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20010044 | Reportability/Ambiguous Terminology/Date of Diagnosis: If a "suspicious" cytology is reportable only when a later positive biopsy or a physician's clinical impression of cancer supports the cytology findings, is the Date of Diagnosis field coded to the later confirmation date rather than to the date of the suspicious cytology? Is a suspicious "biopsy" handled the same way? |
Cytology reported as "suspicious" is not reportable. If the physician confirms the suspicious cytology by making a clinical diagnosis of malignancy, the Date of Diagnosis field is coded to the date of the clinical diagnosis, which may or may not be same date the cytology was performed. Without supporting clinical documentation, the case will remain non-reportable and will not be submitted to SEER. The supporting documentation can be a physician's statement that the patient has cancer, a scan or procedure that identifies cancer, or a positive biopsy. Suspicious "biopsies" are reportable according to SEER's list of ambiguous terms. Suspicious "cytologies" without supporting clinical statements are not. |
2001 | |
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20240045 | Reportability/Ambiguous Terminology--Prostate: Should cases be reported and abstracted based on ambiguous terminology, e.g., suspicious for prostate cancer, when the physician is not treating the case as malignant? See Discussion. |
Please comment on these specific scenarios.
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For each of your scenarios, the medical record information indicates that the case is not reportable based on physician opinion. Do not abstract these cases. Remember that the ambiguous terms list is to be used as a last resort. The ideal way to approach abstracting situations when the medical record is not clear is to follow up with the physician. If the physician is not available, the medical record, and any other pertinent reports (e.g., pathology, etc.) should be read closely for the required information. See page 19 in the SEER Manual, https://seer.cancer.gov/manuals/2024/SPCSM_2024_MainDoc.pdf |
2024 |
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20140033 | Reportability/Ambiguous Terminology--Prostate: Can you clarify why a prostate biopsy diagnosis of “highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy” is not reportable while a biopsy diagnosis of “atypical glands suspicious for adenocarcinoma with insufficient atypia to establish a definitive diagnosis of malignancy” is reportable? See discussion. |
SINQ 20091103 states that prostate biopsies showing “highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy” are NOT reportable. However, SINQ 20071056 states that “atypical glands suspicious for adenocarcinoma with insufficient atypia to establish a definitive diagnosis of malignancy” is reportable. This appears to be an issue of semantics with no clearly outlined method to determine reportability of such cases.
We have two recent cases with similar semantic issues and want to know whether they are reportable.
1) Prostate biopsy with “atypical small acinar proliferation, highly suspicious for adenocarcinoma, with quality/quantity insufficient for outright diagnosis of cancer.”
2) Prostate biopsy with “atypical small acinar proliferation highly suspicious for adenocarcinoma but due to the small size of focus, findings are not definitively diagnostic.” |
Both case examples provided are reportable using instructions for ambiguous terminology. The diagnoses are qualified by the words "highly suspicious" because neither diagnosis is definitive ("insufficient for outright diagnosis of cancer" and "not definitively diagnostic."). However, we follow our instructions for interpreting ambiguous terminology and report these cases.
SINQ 20091103 differs slightly. The final diagnosis in 20091103 declares unequivocally "not diagnostic of adenocarcinoma." That phrase in the final diagnosis negates the ambiguous terminology. The situation in 20071056 is similar to the two examples above - the ambiguous terminology instructions apply. |
2014 |
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20071060 | Reportability/Ambiguous Terminology--Esophagus: Is a case with a biopsy diagnosis of "... focal areas suspicious for adenocarcinoma in situ change" reportable if the diagnosis on the partial esophagectomy specimen only includes the phrase "... with foci of high grade dysplasia; no invasive carcinoma identified"? |
The case is not reportable. The biopsy with a suspicious result (suspicious for adenocarcinoma) was disproven by the esophagectomy. |
2007 | |
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20010094 | Reportability/Ambiguous Terminology--Breast: Should the American College of Radiology (ACR) BI-RADS assessment categories 4 [Suspicious Abnormality--biopsy should be considered] and 5 [Highly Suggestive of malignancy-appropriate action should be taken], impressions for mammograms and sonograms, be used as the sole basis for reportability? See discussion. |
ACR website: Category 4: Lesions that do not have the characteristic morphologies of breast cancer but have a definite probability of being malignant. Category 5: lesions have a high probability of being cancer. |
Updated Answer Please refer to Appendix E of the SEER Program Coding Manual for the most up-to-date information, https://seer.cancer.gov/manuals/2018/SPCSM_2018_AppendixE.pdf |
