EOD-Pathologic Review of Number of Lymph Nodes Positive and Examined: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Description.
A breast cancer patient had a FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases.
Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection.
Example 2: Patient received no neoadjuvant therapy.
For cases diagnosed 1998-2003, the number of Regional Nodes Positive and Examined include all nodes examined by the pathologist, unless there is disease progression. In other words, these fields are cumulative. An FNA alone, positive for regional lymph node metastasis is coded as 97 for number positive and 95 for number examined. 1 & 2. Assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Case example: Code number of regional nodes positive as 01, number examined as 07.
Grade, Differentiation--Bladder: How is this field coded for a five grade system? See Description.
Example: Invasive, high grade transitional cell carcinoma (Grade 4-5/5)
For this example, code grade as 4 based on the term "High grade." If "high grade" was not stated, the grade would be coded as 9, not determined. There is no SEER translation between the ICD-O grades and a five grade system for bladder. None of the pathololgist experts we querried knew of a five grade system for bladder.
Multiple Primaries (Pre-2007)--Breast: For a patient with a remote history of lobular breast carcinoma, would a new diagnosis of lobular breast carcinoma with DCIS be a new primary, even though the physician designates it as recurrent? See Description.
A history of right breast lobular ca in 1991 treated with a partial mastectomy. Diagnosed 3/02 with "recurrent right breast ca" per physician; pathology in 2002 is lobular and DCIS.
Would the DCIS make this a new primary regardless of the physician's designation of 'recurrent' or is this the same primary?
For tumors diagnosed prior to 2007:
Accession as two breast primaries -- the first lobular ca in 1991; the second lobular and DCIS in 2002.
The differing histologies and the length of time between them negate the physician's designation as "recurrent" in this case.
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.
Histology (Pre-2007)/Primary Site/Diagnostic Confirmation: How would these fields be coded for a diagnosis of cholangiocarcinoma based on clinical findings only? See Discussion.
We have a case of reported "cholangiocarcinoma" of the liver diagnosed only by a CT of the abdomen. There is no pathologic confirmation. CT ABD: Heterogeneous liver mass suspicious for cholangiocarcinoma; mass causes right portal & right hepatic vein occlusion & right and left biliary duct dilatation....
Should this be coded to cholangiocarcinoma by radiology alone and should it be liver as primary site?
For tumors diagnosed prior to 2007:
Code according to the prevailing medical opinion in this case. If no further information can be obtained, code as cholangiocarcinoma of the intrahepatic bile duct.
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.
Grade, Differentiation: Is grade always coded to 4 for a diagnosis of Ewing's sarcoma?
Do not code the ICD-O-3 grade for Ewing sarcoma unless documented in the record.
In the TNM system, grade is required to place Ewing sarcoma into a stage group. For TNM staging purposes, Ewing sarcoma is classified as G4. Do not apply TNM rules to ICD-O coding.
Reportability/History (Pre-2007)/Behavior Code--Ovary: Should the matrix principal in Rule F be applied to code a 2002 right ovary case to 8462/3 [Papillary serous borderline ovarian tumor] when peritoneal washings reveal the same histology?
For tumors diagnosed prior to 2007:
Do not apply the matrix principle in this case. This ovarian tumor is not reportable (behavior /1 per ICD-O-3). The peritoneal washings reveal the same histology (/1), rather than malignant cells. Based on the information provided, there is no evidence to support changing the behavior code.
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.
Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description.
Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?
Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias.
Histology (Pre-2007)/Sarcoma: What code is used to represent the histology "Ewing's Sarcoma/Primitive Neuroectodermal Tumor (PNET)"? See Description.
A comment on one path report states "some authors consider both Ewing's & PNET to be the same biologic entity given that they share the same translocation between chromosomes 11 & 22." The pathologists at our children's hospital agree with this statement and contend that the two should have the same histologic code.
For tumors diagnosed prior to 2007:
Code histology as 9260/3, Ewing sarcoma. Ewing sarcoma is a specific histology on the continuum of primitive neuroectodermal tumors. Code Ewing sarcoma as it is more specific than PNET, NOS.
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.
Histology (Pre-2007)--Stomach: What code is used to represent the histology of "mucin-secreting adenocarcinoma, intestinal type "for a stomach primary?
For tumors diagnosed prior to 2007:
For this specific example, code histology to 8481 [Mucin-producing adenocarcinoma] as it is a more specific cell type with inherent prognostic information.
Code 8255/3 [Adenocarcinoma with mixed subtypes] is not appropriate for this case because "intestinal type" is a more specific description of this cancer and not another type of cancer. There are two broad categories of gastrointestinal adenocarcinomas: Intestinal and Diffuse.
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.
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