Terminology/Terms of involvement: When the terms "lytic" or "lysis" are used in an imaging study, are they to be interpreted as synonymous with metastasis, or can these terms be used to describe a non-malignant condition?
Although the term "lytic lesion" is often used to describe bone lesions and "tumor lysis" develops in response to systemic therapy, the words are not a part of the SEER list of terms used to describe involvement. Do not code distant metastasis based only on these words.
Grade, Differentiation--Lymphoma/Leukemia: What code is used to represent this field when the phenotype is combined B cell and T cell?
For cases diagnosed prior to 1/1/2010:Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable]. There is no combination code for B cell and T cell. There is also no hierarchy established for choosing one code over the other. Therefore coding such a case as a pure B cell or a pure T cell would misrepresent the phenotype.
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.
Grade, Differentiation--Unknown Site: Is grade coded to 9 [Cell type not determined, not stated or not applicable] for all unknown primaries?
Most unknown primaries would be coded to grade 9 [Cell type not determined, not stated or not applicable] in the Grade, Differentiation field unless the case is coded to one of the histologies for which the grade is implied, such as undifferentiated carcinoma, NOS [802034].
Spanish Surname or Origin: If Asians, Blacks and Whites with non-Spanish surnames are born in a Spanish country, is this field coded to Spanish or non-Spanish? See discussion.
For example, how do we code Miyako Mitsubishi with race listed as Japanese who was born in Peru or Sylvia Shapiro with race listed as White who was born in Argentina?
For both cases, code the Spanish Surname or Origin field to 0 [Non-Spanish/Non-Hispanic]. Persons with non-Spanish surnames would not be coded as being Spanish solely because they are born in a Spanish country. Do not code Spanish ethnicity based only on birthplace. Place of birth is a separate data item and it can be used in data analysis to identify this particular group of people.
EOD-Lymph Nodes--Breast: Are lymph nodes described as being either "keratin positive" or "keratin positive for metastasis" to be coded as involved lymph nodes?
For cases diagnosed between 1998-2003:
Lymph nodes that are only "keratin positive" would not be coded as involved lymph nodes. The pathologist uses this expression to mean that the nodes stained positive for keratin that does not mean they are also involved with cancer.
However, if the pathologist uses these stains to make a definitive diagnosis of metastatic carcinoma (i.e., uses the expression "keratin positive for metastasis"), then code the nodes as involved.
Histology (Pre-2007)--Breast: Are diagnoses of "infiltrating duct and mucinous carcinoma" and "duct carcinoma, mucinous type" both coded to the histology code of 8523/3?
For tumors diagnosed prior to 2007:
Code "Infiltrating duct and mucinous carcinoma" to 8523/3 [Infiltrating duct mixed with other types of carcinoma] according to the instructions for coding a single tumor with complex histology in Appendix C of the 2004 SEER manual. Assign code 8523/3 when the diagnosis is duct carcinoma mixed with another type of carcinoma. Look for "and" or "mixed" in the diagnosis.
Code the Histology field for a "ductal carcinoma, mucinous type" to 8480/3 [Mucinous carcinoma].
The instructions for coding a single tumor with complex histology are to code the specific type if the diagnosis is "Duct carcinoma, _____ type."
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.
EOD-Extension--Pancreas: How do you code extension when CT scan shows a mass in the head of the pancreas "encompassing" the hepatic branch of the celiac artery? See discussion.
We do not code the term "encompasses" as involvement. However, should we code this case as extension to the peripancreatic tissue, NOS or as unknown?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [Extension to peripancreatic tissue, NOS]. There has to be extension to peripancreatic tissue if the mass encompasses the celiac artery.
EOD-Extension--Lung: Are "aortico-pulmonary window", "paratracheal space", and "subcarina" coded in the EOD extension field or in the EOD lymph node involvement field? See discussion.
Would a lung tumor that extends into the AP window be synonymous with extension into the mediastinum? If so, would this also apply to extension to subcarina, paratracheal space, and other such terms corresponding to areas listed in the mediastinal lymph node field under code 2?
For cases diagnosed between 1998-2003:
Extension into the aortico-pulmonary window, would be coded in the EOD-Extension field as 70 [mediastinal extension]. If the tumor extends into the paratracheal space, subcarina, or other areas listed under the code 2 in lymph nodes, code the EOD-Extension field to 70 to capture this type of involvement.
EOD-Lymph Nodes/EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Lung: How do you code these fields for clinically positive lymph nodes when the result of neoadjuvant treatment is that the lymph nodes are pathologically negative? See discussion.
The pt presents with "mediastinal adenopathy" for a lung primary and was treated with pre-operative radiation therapy. After two months, he was treated with surgery. The 10 lymph nodes removed were all negative. How does SEER code these three EOD fields?
Will an error be triggered in SEER Edits if you code lymph nodes as clinically positive in the EOD lymph node involvement field and yet pathologically negative in the number of regional nodes positive and number of regional nodes examined fields?
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 2 [Mediastinal, NOS]. Code the EOD-Regional Lymph Nodes Positive and Examined fields to 00/10. You will not have a problem with the SEER Edits. The EOD field is coded using clinical and pathologic information. All information gathered within four months of the date of diagnosis (in the absence of disease progression) or through completion of surgery(ies) can be used to code EOD. The clinically positive nodes justify the radiation therapy.
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