Surgery of Primary Site--Ovary: What code is used to represent this field when a patient has a history of a previous organ removal and has additional surgery/organ removal for a present cancer (e.g., History of a 1984 hysterectomy and in 2003 has ovarian primary treated with BSO)?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 52 [Bilateral salpingo-oophorectomy WITH hysterectomy].
EOD/Prostate Pathologic Extension--Prostate: Is a pathology report from a prostate biopsy/transurethral resection of the prostate that states "with intraductal spread" extraprostatic/extracapsular extension or localized?
Code as a localized, intracapsular tumor as ductal carcinoma in situ does not invade. Intraductal spread is describing the neoplasm spreading through the acinar/ductal cells in the prostate specimen. It is an in-situ type of spread and not invasive but almost always presents with an invasive tumor.
Date Therapy Initiated/Reason no treatment--Lymphoma: Is the date of the lymph node biopsy used as the date of treatment if the lymph node biopsy is the first treatment or the only treatment performed? Is the reason for no surgery coded to 0 [Surgery of the primary site was performed]?
For cases diagnosed prior to January 1, 2008, enter the date of the lymph node biopsy (excisional biopsy or biopsy NOS) as the Date Therapy Initiated for a lymphoma when the biopsy is the first or only therapy performed.
Code Reason for No Surgery of Primary Site as 0 [Surgery of the primary site was performed] and the biopsy of a lymph node is coded to 25 in Surgery to Primary Site.
Do not code a fine needle aspiration or core needle biopsy in Surgery of Primary Site.
Update to Current Manual/2018 EOD Manual/EOD Primary Tumor--Bladder: According to the American Joint Commission on Cancer (AJCC), a transurethral resection of the bladder (TURB) cannot make a distinction between involvement of the superficial muscle-inner half (Stage T2a) and the deep muscle-outer half (Stage T2b). Is this same criteria applied to Extent of Disease (EOD)?
EOD follows AJCC criteria in this situation and we have confirmed with AJCC that Stage T2a (superficial muscle) and Stage T2b (deep muscle) cannot be assigned when only a TURB is done.
For EOD Primary Tumor, Bladder, codes 200, 250, 300, 350, can only be used when
Cystectomy is performed
Muscularis propria is involved, AND
Pathology report states superficial muscle (200, 250) or deep muscle (300, 350) is involved
If a TURB is done and there is mention of the muscularis propria invasion (superficial muscle or deep muscle), use EOD codes 370 or 400. If a TURB is done and the pathology report states superficial or deep muscle, ignore and coded as “invasion of muscularis propria, NOS” (EOD codes 370 or 400).
Instructions and code descriptions for EOD Primary Tumor have been updated to indicate this. These updated instructions and code descriptions will be available when SEER*RSA is updated for 2024, Version 3.1 (Sept/Oct 2023). These updates are included here for reference and can be applied for cases diagnosed 2018+.
EOD-Extension--Corpus Uteri: How do you code myometrial involvement described as 1) "to the level of the middle one-third" or 2) "superficial"?
For cases diagnosed 1998-2003:
Evaluate each case carefully.
1. Code the EOD-Extension field to 12 [Myometrium-inner half] because the pathology report indicates involvement of the myometrium "to the level of." However, if you feel that you cannot make that determination with certainty and you cannot ask a pathologist for clarification, then code the EOD-Extension field to 14 [Myometrium, NOS].
2. Code the EOD-Extension field to 12 [Myometrium-inner half] for cases with "superficial" myometrial invasion.
Grade/Sarcoma--Breast: Is the correct grade for high grade angiosarcoma of the breast a code 3 or 4? The breast usually uses a three grade system but sarcoma is not a typical histologic type of the breast.
Assign grade code 4 using the sarcoma table. Nottingham or Bloom-Richardson (BR) Score/Grade does not apply to angiosarcomas. This is a good question and points out needed clarification of the grade rules.
Reportability/Histology--Tongue: Is high grade squamous dysplasia of the tongue reportable; and is it the same as carcinoma in situ (CIS), code 8077/2?
High grade squamous dysplasia of the tongue is reportable as of 2021 and later as 8077/2.
Diagnostic confirmation--Heme & Lymphoid Neoplasms: What is the diagnostic confirmation code for a death certificate only (DCO) diagnosis of acute myeloid leukemia?
Always code diagnostic confirmation to 9 [Unknown whether or not microscopically confirmed; death certificate only] for DCO cases.
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.
Reportability--Appendix: Are low-grade appendiceal mucinous neoplasms reportable?
For cases diagnosed prior to 1/1/2022
A low-grade appendiceal mucinous neoplasm (LAMN) is not reportable. The WHO classification designates LAMN with the behavior code /1 [uncertain whether benign or malignant].