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Report Produced: 02/18/2026 09:20 AM

Report Question ID Question Discussion Answer Year
20091038 CS Tumor Size--Breast: Do the tumor size instructions in the CS Manual take priority over those in the SEER manual? See Discussion. In regards to priority order of sources to be used in coding size for breast and lung, we are instructed to use the site-specific instructions in the 2004 SEER Manual over the general instructions in the CS Manual (see SINQ 20061109). Thus, physical exam size would be used over an imaging size. I&R question 2389 instructs registrars to use an imaging size over a physical exam size. This inconsistency creates confusion for them. Do the answers given in I&R not take into account the information in the SEER Manual? As a SEER Registry, which rules do we tell our hospitals to use? Are ACoS accredited hospitals required to use I&R over SINQ?

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 current SEER instructions and the CS instructions for source of tumor size information are the same. The tumor size priority source instruction in the 2004 SEER manual is not included in the 2007 SEER manual. SINQ 20061109 has been updated for clarification. There is no conflict between SEER instructions and I&R instructions at this time. SEER and the CoC collaborate, endeavoring to provide consistent instructions and to resolve inconsistencies.

 2009
20091068 Primary site--Bladder: What is the appropriate subsite for "adjacent to the bladder neck"? Assign code C679 [Bladder, NOS]. It is not possible to determine the location of the tumor from the description. A tumor that is "adjacent to bladder neck" could be located in the trigone or on the bladder wall (anterior, posterior or lateral). 2009
20091004

Reportability--Kidney: Is the donor or the recipient the reportable patient when a cyst removed from a pre-transplanted kidney is determined to be cancerous? See Discussion.

A patient received a kidney from her son. The son's kidney had a cyst which was removed prior to the transplant and later determined to be renal cell ca. Who do we report, the donor or the recipient?

The renal cell carcinoma should be reported for the donor. The cyst that was determined to be carcinoma was removed before the kidney was transplanted.

 2009
20091103 Reportability/Ambiguous Terminology--Prostate: Is a prostate biopsy that states "highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy" reportable? Do not report. "Not diagnostic of" means that while the pathologist is seeing some features that resemble cancer, there are not enough features to feel comfortable making an unquestionable diagnosis. Watch for another biopsy of the patient in the next 3-6 months. The statement "not diagnostic of" overrules the "highly suspicious" statement. 2009
20091124 CS Eval--Lung: How is the CS Reg Nodes Eval field to be coded when the FNA of a paratracheal lymph node is positive for adenocarcinoma and the patient subsequently undergoes neoadjuvant chemoradiation therapy followed by an excision of multiple lymph node fragments that show adenocarcinoma? See Discussion. The CSv1 scheme for lung shows that code 1 under CS Reg Nodes Eval is a path staging basis. However, the definition for code 1 also states that no regional lymph nodes were removed for examination. Would we use code 1 because the case represents path staging basis? If we select code 5 because regional lymph nodes were dissected, the staging basis would be clinical. If we select code 6, the staging basis would be y.

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.

Use code "6" for the CS LN evaluation field. As explained on page 113 in the 2007 SEER Manual, when post-operative disease is more extensive despite neoadjuvant therapy, this can be coded in the evaluation field. In this case, only an FNA was done on lymph nodes pre-operatively, but actual lymph nodes were removed and documented in the post-neoadjuvant excision of the lymph nodes which documented that they are histologically positive -- proving that the neoadjuvant therapy did not work.

 2009
20091123

Reportability: Is a tumor reportable if the pathology report indicates a non-reportable diagnosis at the time the specimen is removed but subsequent clinical statements state the patient had a reportable tumor? See Discussion.

The 2007 SEER Manual (page 3) states that cases diagnosed clinically are reportable. Exception 2 states if enough time has passed that it is reasonable to assume the physician has seen the negative pathology report, but the clinician continues to call this a reportable disease, accession the case.

