed at the same time in the same breast represent two primaries.

For tumors diagnosed prior to 2007:

Code as a single primary. Follow the guidelines in the SEER Program Code Manual for determining multiple primaries. Simultaneous multiple lesions of the same histologic type in the same site (same breast) are a single primary for SEER, even though the pathologist may perform special studies and state that the patient has more than one primary.

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.

 2002
20110038

Reportability/Behavior: Is a "minimally invasive thymoma" a reportable malignancy if the pathology report does not specifically state it is malignant? See Discussion.

For example, are Types A, B1, B2 and B3 reportable if the pathology report does not state the tumor is a "Malignant Thymoma"?

For cases diagnosed prior to 2021

According to our expert pathologist consultant, code using the terms in the pathology report. Do not try to second guess the pathologist.

  1. Thymomas are /1 and not reportable unless the pathologist states "malignant". This includes A, AB, B1, B2, and B3. Any one of these types of tumors may exhibit invasion but do not code /3 based only on invasion.

  • Code thymoma as /3 if specifically designated "malignant" by the pathologist.

  • Thymic carcinoma and any of its subtypes are malignant, /3.

    		•  2011
    		20200015

    Tumor Size--Clinical--Breast: Does information from any type of biopsy take precedence over an imaging report? See Discussion.

    For example, a patient has a 2.6 cm breast tumor on MRI; a core biopsy measuring 0.7 cm is positive for infiltrating duct carcinoma. Rule #1 states "Use the largest measurement of the primary tumor from physical exam, imaging, or other diagnostic procedures before any form of treatment." However, Rule #9 seems to imply that size from an "incisional biopsy" takes precedence over imaging, even though it is known to be less than the entire tumor in size.

    We do not recommend using the size from a core biopsy for clinical tumor size. A core biopsy does not necessarily obtain enough tissue to know the actual tumor size. Since there is imaging for this patient, it is preferable to record clinical tumor size from the imaging report in this case.

    The instructions will be clarified in the next revision of the SEER manual.

    		 2020
    		20240078

    Reportability/Histology--Lung: Are adenocarcinoma spectrum lesions on lung imaging reportable when no further information is available? See Discussion.

    For example, a chest computed tomography showed multiple subsolid and ground glass pulmonary nodules measuring up to 6 mm; findings favored to reflect adenocarcinoma spectrum lesions.  A literature search seems to indicate that adenocarcinoma spectrum lesions include atypical adenomatous hyperplasia through invasive adenocarcinomas.

    Do not report this case of "adenocarcinoma spectrum lesions" based on the information provided in the absence of a more specific diagnosis. Do not report until/unless a definitive diagnosis of malignancy is made. "Adenocarcinoma spectrum lesion" covers a continuum of lung neoplasms from preinvasive lesions (atypical adenomatous hyperplasia and adenocarcinoma in situ) to invasive lesions (minimally invasive adenocarcinoma and invasive adenocarcinoma).

    Should additional information become available, report the case and assign the histology code if a more specific histology is confirmed later. Use text fields to record the details.

     

    		 2024
    		20190072

    Solid Tumor Rules (2018)/Histology--Lung: What is the correct histology code for minimally invasive adenocarcinoma in the lung, 8140/3 or 8256/3? See Discussion.

    For example, 9/12/18 left lung upper lobe lobectomy: 1.5 cm, 0.8 cm invasive component, lepidic predominant adenocarcinoma with acinar and lepidic patterns, G2, no visceral pleural invasion, no LVI, 0/14 LNS positive. An additional minimally invasive adenocarcinoma, 1 mm, was seen away from the main tumor. The correct coding of the minimally invasive adenocarcinoma will ultimately determine if we have one tumor (using rule M7) versus two primaries (using rule M6).

    Updated answer: Code minimally invasive adenocarcinoma, NOS as 8140/3. This is a new term and code in the 2018 ICD-O-3 New Codes, Behaviors, and Terms-Updated 8/22/18 list. See Solid Tumor Lung Table 3, and Solid Tumor Lung rules H1 and H10.

