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20190030 | Summary Stage 2018/Extension--Prostate: Can imaging be used to code SEER Summary Stage 2018? MRI shows tumor involved the seminal vesicles and the patient did not have surgery. AJCC does not use imaging to clinically TNM stage a prostate case. |
Note 5 was changed in Version 2.0. Per Note 5 of the 2018 SEER Summary Stage Prostate chapter: Imaging is not used to determine the clinical extension. If a physician incorporates imaging findings into their evaluation (including the clinical T category), do not use this information. This note was changed in Version 2.0 (2021 changes) to be in line with how AJCC stages; therefore, AJCC and Summary Stage agree. |
2019 | |
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20190025 | 2018 Solid Tumor Rules/Histology--Colon: What is the histology code of a diagnosis of well differentiated neuroendocrine tumor (NET), grade 2 of the appendix? See Discussion. |
SINQ 20160023 and the Solid Tumor Rules indicate NET G1 (or well differentiated NET) is coded as 8240 and NET G2 is coded as 8249. Clarification regarding grade coding in the CAnswer Forum indicates well differentiated neuroendocrine tumor refers to the histologic type, and not the grade. Therefore, the term well differentiated is ignored for the purpose of grade coding. Neither of these sources clarifies how to code histology for a tumor diagnosed as well differentiated neuroendocrine tumor, grade 2. |
Assign histology code 8249 for histology described as well differentiated NET G2. A synonym for NET of the appendix includes well-differentiated endocrine tumor/carcinoma according to WHO Classification of Tumors of the Digestive System, 4th edition. "Well differentiated" could apply to either NET G1 or NET G2. |
2019 |
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20190018 | Histology--Thyroid: Should any mention of encapsulated be included in the histology coding (8343/3 vs. 8260/3) for papillary thyroid carcinoma cases? See Discussion. |
Example: Left thyroid lobectomy with final diagnosis When the only mention of encapsulation is included in the tumor characteristics of the College of American Pathologists (CAP) summary, not the pathologist's choice of histologic type, what is the preferred histology? |
Assign 8343/3 for encapsulated variant of papillary thyroid carcinoma. If the pathology report is not available, use the histologic type in addition to other information in the CAP Protocol. |
2019 |
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20190009 | First Course Treatment/Surgery of Primary Site--Breast: How is "Goldilocks," also referred to as oncoplastic reconstruction, in the surgery section for breast cancer patients coded? |
Code Goldilocks mastectomy in Surgery of Primary Site. Breast surgery code 30 seems to be the best available choice for "Goldilocks" mastectomy. It is essentially a skin-sparing mastectomy with breast reconstruction. The choice between code 30 and codes in the 40-49 range depends on the extent of the breast removal. Review the operative report carefully and assign the code the best reflects the extent of the breast removal. |
2019 | |
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20190021 | Sequence Number Central--Brain and CNS: How is Sequence Number--Central coded for current/recent benign brain/CNS tumors when the patient has a history of an additional non-malignant CNS tumor diagnosed prior to 2004 (when these tumors became reportable to SEER)? See Discussion. |
We are confused by the SEER Program Coding and Staging Manual 2018 instruction that states: This sequence number counts all tumors that were reportable in the year they were diagnosed even if the tumors occurred before the registry existed or before the registry participated in the SEER Program. Does this rule apply to benign and borderline CNS tumors? Does this mean that any non-malignant CNS tumor diagnosed prior to 2004 should NOT be included in the sequencing (in the 60s range) if we were collecting non-malignant CNS per our State Registry reporting requirements prior to 2004? Example: Patient has a March 2017 diagnosis of right sided vestibular schwannoma (C724-1, 9560/0) and a prior history of left sided acoustic neuroma (c724-2, 9560/0) diagnosed in 1991. How should sequence be coded for each primary in our file? |
For your example, code the Sequence Number--Central as 61 for the 1991 diagnosis if this was a state registry requirement in 1991 and code 62 for the 2017 diagnosis. |
2019 |
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20190103 | Solid Tumor Rules/Multiple primaries--Brain and CNS: What M rule applies to a clinically diagnosed right-sided parietal meningioma undergoing active surveillance, followed by a left-sided frontal anaplastic oligodendroglioma? See Discussion. |
The patient has two, separate, non-contiguous tumors. One tumor is a benign meningioma and the other is a malignant oligodendroglioma. The original plan was not to treat the asymptomatic meningioma. However, after worsening symptoms, imaging and resection proved a separate left frontal lobe malignant tumor. Rule M5 is the only M Rule in the Malignant CNS Multiple Primary Rules, Multiple Tumors module that addresses separate non-malignant and malignant tumors. This rule provides only two criteria to follow when a malignant tumor follows a non-malignant tumor. The first criteria (for non-malignant tumor followed by malignant tumor) states: --Patient had a resection of the non-malignant tumor (not the same tumor) OR --It is unknown/not documented if the patient had a resection. This patient did not have a resection of the original, separate, non-malignant tumor, but the treatment plan was known to not include a resection. Should Rule M5 also apply to cases where the patient never had treatment planned for the separate non-malignant tumor? |
