CS Lymph Nodes--Esophagus: Is a resected positive "periesophageal nodule" coded as an involved lymph node for an esophagus primary? See Discussion.
Per SINQ 20000846: Each gross nodule of metastatic carcinoma in the fat surrounding an organ is counted as one positive regional lymph node. SINQ 2000846 applied to EOD. Can this concept be used for Collaborative Stage?
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 cases diagnosed on or after January 1, 2004:
Search for additional information on the "nodule." Review the gross and microscopic descriptions to determine whether or not the nodule is a lymph node. If it is not possible to obtain further information, apply the downstaging rule and select the Extension or LN code that results in the lower category.
Histology (Pre-2007): Is an intra-abdominal mass with the histology of "squamous cell carcinoma arising in a dermoid cyst" coded to 8070/3 [Squamous cell carcinoma] or 9084/3 [Dermoid cyst with malignant transformation]?
For tumors diagnosed prior to 2007:
Code histology to 9084/3 [Dermoid cyst with malignant transformation] per the ICD-O-3. Dermoid cysts may contain a malignant component of a type typically encountered in other organs and tissues.
For tumors diagnosed 2007 or later, 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.
CS Lymph Nodes--Breast: Clarify the use of code 25 [Movable axillary lymph node(s), ipsilateral, positive with more than micrometastasis (i.e., at least one metastasis greater than 2 mm)] vs code 60 [Axillary/regional lymph node(s), NOS; Lymph nodes NOS] when surgically removed lymph nodes are positive but the size of the metastasis is not stated. See Discussion.
Note 2 in CS manual states: "If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2mm and code LNs as positive in this field. Use code 60 in the absence of other information about regional nodes."
1. If the LNs are known to be axillary LNs, note 2 seems to imply the size can be assumed to be greater than 0.2mm. Would you code 25 or 60?
2. Both codes 25 and 60 map to N1, node involvement. Do they each mean something else in the evaluation process?
3. What would constitute "absence of other information"?
4. Is the use of 60 over 25 specific to SEER registries or all users?
5. Abstractors are trained to assume LNs are mobile if there is no contrary information. Is this appropriate?
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 CS Lymph Nodes code 25 for breast when there are positive axillary nodes without internal mammary nodes. Code 25 is used in a couple of situations: a. when you know the lymph nodes are clinically movable and only the axillary nodes are involved; b. when you know the size of the metastasis in an axillary lymph node is more than a micrometastasis (i.e., > 2 mm). Code 60 can be used for any regional lymph node (internal mammary, infra- or supraclavicular, as well as axillary. So you can code to 25 if you have "regular" metastases in axillary lymph nodes only. If you don't know whether the mets are micro or regular, use code 60. Assign code 60 when there are positive regional nodes not further described.
1. Assign code 25 for positive axillary lymph nodes.
2. Codes 25 and 60 may map to N1, N1a, N2a or N3a depending on the coding of SSF3.
3. Assign code 60 when there is not enough information to assign a code from 13 to 50.
4. CS instructions are the same for all users. There are no CS instructions specific to SEER registries.
5. Yes, assume lymph nodes are moveable (not matted, not fixed) when there is no information to the contrary.
First Course Treatment: If an "aromatase inhibitor" used as a complement to Tamoxifen is treatment, how should it be coded?
When an aromatase inhibitor is part of the planned first course of therapy, code it under hormone treatment.
When a change of drug is PLANNED, it is part of the same course even if subcategories change. This is the usual situation with Tamoxifen and aromatase inhibitor (for example: Femara). The switch to Femara is planned, so it is not a new course. When a drug change happens that is not planned, it is still the same course if both drugs are in the same category and subcategory. An unplanned drug change to a different subcategory would be a new course.
CS Extension/CS Mets at Dx--Peritoneum: How are these fields coded for extraovarian peritoneal carcinomas presenting with multiple peritoneal implants? See Discussion.
Patient presented with large omental cake and multiple peritoneal implants including implants on the rectosigmoid serosa and right ovary. Path revealed papillary serous adenocarcinoma consistent with peritoneal primary.
Per AJCC Manual, extraovarian peritoneal carcinoma is usually staged with the ovarian staging classification.
We understand that the CS Manual will eventually be revised to include staging for extraovarian peritoneal primaries. In the meantime, how do we use the existing CS scheme for peritoneum to code these 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.
Code CS Extension 99 [unknown] and CS Mets at DX 99 [unknown].
The issue has been sent to the CS steering committee for resolution. This answer will be updated when the steering committee provides a resolution.
Histology--Hematopoietic, NOS: How is an "advanced MDS (RAEB-T)/emerging AML" coded when discovered on a bone marrow biopsy?
For cases diagnosed prior to 1/1/2010:Code histology to 9984/3 [RAEB-T]. This particular MDS is refractory anemia with excess blasts in transformation. It has not yet progressed to acute myeloid leukemia.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Date of Diagnosis/Ambiguous Terminology--Lung: Would the date of a PET scan that states there is a mass in the lung which is "in the range of malignancy " be coded as the date of diagnosis or would the date of a subsequent bronchoscopy with biopsy be used for diagnosis date because it confirms a malignancy?
The date of diagnosis in this case is the date of the bronchoscopy with biopsy.
"In the range of malignancy" is not one of the ambiguous terms that are reportable. Please see the list of reportable ambiguous terms on page 3 of the 2004 SEER manual. Do not accession cases based on ambiguous terms not found on the reportable list.
CS Lymph Nodes--Colon: Are positive paracecal lymph nodes for cecal primaries coded to 10 [paracolic] or code 20 [cecal: anterior (prececal), posterior (retrocecal); NOS]?
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 20 [Regional lymph node(s) for specific subsites]. Paracecal means near the cecum. Paracecal lymph nodes are regional nodes for the cecum and not for other colon subsites.
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