2001 |
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20200035 | Reportability/Ambiguous Terminology--Brain and CNS: Is the expression differential considerations a synonym for differential diagnoses? See Discussion. |
Example: An MRI Spine showed a large expansile mass arising from the sella turcica and extending into the suprasellar cistern, but the radiologist only noted: The leading differential considerations include pituitary macroadenoma or a large suprasellar base meningioma. The patient was subsequently pathologically diagnosed with a pituitary adenoma. It is unclear if the diagnosis date should be coded to the MRI date. There are two existing SINQ questions regarding the term consider. SINQ 20061094 confirms a diagnosis that is considered to be is reportable because it is unambiguous, but SINQ 20081033 states the phrase malignancy is highly considered is not a reportable ambiguous term. How should we interpret differential considerations? If differential considerations is equivalent to a differential diagnosis, then this patient was clinically diagnosed on imaging. However, if differential considerations is not reportable, then there was no diagnosis prior to the resection. |
In an ideal situation, the radiologist should be consulted to determine what he/she meant by "differental considerations." If that is not possible, given the context and usage, "differential considerations" in this case can be interpreted as differential diagnoses. And since the two differential considerations are both reportable, this case is reportable as of the date of the MRI. |
2020 |
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20200046 | Reportability--Vulva: Is well differentiated vulvar intraepithelial neoplasm (dVIN) reportable? See Discussion. |
Is this histologic terminology synonymous with 8071/2 Differentiated-type vulvar intraepithelial neoplasia? Per the 7/20/2018 updates to the 2018 ICD-O-3 Histology list, the reportability flag was changed from N to Y for Differentiated-type vulvar intraepithelial neoplasia as well as Differentiated penile intraepithelial neoplasia, both 8071/2. It appears that both SINQ 20180020 and the second half of SINQ 20160069 are no longer valid and should be deleted. |
Report well-differentiated vulvar intraepithelial neoplasm (8071/2). Our expert pathologist consultant regards this as reportable. Well-differentiated is synonymous with differentiated in this context. The older SINQ questions have been removed. |
2020 |
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20150061 | Reportability--Vulva: Is this reportable? We have begun to see the following diagnosis on biopsies of the vulva with the statement below. The diagnosis is being given as simply VULVAR INTRAEPITHELIAL NEOPLASIA, no grade is noted. See discussion. |
The note explains: The International Society for the Study of Vulvovaginal Disease (ISSVD) in 2004 revised its classification of VIN by eliminating VIN 1 and combining VIN 2 and VIN 3 into a single category (see table below). Classification of VIN (usual type) ISSVD [International Society for the Study of Vulvovaginal Disease]1986 classification 2004 classification VIN 1 VIN2 VIN3 VIN Note: VIN 2 and VIN 3 combined into single [non-graded] category, VIN Reference: Scurry J and Wilkinson EJ. Review of terminology of precursors of vulvar squamous cell carcinoma. Journal of lower genital tract disease, 2006; 10(3): 161-169 |
Vulvar intraepithelial neoplasia with no grade specified is not reportable. Reportability instructions have not changed. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf |
2015 |
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20180034 | Reportability--Vulva: Is a biopsy showing high grade squamous intraepithelial lesion (VIN II) in the vulva reportable for cases diagnosed in 2018? See Discussion. |
In comparison to SINQ 20180022, this case does not mention VIN III anywhere in the final diagnosis. Is any mention of HGSIL in the final diagnosis reportable, even if it is qualified with a non-reportable term in parenthesis or CAP protocol? |
Since this HSIL diagnosis is specified as VIN II, do not report it. WHO includes both VIN II and VIN III as synonyms for HSIL of the vulva. HSIL is reportable and VIN III is reportable. VIN II is not reportable. |
2018 |
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20230014 | Reportability--Thyroid: Is a case with thyroid fine needle aspirate (FNA) cytology with nodule 1 Bethesda category 5 and nodule 2 Bethesda 6, reportable in 2021? Does the Bethesda category 5 or 6 have any bearing on reportability? |
In the absence of information to the contrary, thyroid FNAs designated as Bethesda classification category VI are reportable. Thyroid FNAs designated as Bethesda classification category V are not reportable unless there is additional information confirming a reportable diagnosis. For both Bethesda V and VI, NCCN Guidelines recommend total thyroidectomy or lobectomy (depending on tumor size and nodal involvement) for the purposes of definitive diagnosis/treatment, so additional information should be available. We will add this to the next version of the SEER manual. In your example, nodule 1 Bethesda V is not reportable. Nodule 2 Bethesda VI is reportable. |
2023 |
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