Reportability/Diagnostic Confirmation--Leukemia: What is the diagnostic confirmation if a positive BCR/ABL result is diagnostic of a malignancy in a patient suspected to have chronic myelogenous leukemia? See Discussion.
Example 1: Peripheral smear states: "No morphologic evidence of chronic myelogenous leukemia."
Addendum: Molecular diagnostic studies showed a positive rearrangement for the BCR gene with the M-bcr (CML type) and of bcr-abl transcript expression".
Example 2: Hematopathology is negative.
Molecular diagnostic study: "fluorescent in situ hybridization (FISH) studies exceeded the limits established by the XXX Cytogenetics Laboratory for this probe set, and thus, demonstrated statistical evidence of BCR/ABL fusion."
For cases diagnosed prior to 1/1/2010:
Do not determine reportablility using cytogenetics or molecular studies alone.
Since these are not routine screening tests, we suggest that you query the physician and review the medical record to see what prompted the study and what is being done with the result, but the test alone is not in and of itself sufficient to report the case.
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.
First Course Treatment/Surgery of Primary Site--Lung: How is radiofrequency ablation for lung primaries coded?
Assign code 15 [Local tumor destruction, NOS] in the Surgery of Primary Site field. RFA is a technique where a probe placed in or near a tumor sends radio waves into the tumor, causing it to heat up and kill the cancer cells. RFA doesn't fit neatly into code 12 or 13, so we are left with the NOS code.
Reportability--Brain and CNS: Does a case of astrogliosis meet the criteria for gliomatosis cerebri? See Discussion.
Case clinically stated to be a glioma of the brain. Pathology from resection states astrogliosis.
Anderson's Pathology defines astrogliosis as astrocytic proliferations. Gliomatosis cerebri is defined as diffuse neoplastic transformation of poorly differentiated astrocytes over a wide area; predominantly invovles hemispheric white matter.
The pathologic diagnosis for this case, astrogliosis, is not reportable to SEER. Take the definitive diagnosis for this case from the pathology report from the resection. The pathology report takes precendence over the clinical diagnosis.
Primary Site--Breast: If a patient has multifocal tumors all in the upper outer quadrant of the breast, is the primary site coded to C-504 because all of the tumors are in UOQ or would the site be coded to C509 to reflect the fact that multiple tumors exist?
Code the primary site to C504 [Upper outer quadrant]. All disease is located in one quadrant, code that quadrant. When disease involves two or more quadrants and the point of origin cannot be determined, code C509 [Breast, NOS]. See 2004 SEER manual, page C-470 for instructions about invasive and in situ in different quadrants.
Reportability/Behavior--Brain and CNS: How is a brain "neoplasm" diagnosed only by CT scan reported to SEER? See Discussion.
We have a significant number of patients who come into our emergency room and are diagnosed with a brain neoplasm by CT scan. They are transferred to another facility for further care. Some of those facilities will give us information - histology, treatment, etc. Some will not. How are we supposed to report these brain neoplasms if we don't know if they are benign or malignant? Can we report them as behavior code 9 or do we just report them as benign if we can't get any further information?
The case above is reportable and 8000/1 is the most appropriate histology/behavior code. A clinical diagnosis alone from diagnostic imaging reporting a brain 'neoplasm' (with a diagnosis date supporting the reportable case requirements) even with no other information available (from biopsy or resection) is reportable. Care should be taken when reviewing terms used by the radiologist on these reports, since some tumors exhibit defining characteristics that can be picked up on diagnostic imaging.
Histology (Pre-2007)--Melanoma: How is a 2004 "malignant melanoma, nodular type, epithelioid cell type" coded?
For tumors diagnosed prior to 2007:
Assign code 8771 [Epithelioid cell melanoma]. Code the cell type when specified.
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.
Reportability/Behavior--Thyroid: Does the term "invasion" indicate the presence of a malignant tumor? See Discussion.
Left thyroid lobectomy showed microfollicular neoplasm with evidence of minimal invasion. Micro portion of path report stated, "The capsular contour is focally distorted by a finger of the microfollicular nodule which appears to penetrate into the adjacent capsular and thyroid tissue."
We recommend that you contact the pathologist for further information. If no further information is available, do not accession this case based on the information provided. There is no definitive statement of malignancy.
If the case was sent to a consultant, there may be another opinion available. If there is information in the record, or the treating physician can be contacted, find out whether the tumor was benign or malignant and whether there was any further treatment.
According to our pathologist consultant, based only on the information above and nothing else, do not report since there is no diagnosis of malignancy.
CS Lymph Nodes/CS Mets at Dx--Lung: In which CS field is a focus of squamous cell carcinoma in the soft tissue coded for a lung primary? See Discussion.
Final Pathologic Diagnosis:
1. Right upper lobe mass, lobectomy: Extensive well differentiated squamous cell carcinoma
2. Right hilar lymph nodes: No tumor identified in nine hilar lymph nodes. A focus of squamous carcinoma is present in soft tissue
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 a separate focus of squamous cell carcinoma in soft tissue in the CS Mets at DX field. Use this field to capture discontinuous metastasis. Code CS Mets at DX as 40 [Distant mets except distant lymph nodes] for the case described above.
CS Tumor Size--Rectum: Should the tumor size be coded to 080 from the colonoscopy size or 075 from the CT scan size? See Discussion.
6/29/04 Colonoscopy with biopsy: near obstructing circumferential friable mass extending from 8 to 16cm above anal verge. 6/30/04 CT Scan Abdomen/Pelvis: 7.5X7.2cm large rectal mass. The patient had radiation with concurrent 5-FU. Surgery is done after treatment.
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 tumor size as 080 (8cm). Code the largest pretreatment size recorded when there is preoperative systemic treatment.
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