    		 2019
    		20180045

    Solid Tumor Rules (2018)/Histology--Breast: The Histology Coding Instructions for breast cancer indicate the term type is not used to code histology unless documented to be greater than or equal to 90% of the tumor. Does this also apply if the format of pathology reports submitted in the College of American Pathologists (CAP) protocol from a specific facility always describes the histology under the heading, Histologic type: ___? See Discussion.

    For certain facilities in our area, the breast pathology reports using a CAP protocol format are formatted as follows; the Final Diagnosis will state Infiltrating carcinoma with the following features. The features list the specific tumor characteristics required in the CAP protocol formatting. The histology is always displayed in the list form and specified as Histologic type: (for example, Histologic type: Ductal carcinoma). Is this specific histology really to be ignored because it is preceded by the word type even if this is just a consequence of the pathology report formatting?

    In the CAP protocol, the term Histologic Type is a label where the histology that corresponds to the largest carcinoma is collected. According to the CAP protocol for invasive breast cancer, the histologic type corresponds to the largest carcinoma. If there are smaller carcinomas of a different type, this information should be included under "Additional Pathologic Findings." The findings noted in the Final Diagnosis, Histologic Type, and Additional Path Findings of the protocol should be used to determine the histology.

    When there are multiple histologies and

    1) the subtype or variant is listed as 90% when there is a Not Otherwise Specified/No Specific Type (NOS/NST) and a subtype, or

    2) the subtype/variant histology reflects the majority of the tumor when there are two or more different histologies (two or more distinct subtypes)

    Code the subtype/variant; otherwise, use the Specific and Not Otherwise Specified/No Specific Type (NOS/NST) Terms and Code listed in Table 2 (columns 1 and 2) of the 2018 Solid Tumor Rules for Breast Cancer.

    		 2018
    		20100042

    Reportability--Heme & Lymphoid Neoplasms: Given that there appears to be many differences in the reportability of these case types pre- and post-2010 (e.g., [refractory] thrombocytopenia), is there a list available that gives the reportability dates for these diseases? See Discussion.

    For cases diagnosed prior to 2010 "thrombocytopenia" was not reportable. According to the Heme Database, the term "refractory thrombocytopenia" is now reportable for cases diagnosed 1/1/10 and later. It would be helpful to have a list of diagnosis date requirements for the different hematopoietic diseases.

    For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

    Thrombocytopenia (NOS) is not reportable per Appendix F. However, the term "refractory thrombocytopenia" [9992/3] is reportable for cases diagnosed 2010 or later.

    There has been no change in the reportability for thrombocytopenia. The hematopoietic "help" system lists all of the synonyms, variants, and abbreviations for diseases.

    See the Hematopoietic & Lymphoid Neoplasm Coding Manual for changes in reportability associated with these cases.

     

  • Appendices D1a and D1b provide all of the new histology terms and codes.

  • Appendix D2 lists the newly reportable conditions.

    • Terms and codes in Appendix D are effective 01/01/10 and later. Refractory thrombocytopenia is included in D1a and D1b. The notes for D1a and D1b provide explanation and reiterate the dates these terms are effective.

    SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

    		2010
    		20230073

    First Course Treatment/Surgery of Primary Site--Liver/Intrahepatic Bile Ducts: For a liver/intrahepatic bile duct primary, is an alcohol embolization the same thing as a percutaneous ethanol injection (PEI)?  See Discussion.

    For C220-C221 primaries, Surgery of Primary Site includes code A150 for Alcohol tumor destruction (percutaneous ethanol injection/intratumoral injection of alcohol/alcohol ablation). The SEER and STORE manuals also indicate that alcohol embolization should be coded as Other Therapy, code 1. We are trying to determine whether alcohol embolization should be coded under Surgery of Primary Site or Other Therapy.

    Code alcohol ablation under Surgery of Primary Site 2023. Code alcohol embolization as Other Therapy when tumor embolization is performed using alcohol as the embolizing agent.

    Alcohol ablation, also known as an ultrasound-guided percutaneous ethanol injection (PEI); is treatment that involves injecting concentrated alcohol directly into the tumor. Embolization uses special techniques to close off blood flow by introducing special medications or using other techniques designed to block blood vessels. Types of embolization are arterial embolization as with alcohol (ethanol), chemoembolization, and radioembolization. Refer to the current SEER Program Coding and Staging Manual when assigning surgery and embolization procedures.

    		 2023