2016 SEER Manual/Primary Site--Corpus Uteri: Is the primary site C541 (endometrium) or C543 (uterine fundus) when the histology states endometrial adenocarcinoma, endometrioid type, but tumor site states fundus? See Discussion.
Pathology--Final description: Uterus, cervix, bilateral fallopian tubes and ovaries, total hysterectomy and bilateral salpingo-oophorectomy: Endometrial adenocarcinoma, endometrioid type, well differentiated, FIGO 1/3. Myometrial invasion: focal myometrial invasion (30% of myometrium) Tumor size: 2 x2 cm Tumor site: Fundus, exophytic/polypoid lesion Gross description: The 3.0 cm in length by 2.5 cm in diameter triangular endometrium is tan-red and smooth with a 2.0 x 2.0 cm tan-pink, exophytic fundic mass which extends on to both anterior and posterior aspects, 4.1 cm from the os.
We recommend coding endometrium, C541, as the primary site for this case. While coding to fundus would not be incorrect, according to our expert pathologist consultant, "it is more appropriate in a setting in which the region of the uterus is of importance, e.g. with a myoma or a myosarcoma, or if the endometrioid carcinoma were NOT in the endometrium but arising in a focus of adenomyosis within the fundic myometrium."
EOD 2018/EOD Primary Tumor/Tumor Size--Clinical--Prostate: How is Tumor Size--Clinical coded when there is an incidental finding of prostate cancer on prostatectomy for another reason? See Discussion.
SEER*RSA states EOD Primary Tumor should be coded to 800 for an incidental finding of prostate cancer on prostatectomy for other reasons.
The SEER Manual states to assign code 000 for Tumor Size--Clinical when EOD Primary Tumor is coded to 800; however, the definition for Tumor Size--Clinical indicates clinical classification is composed only of diagnostic workup prior to treatment.
If there is no clinical workup for an incidental finding of prostate cancer, code 000 does not seem appropriate (does not meet criteria for clinical classification). Code 999 seems more appropriate for incidental findings during surgery for other reasons. The SEER Manual does not provide this exception in the current instruction.
Assign code 000 for Tumor Size--Clinical when EOD Primary Tumor is coded 800 (No evidence of primary tumor). Code 000 indicates no tumor was found since there was no clinical workup to identify this incidentally found cancer. This is a special instruction for cases coded 800 in EOD Primary Tumor. Text fields can be used to record details.
Ambiguous terminology/Reportability--Thyroid: Should a thyroid case be accessioned based only on a cytology that is consistent with papillary carcinoma? See Discussion.
Instructions in the 2007 SPCSM state that we are not to accession a case based only on a suspicious cytology. Does this rule apply only to the term "suspicious" or does it apply to all ambiguous terms? Example: FNA of thyroid nodule is consistent with papillary carcinoma.
Do not accession the case if the cytology is the only information in the medical record. The phrase "Do not accession a case based only on suspicious cytology" means that the cytology is the only information in the record. If there is other information that supports the suspicion of cancer (radiology reports, physician statements, surgery), then accession the case. The phrase "suspicious cytology" includes all of the ambiguous terms.
SEER Manual/Reportability--Ambiguous Terminology: Please clarify the reportability and relevant date ranges of the following ambiguous terminology: almost certainly, most certainly, and malignant until proven otherwise. See Discussion.
SINQ 20180104 indicates, in the absence of further info, the terms “almost certainly” and “until proven otherwise” are NOT reportable. There is no date range provided for this answer.
SINQ 20200027 indicates, in the absence of further info, the term “most certainly” IS reportable. There is no date range provided for this answer.
SEER Program Coding and Staging Manual 2022 indicates, in the absence of further info, the terms “until proven otherwise” and “most certainly” ARE reportable.
Essentially, we are hoping for an update of SINQ 20180104 due to 2022 reportability change. Clarification to the equivalence of “almost certainly” and “most certainly” would also be helpful.
Use the ambiguous terminology list as a guide in the absence of additional information after reviewing all available information and consulting the physician who diagnosed and/or staged the tumor.
Equivalent to "Diagnostic for" malignancy or reportable diagnosis
most certainly carcinoma
malignant until proven otherwise
NotEquivalent to "Diagnostic for" malignancy or reportable diagnosis
almost certainly ("almost" conveys uncertainty in comparison to "most" as in "most certainly")
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