SEER reporting guidelines state that severe dysplasia is not reportable, however, many clinicians regard it to be equivalent to carcinoma in situ.

Example 1: In 09-2007 the pathology report for excisional biopsy of right floor of mouth states the final diagnosis is severe dysplasia. At the time, the case is not accessioned based on non-reportable pathology. Patient is subsequently admitted in 3-09. According to the clinical history the patient was diagnosed with squamous cell carcinoma in 2007 and treated with laser. Is this reportable? If yes, how is behavior to be coded? How is "Ambiguous Terminology at Diagnosis" to be coded?

Example 2: In 2-08, the pathology report for a punch biopsy of a skin lesion states the final diagnosis is atypical melanocytic hyperplasia. In 3-08, patient is admitted for re-excision. The clinical diagnosis states re-excision being done for melanoma in situ.

Reference: SINQ 20061123

A tumor that is non-reportable based on the pathology report diagnosis should not be accessioned if later clinician statements mistakenly refer to it as a reportable tumor. The exception in the 2007 SEER manual on page 3 is intended to allow the registrar to accession a case when the clinician actually disagrees with the pathology report and clinically diagnoses a reportable tumor.

 2009
20091018 MP/H Rules/Multiple Primaries/CS Extension: How many primaries are to be accessioned when tumors are present bilaterally in the pleura and fallopian tubes? See Discussion.

For both pleura and fallopian tube, the MP/H rules indicate that bilateral involvement of these sites should be coded as multiple primaries. However, both of these sites have CS extension codes that classify the contralateral disease as regional extension.

Is a case described as a left sided pleural mesothelioma that has right sided pleural disease coded as one or two primaries? How is CS coded?

For cases diagnosed 2007 or later:

For a pleural or fallopian tube primary, if there is tumor(s) on the left and separate tumor(s) on the right and neither is stated to be metastatic from the other, abstract as multiple primaries according to rule M8 for other sites. If both sides are involved, but there is only one tumor, rule M2 for other sites applies and this is a single primary. Code each primary separately in CS.

 2009
20091087 Reportability--Appendix: Is a metastatic low-grade appendiceal mucinous neoplasm reportable if the pathologist states that it is a borderline tumor of the appendix? See Discussion. Low-grade appendiceal mucinous neoplasm; Lt ovary, cul-de-sac, omentum, and small bowel: Metastatic low-grade appendiceal mucinous neoplasm. Per pathologist this is a borderline tumor of the appendix. Borderline tumors (other than brain and CNS) are not reportable to SEER. In the case of borderline tumors, the term "metastatic" does not automatically make them reportable. When the "metastatic deposits" are also borderline, the case is not reportable. For this case in particular, the "metastases" are actually (benign) implants and not malignant or invasive mets. 2009
20091064 Radiation Sequence with Surgery--Head & Neck: How is this field coded for a tonsil primary diagnosed on 4/16/07 by a regional lymph node FNA when the patient subsequently initiates radiation on 5/8/07 and has a tonsillectomy with neck dissection on 7/30/07? The best way to handle this situation is to assign code 2 [Radiation before surgery] in Radiation Sequence with Surgery. Code 2 provides the best description of the sequence of events in this case. Radiation was delivered prior to the resection of the primary site. 2009
20091062 CS Site Specific Factor--Head & Neck: How is Site Specific Factor 2 coded when the pathologist describes regional lymph nodes as "matted"? See Discussion. The primary tumor is located in the tonsil. The patient underwent neck dissection. Pathology report stated there were matted regional lymph nodes. Does the term matted describe extracapsular extension? The definition for site specific factor 2 uses the term "fixed" to describe extracapsular extension (but not matted). For breast, fixed/matted appear to be interchangeable. Would they also be interchangeable for head and neck cases?

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."Matted" is not a synonym for "Fixed" in the CS schema for Head and Neck. "Matted" is not indicative of extracapsular extension for the Head and Neck schema.

 2009