Ambiguous Terminology: Why do the instructions for this field use the term "accession" rather than "abstract"?
The purpose of the new data item "Ambiguous Terminology" is to identify cases that were put into the cancer registry database without a conclusive diagnosis. The decision to accession the case was influenced by ambigous terminology. The emphasis is on accessioning the case rather than abstracting it.
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.
Behavior--Bladder: What behavior code is used for a TURB path specimen diagnosis of "non-invasive urothelial carcinoma, no muscle found, depth of invasion cannot be assessed" when the clinician stages the case as Ta? See Discussion.
The SEER site specific coding module for bladder says, "If the only surgery performed is a TURB and if it is documented that depth of invasion cannot be measured because there is no muscle in the specimen, code the behavior as malignant and not in situ."
Assign behavior code 2 [in situ] based on the physician's stage Ta.
When no other information is available and the TNM designation is not available, use the instructions on page C-844 in Appendix C of the 2007 SEER manual as a default.
Reportability--Melanoma: Is a skin excision final diagnosis of "melanocytic tumor with uncertain malignant potential" reportable if the path COMMENT states the initial shave biopsy diagnosis was "melanocytic tumor with uncertain malignant potential [minimal deviation melanoma]"? See Discussion.
SKIN, RIGHT FOOT, EXCISION: CHRONIC SCARIFICATION WITH RESIDUAL ATYPICAL MELANOCYTES IN THE DERMIS IDENTIFIED, BUT COMPLETELY EXCISED.
Comment: The prior outside biopsy report indicates that the lesion was a melanocytic tumor of uncertain malignant potential (minimal deviation melanoma) measuring at least 2.5 mm in depth. There was apparently no in situ component. Special stains performed here are similar, with positive reactivity for Melan A and S-100. The cells are atypical, but there are reactive changes, making it impossible to accurately assess the true nature of the lesion in this biopsy. If this is a minimal deviation melanoma, it would be classified as a T3 (T3a since there is no description in the outside report of ulceration) lesion. The atypical melanocytes extend to a depth of 1.1 mm in this 2 mm deep biopsy, but are completely excised, both at the deep margin and at all of the peripheral margins (closest margin is superior, with clearance of 7 mm).
PATH FROM INITIAL BIOPSY: Diagnosis: Rt dorsal foot, shave biopsy: Melanocytic tumor of uncertain malignant potential (see comment). Tumor depth at least 2.5mm Deep margin involved. Comment: As a primary lesion, I would favor that this represents a melanocytic tumor with indeterminate biologic potential also known as minimal deviation melanoma. The lesion does extend to the deep margin and wider excision is recommended.
This case is not reportable. Based on the information provided, there is no definitive diagnosis of malignancy.
MP/H Rules/Multiple Primaries--Melanoma: Is there a difference between multiple primary rules M6 and M7 because both rules state that tumors occurring more than 60 days apart are to be reported as multiple primaries? See Discussion.
Rule M6 clearly states that an invasive melanoma occurring more than 60 days after an in situ melanoma is a multiple primary. However M7 states that any melanomas diagnosed more than 60 days apart are multiple primaries. Since M7 does not state malignant melanomas diagnosed more than 60 days apart, this implies that any scenario:
in situ following an invasive,
invasive following an in situ,
in situ following an in situ,
or invasive following an invasive
are all multiple primaries if more than 60 days apart. If that is the intent of M7, then M6 is totally unnecessary. If the intent of M7 is only for an invasive following an invasive, then the word malignant needs to be inserted as the first word of rule M7.
For cases diagnosed 2007 or later, M7 is intended to apply to in situ and invasive melanomas. Therefore, M6 and M7 are repetitive.
This will be corrected when revisions are made to the MP/H rules. In the meantime, both M6 and M7 result in multiple primaries so it does not matter which rule is used.
Reportability/Diagnostic Confirmation: If a diagnosis based solely on positive flow cytometry is reportable even if a bone marrow biopsy is negative, how is diagnostic confirmation coded?
For cases diagnosed prior to 2010
The case is reportable if a recognized medical practitioner says the patient has cancer.
A flow cytometry alone is not diagnostic but it may be supported by either a positive bone marrow or a clinician's statement. If the clinicians statement is based only on flow cytometry, code diagnostic confirmation to 8 [Clinical diagnosis only].
CS Extension/Histology (Pre-2007)--Bladder: Is the histology coded to 8010/2 [carcinoma in situ] or to 8130/2 [papillary transitional cell carcinoma, non-invasive] for a 2006 bladder tumor with a final path diagnosis of "mixed non-invasive papillary TCC and flat carcinoma in-situ" and is CS Extension coded to 01 [Papillary transitional cell carcinoma state to be noninvasive]or to 06 [Carcinoma in situ]? See Discussion.
If the correct code for histology is 8130/2 and CS Extension is 06, this combination does not pass NAACCR edits.
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.For tumors diagnosed prior to 2007, code CS Extension to 06 and histology to 8130/2. Override the NAACCR edit.
For cases diagnosed 2007-2014, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Reportability--Brain and CNS: Does a neurofibroma actually arise in peripheral nerve roots like a schwannoma even if it is referred to as a "C6-T1 intradural spinal cord tumor" and is therefore not reportable?
Schwannomas and neurofibromas of the peripheral nerves are not reportable. Schwannomas of the nerve root or spinal dura are reportable.
MP/H Rules--Urinary: How many primaries are abstracted when a patient has a May 2000 invasive papillary transitional cell carcinoma of the bladder, a November 2004 invasive papillary transitional cell carcinoma of the right ureter and a May 2007 urothelial carcinoma in situ of both the left and right ureters?
For cases diagnosed 2007 or later:
Using the pre-2007 multiple primary rules, the PTCC of the bladder in 2000 and the invasive TCC of the right ureter in Nov. 2004 would have been abstracted as separate primaries.
Use the 2007 MP/H rules to evaluate the May 2007 diagnosis. Start with rule M3. Stop at rule M8. The May 2007 diagnosis is the same primary.
Rule M4 does not apply because of the 2000 bladder primary. A clarification will be added to M4 to stress that for the urinary rules, any urinary tumor up to the present point in time is counted when applying this rule.
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