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Report Produced: 10/01/2024 18:30 PM

Report Question ID Question Discussion Answer Year
20041102 CS Tumor Size--Breast: How is this field coded when a core needle biopsy removes the majority of the tumor? See Discussion.

Rule 4.j on page 128 of the 2004 SEER Manual states "Do not code the tumor size from a needle biopsy unless no residual tumor is found on further resection".

Example: 3/04/04 core biopsy Rt breast grade 1 infiltrating ductal carcinoma tumor size 0.8cm. 3/10/04 Lumpectomy: 3mm focus of residual infiltrating ductal carcinoma. If we can not take the size of the core needle biopsy, do we use the residual size of 3mm or the clinical size which was 1cm on mammogram?

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 the tumor size from the mammogram. Do not code the tumor size from the needle biopsy because residual tumor was present in the lumpectomy specimen.

 2004
20041083 CS Lymph Nodes/CS Reg Nodes Eval -- Rectum: If the rectal tumor is not treated with a resection but on endoscopic ultrasound the patient is stated to have a lymph node above the primary tumor and the physician stages the case clinically as N1, should the CS Lymph Nodes field be coded to 30 [Regional lymph node(s), NOS] or 10[Rectal, NOS]? Should the evaluation field be coded to 0 [No lymph nodes removed. Evidence based on other non-invasive clinical evidence] or 1 [No lymph nodes removed. Evidence based on endoscopic examination.]? See Discussion.

Rectal primary:

5/04 sigmoidoscopy w/bx of rectal mass: adenocarcinoma. 6/04 Endoscopic ultrasound of rectal mass: invasion through wall but no definite invasion of prostate or seminal vesicles; 7.5mm lymph node located above tumor, no other enlarged lymph nodes detected. Patient did not have surgery. Physician staged lymph node involvement to clinical N1.

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 10 [Regional lymph nodes] based on the physician's N1. Assign code 10 because it is the lowest numerical CS code that corresponds to N1 in the scheme for rectum. Use the physician's assignment of TNM when the information in the medical record is incomplete or ambiguous. Code CS Reg Nodes Eval field 0 [No lymph nodes removed] for the case described above because there is no indication that N1 was assigned based on the endoscopic exam. The NI may be based solely on TNM documentation provided by the clinician and you do not know what the clinician used as the basis for the staging.

 2004
20041078

Ambiguous Terminology: Is the expression "has the markings of a malignancy" a clinically reportable term? See Discussion.

12/02 Baseline mammogram: spiculated mass with associated marked retraction located in UOQ lt breast. This has the markings of malignancy. Several microcalcifications in outer aspect of rt breast. BI-RADS 5 higly suggestive of malignancy.

Do not accession cases using only the term "has the markings of malignancy." This term is not on the list of ambiguous terms that are reportable. If the term does not appear on either the reportable or not reportable list, the term is not diagnostic of cancer. Do not accession the case.

Please see SINQ 20010094 in reference to BI-RADS terminology.

 2004
20041066

Reportability/Date of Diagnosis--Ovary: Is a patient SEER reportable in 2001 or 2003 if she presented with a diagnosis of papillary serous tumor of low malignant potential [borderline tumor] per the 5/2001 surgery but at the time of the planned second look laparoscopic surgery is stated to have Stage 3A ovarian cancer? See Discussion.

A patient was seen in 5/2001 for large pelvic mass growing from right ovary. After TAH and USO and partial omemtectomy, path diagnosis was papillary serous tumor of low malignant potential (borderline tumor), unruptured. Right ovary and omental implant have identical histologic appearance, except the psammoma body formation and the ovary does not.

Patient does not return for lap as planned in 6-12 months.

In 1/03 she returns to hospital with abdominal pain and has debulking, hemicolectomy and Hartmann's procedure. 1/03 Path report "metastatic papillary serous adenoca." Chart now says "History of stage 3A ovarian cancer."

Yes, this case is reportable in 2003. Malignancy was confirmed in 2003. The diagnosis made in 2001 is not reportable for that year, and was not reviewed or revised according to the information provided.

 2004
20041045 Histology (Pre-2007)--Ovary: What code is used to represent clear cell cystadenocarcinoma of the ovary?

For tumors diagnosed prior to 2007:

Code histology to 8310/3 [Clear cell adenocarcinoma, NOS]. This is consistent with the WHO Classification of Tumours and reflects the current practice of placing less emphasis on "cyst-" prefix for ovarian malignancies.

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.

 2004
20041054 CS Extension--Prostate: For a tumor that is clinically inapparent, but a biopsy from the prostatic apex is positive, is this field coded to 15 [Tumor identified by needle biopsy, e.g., for elevated PSA (clinically inapparent)]?

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.

Yes. Code CS Extension-Clinical Extension to 15 [Tumor identified by needle biopsy, e.g., for elevated PSA (clinically inapparent)] for clinically inapparent prostate cancer with positive apex biopsy.

 2004
20041080

Behavior Code/CS Extension--Brain and CNS: How are these fields coded when the final diagnosis on pathology indicates that an atypical meningioma invades the brain and the bone flap specimen indicates extensive invasion through the full thickness of the calvarium? See Discussion.

FDx on the path is: A. Rt frontotemporal brain tumor: Atypical meningioma, WHO grade II (out of III). B. Arachnoid tissue: Atypical meningioma with small focus of invasion into superficial brain and focal perivascular spread. C. Bone flap: Atypical meningioma with extensive invasion through full thickness of the calvarium.

Comment: Although this tumor shows a small focus of brain invasion, it should be considered a grade II (out of III) meningioma based on its histologic atypia (cellularity, sheeting of tumor cells and prominent nucleoli), elevated Ki-67 index and low mitotic rate.

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 2004, the example above is a benign meningioma and not reportable to SEER.

For tumors diagnosed 2004 or later, code the behavior as 1 [Borderline malignancy]. Code CS Extension as 05 [Benign or borderline brain tumors].

According to expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant.

 2004
20041038 Reportability--Bladder: Is "low grade papillary urothelial neoplasm with no evidence of invasion" reportable to SEER? "Neoplasm" means "new growth," not malignancy. A low grade papillary urothelial NEOPLASM with no evidence of invasion [8130/1] is not reportable to SEER. However, a low grade papillary urothelial CARCINOMA with no evidence of invasion [8130/2] is reportable. 2004
20041049 Histology (Pre-2007): What code is best used to represent a diagnosis of "metaplastic carcinoma, matrix producing type." The tumor shows poorly differentiated infiltrating duct carcinoma and myxoid, cartilaginous stroma.

For tumors diagnosed prior to 2007:

Code the histology to 8575 [metaplastic carcinoma, NOS]. According to the WHO Classification of Tumors of the Breast and Female Genital Organs, metaplastic carcinoma is a type of epithelial breast tumor. Matrix producing carcinoma is a synonym of metaplastic carcinoma. ICD-O-3 does not have a code for matrix producing carcinoma.

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.

 2004
20041025 Immunotherapy/Chemotherapy: Are monoclonal antibodies, such as Avastin and Erbitux, coded as immunotherapy or chemotherapy? See Discussion. In review of the "FDA-approved oncology agents not listed in SEER Book 8" provided in 5/02, it appears "monoclonal antibodies" are coded as immunotherapy. Code Avastin and Erbitux as chemotherapy because both of these drugs are growth inhibitors. Code growth inhibitors (cytostatic agents) as chemotherapy. Do not assume that monoclonal antibodies are coded as immunotherapy. 2004