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20091059 | CS Tumor Size--Breast: How is this field coded for DCIS that is present in scattered small foci over five of eight slides, and the greatest aggregate dimension measures 0.5 cm? See Discussion. | Breast biopsy was prompted by abnormality seen on mammography. Would this be an example of when to code 996 (mammographic/xerographic diagnosis only, no size given; clinically not palpable) applies for the CS Tumor Size field? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Assign code 005 [0.5 cm] in this case. According to the General Instructions for CS tumor size, it is acceptable to code an aggregate size stated by the pathologist (see instruction 4.i). |
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20091053 | Multiple Primaries--Breast: How many primaries should be reported when a lobular carcinoma with positive margins is followed 8 years later by a lobular carcinoma near the previous lumpectomy site? See Discussion. |
Left breast invasive lobular ca diagnosed 3/00 and treated with a lumpectomy, but with multiple positive margins; she received no post operative radiation or other medical treatment (unknown why). 10/08 core biopsy of "an area of distortion" near the scar site is positive for invasive lobular ca. The radiologist states "compatible with recurrence at her previous lumpectomy site" on an x-ray report. One thought is that this should not be a new primary because the patient was never disease free (multiple positive margins) and the patient received incomplete treatment. Or should this be a new primary because the tumors are diagnosed more that 5 years apart? |
Abstract the 10/08 diagnosis as a new primary, per Breast rule M5. In spite of the positive margins and apparently incomplete treatment in 3/00, there is no mention of the presence of disease between 3/00 and 10/08 according to the information provided. |
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20091001 | CS Lymph Nodes/CS Mets at DX--Ovary: Are lymph nodes in the pericolic mesentery of the sigmoid that are removed during ovarian cancer debulking surgery, coded as regional or distant? See Discussion. | Debulking surgery found tumor in both ovaries and in lymph nodes of pericolic mesentery, which was removed en bloc with a segment of sigmoid colon (colon had tumor implants involving serosa). Pericolic nodes are not listed as regional for ovary. However Note 2 in the CS manual for Extension states "sigmoid mesentery" is a regional pelvic organ, and that metastatic deposits here should be coded in the extension field, not as distant mets. Should lymph nodes from this same area be coded as regional or distant? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2. Lymph nodes in the mesentery of the sigmoid colon are regional for an ovarian primary. Code involved sigmoid mesenteric nodes under CS Lymph Nodes. |
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20091035 | CS Extension--Ovary: What code is used to capture omental caking? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.The term "omental caking" refers to a thickened omentum. In the case of ovarian cancer, omental caking is always indicative of involvement of the omentum. The omentum is an abdominal structure for the purposes of CS extension. Assign the appropriate code between 70-73.
When the size of implants is not stated, but operative report and scans state omental caking, code 71 would be best. When there are no size measurements on the operative report or scan or elsewhere, there is not enough information to assign 72. The choice of code between 70 and 73 will depend on the details of the specific case. |
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20091025 | MP/H Rules/Multiple primaries--Urinary: How should we handle urinary tract tumors diagnosed before the MP rules went into effect when determining the number of primaries to report primaries? How do you apply rules M5, M6 and M8 when an invasive bladder tumor and other urinary site tumors occur before and after the effective date of these rules? See Discussion. |
Example: Patient with a prior in situ carcinoma of the bladder in 11/89, left ureter papillary transition cell carcinoma in situ diagnosed in 5/05, left renal pelvis papillary transition cell carcinoma in situ diagnosed in 8/07 and invasive bladder carcinoma diagnosed in 3/08. When an invasive bladder tumor and other urinary site tumors occur, do you stop with the bladder at rule M5 and M6 never reaching M8? |
For cases diagnosed 2007 or later: Use the 2007 MP/H rules for urinary sites to assess diagnoses made in 2007-2014. Use the multiple tumors module to compare a diagnosis in 2007-2014 to an earlier diagnosis. For the example above, start by comparing the left renal pelvis diagnosis in 8/07 to the earlier left ureter primary diagnosed 5/05. Start with rule M3. Stop at rule M8. The 8/07 renal pelvis diagnosis is not a new primary. Next, compare the 3/08 bladder tumor to the earlier left ureter primary diagnosed 5/05. Start with rule M3. Stop at rule M5. The 3/08 bladder tumor is a new primary because it is an invasive diagnosis following an in situ diagnosis. Use only the more recent of the two earlier urinary diagnoses for comparison. Do not compare the 2007 and later diagnoses to the 11/89 in situ bladder primary in this case. |
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20091051 | MP/H Rules/HistologyCorpus Uteri: How should histology be coded for a "carcinosarcoma with high grade sarcomatous component within a polyp, with greater component of endometrioid carcinoma and foci papillary serous carcinoma within polyp"? | For cases diagnosed 2007 or later, assign code 8980/3 [Carcinosarcoma] according to rule H17. Rule H12 does not apply since the final diagnosis is not "adenocarcinoma." | 2009 | |
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20091114 | MP/H Rules/Multiple primaries--Breast: Would a left chest wall mass excision stated to be ductal carcinoma consistent with a breast primary and, "compatible with either local recurrence or potentially a metastasis" be a new primary per the MP/H rules? See Discussion. | Patient underwent mastectomy in 1986 for infiltrating ductal carcinoma of left breast. Excision of left chest wall mass in March 2009 showed ductal carcinoma consistent with breast primary. The pathology report COMMENT stated it would be compatible with either local recurrence or a metastasis. The patient's primary breast carcinoma material is not available for direct comparison and the MP/H rules instruct us to ignore metastasis. | For cases diagnosed 2007 or later, the MP/H rules do not apply to metastasis. If there is no further information available for this case, the MP/H rules do not apply to the 2009 diagnosis. | 2009 |
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20091125 |
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. | 2009 |
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20091102 | MP/H Rules/Histology--Thyroid: How should histology be coded for a diagnosis of "papillary sclerosing carcinoma" with an additional description of the tumor being "nonencapsulated"? See Discussion. | Pathology report reads, "Papillary sclerosing carcinoma." In one case, the results are in CAP protocol format and next to 'Encapsulation of tumor' it says 'No.' In the other case, it is not in CAP format, but the microscopic description says, 'encapsulation of tumor - no.' Is the correct code 8350? | For cases diagnosed 2007 or later, code 8350 [Nonencapsulated sclerosing carcinoma] per MP/H Other Sites Rule H11. The definition for 8350 in the Morphology section of ICD-O-3 includes nonencapsulated as well as diffuse sclerosing papillary carcinoma. When the pathologist states 'No' for encapsulated, that means nonencapsulated. | 2009 |
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20091063 | CS Lymph Nodes--Head and Neck: How is this field coded when a positive neck FNA is followed by a neck dissection that contains one of seventeen positive lymph nodes? See Discussion. | The primary site is the right tongue. The patient underwent FNA of a right neck mass that was positive for squamous cell carcinoma. Subsequent right modified radical neck dissection showed one out of seventeen nodes positive for metastatic carcinoma. For head and neck primaries, the CS LN codes 10-19 represent a single positive ipsilateral regional node. Codes 20-29 represent multiple positive ipsilateral nodes. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.If the neck dissection included the area of the positive FNA, count only the positive nodes from the dissection. Avoid double-counting a positive node for both an FNA and a dissection. In the unlikely event that the dissection did not include the area of the positive FNA, add one positive node to the count from the dissection. This instruction supersedes previous instructions. |
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