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Report Produced: 11/22/2024 07:13 AM

Report Question ID Question Discussion Answer Year
20000430 Histology (Pre-2007)--Colon: What code is used to represent histology when the surgeon describes a sessile polyp and the final path diagnosis is stated as: "Rectal sessile polyp: Invasive moderately differentiated adenocarcinoma" (pathologist does not state that it is "arising in a sessile polyp")?

For tumors diagnosed prior to 2007:

Code the Histology field to 8210/3 [adenocarcinoma arising in a polyp]. The structure in which this adenocarcinoma is arising, is a polyp.

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.

 2000
20000429 EOD-Size of Primary Tumor--Breast: For breast cancer cases, is code 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)] to be used only when there is no work-up beyond a clinical one? See discussion.

Usually when a mammogram has a malignant diagnosis, the tumor is clinically palpable, but occasionally the tumor is not palpable.

For example, on the mammogram, lesions are identified in the breast. PE--the breasts are palpably normal. Breast biopsies--two ductal carcinomas, no statement of size. Mastectomy--no residual. Should the size be coded to 999 rather than 002?

For cases diagnosed 1998-2003:

In the case you provided, code the EOD-Size of Primary Tumor field to 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)]. A known code in the size field should always take precedence over 999 [Not stated]. Code size from the records in priority order as stated in EOD, from pathology, op report, PE, mammogram, etc. (See EOD for complete instructions.)

Code size as 999 only when there is a clinically palpable lesion with no size stated in the path, PE, or mammogram.

If there is a lesion seen on mammogram that is not clinically palpable, a stated size taken from the path or mammogram would take precedence over code 002; however, if there is no stated size, use code 002 rather than 999.

 2000
20000428 EOD-Clinical Extension--Prostate: How do you distinguish between clinical extension codes of 10, 13, 14, and 20 for cases with a benign prostate per digital rectal exam that appear localized after TURP/prostatectomy? Can the clinical extension code of 10 be used if the term "microscopic carcinoma" is noted in the pathology report without also mentioning "foci" or "Stage A" for clinically inapparent tumors?

For cases diagnosed 1998-2003:

When the prostate feels benign and the cancer is found incidentally at the time of the microscopic exam, code the EOD-Extension field to 10 [number of foci or % of involved tissue not specified]. Code as 13 (less than or equal to 5%) or 14 (greater than 5%) if percentage involved is given in the tissue resected. If the path report states "solitary focus of carcinoma" without mentioning the total amount of tissue resected, code extension to 13. If there is more than one focus, code extension to 10. Don't assign a code of 20 unless the tumor is clinically apparent.

 2000
20000422 Surgery of Primary Site: Should laparoscopy be coded as exploratory surgery? See discussion. Many surgeons are doing exploratory surgery with laparoscopy involving a very small incision, but they can examine organs and take biopsies. Should laparoscopy be coded as exploratory surgery? For cases diagnosed 1/1/1998 and later: Exploratory surgical procedures, such as laparoscopic surgeries, are not coded in the Surgery of Primary Site field. 2000
20000421 Surgery of Primary Site/Reconstruction-First Course--Breast: If the plan is to "reconstruct" the breast 6 months after an ipsilateral modified radical mastectomy, is the time span a problem or should it be coded in the Surgery of Primary Site field because it was planned? For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 55 [Modified radical mastectomy WITHOUT removal of uninvolved contralateral breast, Implant]. The time span is not a problem as long as the reconstruction was planned as first course, which is indicated by tissue expander insertion at the time of the original surgery. 2000
20000420 Date of Diagnosis--All Sites: Is it better to estimate the month in the date of diagnosis field using the re-excision pathology report date or code the month to unknown if the only available information is the re-excision date? See discussion.

The only available information is the following pathology report:

On 7/18/00 a wide excision of the primary lesion is done. The report reads, "Lesion approximately 1 cm. Residual superficial spreading malignant melanoma with deepest penetration 4 mm."

Code the Date of Diagnosis field to 07/2000 for this case. Estimate the month of diagnosis whenever possible.

Given the usual delay between the initial excision of the lesion and a wide excision for a melanoma, estimate the month of diagnosis as July.

 2000
20000419 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.

 2000
20000418 Measured Thickness/EOD-Extension--Melanoma: If the Clark's level is not provided, can it be estimated using the depth of invasion provided in the pathology report and associating that number with the Clark's levels identified in the SEER Summary Staging Guide?

For cases diagnosed 1998-2003:

No. Do not use the SEER Summary Stage Guide or any other guide to derive an estimated Clark's level from the thickness identified in the pathology report. The two measurements need to come directly from the pathology report. Each is coded separately in EOD. Thickness is collected in a separate field so we can capture the actual measurement stated in the pathology report. This has made it possible for us to group depth of invasion for analysis purposes in any manner we might wish. In addition, we can always collapse this information to the Summary Stage or TNM using the AJCC rules. AJCC rules use both depth of invasion and thickness in determining pathologic staging, and, if there is an inconsistency between them, the rules say code to the higher T classification, that is, the least favorable finding.

 2000
20000280 Primary Site--Breast: Is there a hierarchy for coding subsite for breast cases when there is conflicting information in the physical exam, mammogram, operative and pathology reports as to the exact location of the primary? See discussion.

Example: Two mammograms were performed. One report indicates the lesion is at 12:00 and the other indicates it is in the upper central quadrant. However, the pathology report from the modified radical mastectomy specimen indicates the mass is in the UIQ.

According to one of our physicians, when a pathologist has a mastectomy specimen with attached axillary contents, the location of the lesion (subsite) is very accurate.

Code the Primary Site field to C50.2 [upper inner quadrant]. In general, the priority for using information is pathologic, operative, and clinical findings. The pathology report would take precedence in this case.

The 2004 SEER Program Code manual will include the following instructions for determining breast subsite.

Priority Order for Coding Subsites

Use the information from reports in the following priority order to code a subsite when the medical record contains conflicting information:

1 Pathology report

2 Operative report

3 Physical examination

4 Mammogram, ultrasound

If the pathology proves invasive tumor in one subsite and insitu tumor in all other involved subsites, code to the subsite involved with invasive tumor.

 2000
20000277 Ambiguous Terminology: Should SEER's lists of ambiguous terminology be modified to reflect how pathologists and radiologists actually use these terms? See discussion. Pathologists and radiologists say the term "suggestive" is used to describe a lesion that may be malignant, and the term "suspicious" is not used to describe lesions that may be malignant. According to the physician director of our Breast Center the FDA governs the use of terminology, and the term "highly suggestive" instead of "highly suspicious" must be used if there is a greater chance that a mass is malignant.

We recognize that the way clinicians and registrars speak is often different, and that the differences vary from region to region.

Our Medical Advisory Board reviewed the lists of ambiguous terminology before they were included in the third edition of the SEER EOD and the SEER Program Coding and Staging Manual 2004. Since that time, specific terminology has been mandated for describing mammography results. We know some of these terms are discrepant with our ambiguous terminology list.

As of 2007, the standard setters (CoC, NPCR, SEER and CCCR) all use the same ambiguous terminology list. Changes to the list must be approved by the NAACCR Uniform Data Standards Committee.

 2000