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.
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.
Reportability/Histology--Gallbladder: Is Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia reportable? The primary site is gallbladder.
Intracholecystic papillary neoplasm (ICPN) with low-grade intraepithelial neoplasia is not reportable. The WHO assigns a behavior of 0 to these neoplasms.
First course treatment/Radiation Therapy--Prostate: How do you code fiducial markers for prostate cases?
Do not code fiducial markers as a form of radiation treatment; rather, code the radiation therapy in the radiation treatment section. Fiducial markers are small metal spheres, coils, or cylinders that are placed in or near a tumor to help guide the placement of radiation beams during treatment.
CS Site Specific Factor 1--Colon: If the registrar did not support the CEA code recorded with the appropriate text documentation, should the central registry accept the registrars coding or change the value to 999?
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.Accept your registrars' codes at your discretion. It is encouraged, but not required, to enter text for CS data elements. These cases do not automatically default to code 999.
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: What codes are used to represent these fields when only a regional lymph node (positive) aspiration is performed?
For cases diagnosed 1998-2003:
With the exception of those sites/histologies that require 99 in these fields, code the Number of Regional Lymph Nodes Positive field to 97 [Positive nodes but number of positive nodes not specified]. Code the Number of Regional Lymph nodes Examined field to 95 [No regional Lymph nodes removed, but aspiration of regional Lymph nodes was performed].
Reportability--Myelodysplastic Syndrome: How we handle cases of myelodysplastic syndromes identified in 2001 casefinding documents that are determined to have an "unknown diagnosis" date after review of the patient's hospital medical record?
Myelodysplastic syndrome cases with unknown dates of diagnosis identified in pre-2001 casefinding documents should not be accessioned and are not SEER reportable.
For cases identified in 2001 casefinding documents, when the diagnosis date cannot be confirmed using the medical records typically accessed by the registrar or central registry staff, do not accession these cases; they are not SEER reportable. This default applies only to those cases identified in 2001 casefinding documents.
For cases identified in 2002 or later casefinding documents, the attending physician should be contacted and asked to clarify the diagnosis date for cases identified with unknown dates of diagnosis. Clarifying the diagnosis date is necessary to determine whether the case is reportable and whether it should be accessioned.
EOD-Regional Lymph Nodes--Breast: Are subpectoral nodes the same as interpectoral nodes and, therefore, regional for breast primaries?
Subpectoral lymph nodes are regional nodes for breast primaries. Subpectoral is the term generally used to describe the placement of a prosthesis during reconstruction (under/behind the pectoralis major muscle). That is the same location for interpectoral, or Rotter's, nodes.
Behavior Code--Bladder/Lymphoma: Should the "in situ" designation on a bladder primary's pathology report be ignored that states a diagnosis of "in situ lymphoma"?
Ignore the in situ designation. You cannot assign an in situ behavior code to a lymphoma primary. The term or designation of "in situ" is limited to solid tumors; carcinoma and/or cancer.
Surgery of Primary Site--Prostate: Is a prostate saturation biopsy coded under diagnostic biopsy or surgery?
A prostate saturation biopsy is a transperineal template-guided stereotactic saturation prostate biopsy that typically produces 30 to 80 core biopsies. This is an alternative biopsy technique used for some high-risk patients including men with persistently elevated PSA, those who have atypia on prior prostate biopsies, or men with biopsies showing high-grade prostate intraepithelial neoplasia (PIN). Although this is a different procedure, it is still a diagnostic biopsy. Do not code prostate saturation biopsy under Surgery of Primary Site.
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