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Report Produced: 11/25/2024 01:56 AM

Report Question ID Question Discussion Answer Year
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
20021056

Histology (Pre-2007)/Terminology: Are "pattern", "architecture", and "architectural pattern" terms that indicate a majority of tumor?

For tumors diagnosed 2004 to 2006:

The terminology "Architectural pattern: ____________," when used in the final pathology diagnosis, indicates a subtype that can be coded. This type of format in a pathology report is based on a College of American Pathologists (CAP) protocol. Disregard "pattern" and "architecture" when not used in accordance with the CAP protocol. See www.cap.org for cancer protocols.

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
20021055 EOD-Extension--Liver: Can we use CT scan descriptions such as "portal vein thrombosis" or "extensive infiltration of the liver" or "diffuse infiltration of the liver" to code extension for liver primaries? See discussion.

1. Would you code portal vein involvement for a CT scan description of "portal vein thrombosis"?

2. Would you code more than one lobe of the liver as involved for CT scan descriptions of "extensive infiltration of the liver" or "diffuse infiltration of the liver"?

For cases diagnosed 1998-2003:

1. No. Thrombosis can be caused by non-cancerous conditions.

2. Yes. Code the EOD-Extension field to 65 [Multiple (satellite) nodules in more than one lobe of the liver] when "extensive infiltration" or "diffuse infiltration" is stated.

 2002
20021054 Histology (Pre-2007)--Breast: What code is used to represent the histology "invasive ductal carcinoma, mucinous type and invasive lobular carcinoma"?

For tumors diagnosed prior to 2007:

Code the Histology field to 8522/3 [infiltrating duct and lobular carcinoma] per rule 1 of the Coding Complex Morphologic Diagnoses, because the tumor is both lobular and ductal.

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
20021053 EOD-Extension--Pancreas: How would you code extension for the following non-surgically treated pancreas primaries? None of these cases has TNM staging to assist with classifying the extent of disease. See discussion.

1) CT scan: Cystic lesion in body of pancreas. Discharge dx: pancreas ca.

2) Discharge dx: CBD obstruction due to probable early ca in head of pancreas.

3) CT scan: mass involves the head and body of the pancreas. No evidence of abdominal mets. Discharge dx: Locally advanced pancreatic ca.

4) H&P: Pt with splenomegaly probably secondary to splenic vein thrombosis and a large ca of the tail of pancreas. Imp: Advanced pancreatic ca of the tail of pancreas. Would you code extension to splenic vein [56]?

5) H&P: Pancreatic ca with extension or mets into porta hepatis. (Would you assume direct extension or mets?)

6) CT scan: Pancreas ca. Significant peritoneal implants. (Would you assume the implants to be related to the pancreas primary and code as involvement?)

For cases diagnosed 1998-2003:

The information provided for these pancreatic primary examples is very limited. Additional information should be sought. If not available, code the EOD-Extension field to:

1) 10

2) 10

3) 10

4) 99

5) Assuming primary in head, body or tail of pancreas, 76

6) 85

 2002
20021052

EOD-Extension--Pancreas: Should these terms be ignored when coding extension to 10 or 30, or do they indicate involvement for non-surgically treated pancreas primaries?

1) Stricture of the common bile duct

2) Common bile duct is narrowed

3) Common bile duct is obstructed

4) Common bile duct dilation

5) Malignant stricture of the common bile duct

6) Ampullary or common bile duct stricture with a negative biopsy or brush.

For cases diagnosed 1998-2003:

Ignore these terms when coding extension to 10 or 30. These terms do not verify involvement by pancreatic cancer of the organs mentioned. Other non-malignant circumstances could cause these conditions.

 2002
20021051 EOD-Extension--Pancreas: Can you explain the difference between code 10 [confined to pancreas] and code 30 [Localized, NOS]. See discussion. For example, a CT scan mentions no extension beyond the head, body or tail of the pancreas and there is no surgical resection. Should we code extension to 10 or 30?

For cases diagnosed 1998-2003:

Code the EOD-Extension field to 10 [confined to pancreas] because a scan supported the finding of no extension beyond the pancreas.

If the abstractor reviewing the medical record has scans, op reports, and/or pathology reports stating that the tumor is confined to the pancreas, code extension to 10 [confined to pancreas].

However, if the medical record only provides a patient history from a physician stating that the patient had localized pancreas, code extension to 30 [localized, NOS]. The NOS codes are used only when there is not enough information to code the specific codes (in this case, 10 or 20).

 2002
20021050 EOD-Extension--Pancreas: If the tumor involvement for a case falls between two different regional extension codes, should we code to the lesser of the two codes or should we code extension as unknown? See discussion.

Example 1: CT scan description: Mass in the head of the pancreas. The duodenum is "surrounded" by tumor. Should we code extension to 40 [peripancreatic tissue extension, NOS] or 99 [unknown] because the extension code could be further than 40. It could be 44 [extension to duodenum].

Example 2: CT scan description: Mass in region of pancreatic head and "root" of superior mesenteric artery consistent with pancreatic cancer. Should we code extension to 40 [peripancreatic tissue extension, NOS] or 99 [unknown] because the extension code could be further than 40? It could be 54 [extension to major blood vessels].

For cases diagnosed 1998-2003:

In both examples, code the EOD-Extension field to 40 [peripancreatic tissue extension, NOS]. Choose the lowest of a known possible extension code over an unknown code.

 2002
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.

 2002
20021047 Surgery of Primary Site--Bladder: Do we code "random bladder biopsies" as an excisional biopsy (27) or as no cancer directed surgery (00) even if the only involvement mentioned on the pathology reports is "focal carcinoma in situ"? Code the Surgery of Primary Site field to 00 [None; no surgery of primary site] when only random biopsy procedures are performed on the bladder. 2002