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STR Manual, Table 12, Thyroid Histologies, includes "Invasive encapsulated follicular variant of papillary thyroid carcinoma" as histology 8340/3 and is on its own row from other papillary thyroid carcinomas (PTC). A new footnote was added which states, "IEFVPTC and Infiltrative follicular variant of papillary thyroid carcinoma (a PTC subtype) share a histology code, but they are distinctly different histologies. They are on different rows of the table and are different primaries." However, IEFVPTC (and its synonyms) are listed in the ICD-O-3.2 as 8343/3, and 8343/3 was listed as a subtype/variant of papillary thyroid carcinoma in previous versions of the STR Manual.

Historically, synchronous ductal and lobular tumors have been accessioned as a single primary. These were previously covered under Rule M10, which was removed from the (STR) Manual 2026 Update. While the previous iteration of Rule M10 was problematic, the main issue related to the lack of a timing component within the rule (i.e., indicating it applied to synchronous ductal and lobular tumors).

Using the current Breast STR, when there are two (or more) simultaneous tumors which are not mixed lobular and ductal within each tumor, the applicable M Rule is Rule M13: Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3. To apply the M Rules, a provisional histology must be assigned to EACH tumor so we cannot code each tumor as 8522 before we start applying the M Rules. These provisional histologies would be 8500 and 8520, and these are on different rows in Table 3.

Patient failed treatment with Azacitidine for MDS with multilineage dysplasia (9985/3) diagnosed 1/2024, and on re-biopsy of bone marrow 11/2025, histology is now MDS with excess blasts (9989/3). These diagnoses are the same primary using the Hematopoietic and Lymphoid Neoplasms (Heme) Database. The physician has prescribed treatment of Anti-Thymocyte Globulin (ATG)/Cyclosporine/Prednisone. SEER*Rx Database says not to code as ATG and Cyclosporine are antirejection medications post-transplant, but the oncologist is using this combination for treatment.

Code A280 is defined as a total removal of the ovarian tumor or removal of a single ovary (oophorectomy) WITH a hysterectomy. The unilateral removal of both the fallopian tube and ovary [(salpingo-) oophorectomy] is included in surgery codes A350-A370. However, the SEER Note under code A280 states, "Also use code A280 for current unilateral (salpingo-) oophorectomy with previous history of hysterectomy." Should this SEER Note read, "Also use code A280 for current unilateral oophorectomy with previous history of hysterectomy"?

The patient has a known history of polycythemia vera (PV). The Hematopoietic and Lymphoid Neoplasms Database (Heme DB) entry for myelodysplasia-related acute myeloid leukemia ("acute myeloid leukemia post myelodysplastic-myeloproliferative neoplasm") states, "The pathologist must make the diagnosis of being myelodysplasia-related." However, it's unclear if the pathologist's statement of an acute myeloid leukemia (AML) "transforming from" counts as the AML being myelodysplasia-related since AML can arise/transform from PV. The Heme DB does indicate histology 9895 should not automatically be used just because the patient has a history of MPN.

The bone marrow did not identify any of the specific cytogenetic or molecular abnormalities listed in the Heme DB. However, next generation sequencing identified mutations in BCOR, DNMT3A, IDH1, JAK2, EZH2. The managing physician's clinical diagnosis was "AML arising from polycythemia vera."

2026 SEER Manual Appendix E states PI-RADS (4 and 5) are reportable; they can be used to code the diagnosis date.

The Date of Diagnosis Coding Instruction 3 in the SEER Manual states:The first diagnosis of cancer may be clinical (i.e., based on clinical findings or physician’s documentation) Note: Do not change the date of diagnosis when a clinical diagnosis is subsequently confirmed by positive histology or cytology.

2026 STORE Manual states:

PI-RADS, BI-RADS, LI-RADs alone are not reportable for CoC. PI-RADS, BI-RADS, L-RADS confirmed with biopsy or physician statement are reportable to CoC. Date of diagnosis is the date of the positive biopsy or definitive statement from physician.

Example: 01/04/2023 MRI identified both PI-RADS 4 and 5 lesions bilaterally. No work-up immediately followed and there is no chart information to account for the delay. The patient was seen again by urology and a 05/20/2024 biopsy proved adenocarcinoma. The patient underwent a prostatectomy approximately 6 months after biopsy on 01/13/2025. Biopsy diagnosis followed MRI diagnosis more than 16 months later and the plan was for active treatment.

When further work-up does not shortly follow the MRI, and no information is available to the central registry to account for the delay, should the date of the biopsy be used to code diagnosis date?

Using the SEER PI-RADS diagnosis in these cases makes it appear as if any first course treatment is often greater than 1 year after "diagnosis," when it is really only approximately 6 months after the biopsy.

Which source should be used to code diagnosis date in these cases?

Case 1: 01/04/2023 MRI identified both PI-RADS 4 and 5 lesions bilaterally. No work-up immediately followed and there is no chart information to account for the delay. The patient was seen again by urology and a 05/20/2024 biopsy proved adenocarcinoma. The patient underwent a prostatectomy approximately 6 months after biopsy on 01/13/2025. Biopsy diagnosis followed MRI diagnosis more than 16 months later and the plan was for active treatment.

Case 2: 02/05/2024 MRI identified a PI-RADS 5 lesion. No work-up immediately followed and there is no chart information to account for the delay. The patient was seen again by urology and a 08/29/2024 biopsy proved adenocarcinoma. After consultation with the urologist, active surveillance was recommended on 01/27/2025. Biopsy diagnosis followed MRI diagnosis more than 6 months later and the plan was for active surveillance.

Patient has a CT of the abdomen and pelvis that shows a 11.6 cm mixed cystic-solid right adnexal mass most concerning for malignancy. She then has a right salpingo-oophorectomy with numerous adhesions throughout abdomen/pelvis; mass emanating from right ovary, well encapsulated, filling the entire cul-de sac pelvic cavity; left ovary not found, uterus absent.

Pathology: Right Ovary Integrity: Capsule ruptured; Tumor Site: Right ovary; Tumor Size: Greatest Dimension (Centimeters) - 7 cm; Histologic Type: Serous borderline tumor; Histologic Grade: GB, borderline tumor; Ovarian Surface Involvement: Not identified; Fallopian Tube Surface Involvement: Not identified; Implants: Not sampled; Other Tissue / Organ Involvement: Not applicable; Peritoneal / Ascitic Fluid Involvement: Malignant cells present; Chemotherapy Response Score (CRS): No known presurgical therapy; REGIONAL LYMPH NODES Regional Lymph Node Status: Not applicable (no regional lymph nodes submitted or found)

pT Category: pT1c3; pN Category: pN not assigned (no nodes submitted or found); FIGO Stage: IC3

In the Heme Manual, published October 2025, the ambiguous terminology used to determine reportability for heme and lymphoid neoplasms (Case Reportability Instructions) was updated and "consistent with" was removed. However, this is an ambiguous term that is used to describe reportability (and not just histology). The term "consistent with" was previously included as a reportable ambiguous term used to report cases prior to this update.

The updated Heme Manual is clear regarding "consistent with" now being a definitive diagnosis for the purpose of coding histology. However, the Note under instruction 4 states, "Do not apply these changes to casefinding, reportability, or staging." Is "consistent with" an exception to this Note? Or should it be re-added to the ambiguous terms related to reportability?

Patient was diagnosed with smoldering myeloma in October 2021 and put on surveillance. In May 2024, the patient became symptomatic and started chemotherapy.

Is the date of diagnosis in 2021, with date of first treatment with chemotherapy in 2024? Or is active surveillance first course and treatment with chemotherapy as second course in 2024?