Apply 2018 Malignant CNS Solid Tumor Rule M5 and abstract multiple primaries when there are multiple CNS tumors, one of which is malignant /3 and the other is non-malignant /0 or /1. According to Note 3, a non-malignant CNS tumor and a malignant CNS tumor are always multiple primaries (timing and primary sites are irrelevant). Prepare two abstracts; one for the non-malignant and another for the malignant tumor. |
2019 |
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20190096 | Solid Tumor Rules (2018)/Multiple primaries--Colon: Is a colorectal anastomotic site recurrence reportable, that is, a second primary, per Rule M7, third bullet, if there is no mention of mucosa but the tumor is seen on colonoscopy? See Discussion. |
Colon, Rectosigmoid, and Rectum Multiple Primary Rule M7 states, Abstract multiple primaries when a subsequent tumor arises at the anastomotic site AND the subsequent tumor arises in the mucosa. We identified tumors at the anastomotic site of previous colon primaries with no mention of mucosa in any of the available documentation. Are there any other indicators that would imply a tumor arising in the mucosa, or do we need this specific statement to apply rule M7? Example: Patient has a history of invasive ascending colon adenocarcinoma diagnosed in October 2017 status post hemicolectomy followed by adjuvant chemo. There is no documentation of disease until August 2019 colonoscopy which shows a mass in the ileocolic anastomosis. Biopsy of the anastomotic site is positive for adenocarcinoma consistent with recurrence of the patient's colonic adenocarcinoma. There is no mention of mucosa found on the pathology report. |
Abstract a single primary using 2018 Colon Solid Tumor Rule M8 in the example provided as there is a subsequent tumor occurring less than 24 months in the anastomotic site, with the same histology and no mention of mucosa. The new tumor would be a new primary when it meets any one of the criteria noted in M7. The tumor does not have to be stated to have arisen in the mucosa. M8 also has three options to determine if a single primary is present. |
2019 |
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20190037 | Solid Tumor Rules/Multiple Primaries--Breast: How many primaries should be abstracted for simultaneously diagnosed non-contiguous invasive duct carcinoma and mucinous carcinoma? Does rule M12 apply since the two histologies are on different rows of Table 3 of the Breast Solid Tumor Rules? See Discussion. |
Core biopsy of left breast at 2:00: Invasive ductal carcinoma, Nottingham score 6/9. Core biopsy of left breast at 4:00: Invasive mucinous carcinoma (variant of ductal carcinoma), Nottingham score 5/9. Post neo-adjuvant mastectomy: Main (largest tumor): Invasive ductal carcinoma, upper outer quadrant grade 2. Secondary tumor: mucinous carcinoma, grade 1 at 4:00. |
Abstract multiple primaries when separate, non-contiguous tumors are on different rows in Table 3 of the Breast Solid Tumor Rules. Use Rule M14 as each row in the table reflects a distinctly different histology, in this case, invasive ductal carcinoma (8500) and mucinous carcinoma (8480). |
2019 |
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20190043 | Diagnostic Confirmation: How is Diagnostic Confirmation coded for malignancies diagnosed by a FoundationOne Liquid biopsy/assay involving circulating tumor DNA in blood only? See Discussion. |
Example: FoundationAct assay of circulating tumor DNA in blood sample results: Tumor type = non-small cell lung carcinoma, NOS, with 3 genomic alterations identified: NRAS Q61H, IDH2 R140Q and TP53 V172F. The tumor was identified on imaging and the imaging findings were not clearly what one would expect to see with a SCLC. |
Code Diagnostic Confirmation as 7, Radiology and other imaging techniques without microscopic confirmation for this case. Results of a FoundationOne Liquid biopsy/assay are not specific enough to diagnose this lung malignancy. |
2019 |
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20190010 | Reportability/Histology--Bladder: Is papillary urothelial neoplasm of low malignant potential (PUNLMP) (8130/1) reportable when also referred to as papillary transitional cell carcinoma, grade 1, no invasion (8130/2) previously? See Discussion. |
The pathology report reads: Urinary bladder, tumor over right ureteral orifice, biopsy: Urinary bladder mucosa (urothelium) and submucosa (lamina propria), with papillary urothelial neoplasm of low malignant potential (previously known as papillary transitional cell carcinoma, grade 1 of 3), no invasion identified. |
This case is not reportable. PUNLMP (8130/1) is the diagnosis stated by the pathologist for this case and PUNLMP is not reportable. The information in parentheses is informational in this case and does not change the pathologist's diagnosis. According to WHO Classification of Tumors of the Urinary System and Male Genital Organs, 4th edition, there is variation of architectural and cytological features between PUNLMP and papillary urothelial carcinoma, low grade, reflecting grading changes from an older classification system. |
2019 |
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