Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20160062 | Grade--Kidney: Should WHO/ISUP grade for renal cell carcinoma be coded for cases diagnosed 2016 and later? See discussion.
|
The 2016 WHO Classification of Tumours of the Urinary System appears to be moving away from using Fuhrman grading toward using WHO/ISUP grade. These seem like similar 4 grade staging systems; however, the SEER Manual specifically states to not use the Special Grade System table for WHO/ISUP. We are seeing the WHO/ISUP grade being used on 2016 pathology reports.
Examples of new grading for renal cell carcinomas Histologic type: Clear cell renal cell carcinoma Histologic grade (WHO/ISUP 2016): Grade 3 in a background of 2 (of 4). And Histologic type: Clear cell renal cell carcinoma Histologic grade (ISUP): Grade 2. |
Do not record WHO/ISUP grade in the grade/differentiation field.
Designated fields for this grade system are being proposed for future implementation. |
2016 |
|
20190066 | Solid Tumor Rules (2018)/Histology--Breast: How is the histology coded for a metastatic carcinoma, consistent with primary breast carcinoma, when no other pathology information is available? See Discussion. |
The 2018 Breast Solid Tumor Rules Equivalent Terms and Definitions - Changes from 2007 Multiple Primaries/Histology Rules states: Mammary carcinoma is a synonym for carcinoma no special type (NST)/duct carcinoma not otherwise specified (NOS) 8500. It will no longer be coded as carcinoma NOS 8010. Should metastatic carcinomas of breast origin be 8500, or is code 8010 (carcinoma NOS) more applicable because histology coding from metastatic sites is not as reliable? |
Code as 8500/3 as it is the only tissue available for this carcinoma associated with a breast primary. Breast carcinoma NST/NOS is now coded as 8500. |
2019 |
|
20190090 | Update to current manual/Extent of Disease/Summary Stage 2018--Fallopian Tube: How are behavior, EOD Primary Tumor, and Summary Stage 2018 coded for a diagnosis of serous tubal intraepithelial carcinoma (STIC) of the fallopian tube? See Discussion. |
The 2018 ICD-O-3 Histology Updates table lists serous tubal intraepithelial carcinoma (C57.0) with a behavior code of 2. The EOD Primary Tumor schema for Fallopian Tube shows STIC has an extension code of 100. It also maps code 100 to Summary Stage 2018 L (localized). Summary Stage 2018 for fallopian tube only documents that intraepithelial tumors are summary stage 0 (in situ). |
We are aware of the issue and have been in discussion with standard setters (SEER, NPCR, AJCC, and NAACCR). At this time, we recommend coding: Histology: 8441/2 Extent of Disease (EOD) Primary Tumor: 000 Summary Stage: 0 AJCC Clin/Path T would be 88, since all in situ lesions are not applicable. Edits will not allow you to have a 8441/2 with a T1. Also, EOD is not currently set up to derive the correct T value, unless you code 100. The change to address the issue will take effect in 2021. |
2019 |
|
20180098 | Solid Tumor Rules (2018)/Histology: Please provide further explanation for prioritizing biomarkers in the histology coding rules. See Discussion. |
The 2018 Solid Tumor (ST) Rules General Rules state: For those sites/histologies which have recognized biomarkers, the biomarkers frequently identify the histologic type. Currently there are clinical trials being conducted to determine whether these biomarkers can be used to identify multiple primaries. Follow the Multiple Primary Rules; do not code multiple primaries based on biomarkers. Additionally, Biomarkers is at the top of the priority order to identify histology in several sections (it appears to be excluded from only Colon, Melanoma and Other sections). In the sections that include this rule, there is not much additional information on using biomarkers. Can you please provide further explanation for prioritizing biomarkers in the histology coding rules? For example, will the ST manual be updated when we need to look for specific biomarkers in a diagnosis? |
Instructions for biomarkers will be added to other site rules when applicable. The use of biomarkers to determine a specific histologic type is not yet a standard of care in the majority of cases. |
2018 |
|
20200087 | Solid Tumor Rules (2018)/Histology--Thyroid: What is the correct histology code for a micropapillary thyroid carcinoma for cases diagnosed 1/1/2021 and later? See Discussion. |
The 2021 ICD-O-3.2 Update includes papillary microcarcinoma (8341/3) as the preferred term for thyroid primaries (C739). However, there are multiple SINQ entries instructing registrars not to use code 8341/3 for diagnoses of micropapillary carcinoma of the thyroid (including SINQ 20071076, 20081127, 20110027, 20150023, and 20180008). SINQ 20150023 specifically indicates: Per the WHO Tumors of Endocrine Organs, for thyroid primaries/cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult (1 cm or less in diameter) and was found incidentally. WHO does not recognize the code 8341 and classifies papillary microcarcinoma of the thyroid as a variant of papillary thyroid carcinoma and codes histology to 8260. If the primary is thyroid and the pathology states papillary microcarcinoma or micropapillary carcinoma, code 8260 is correct. Does this clarification apply to cases diagnosed 2021 and later? If WHO feels the term micropapillary still does not refer to a specific histologic type for the thyroid, why is 8341/3 listed as a preferred term for this morphology/site combination? For cases 2021 and later, should a diagnosis of Incidental papillary thyroid microcarcinoma (3 mm) in left lower pole, be coded as 8341/3 per the ICD-O-3.2, or as 8260/3 per clarification in multiple SINQ entries? This question was prompted from preparing SEER*Educate coding exercises. We will use the answer as a reference in the rationales. |
Continue to code micropapillary thyroid carcinoma to 8260/3 until instructed otherwise. This coding instruction is based on input from expert endocrine pathologists. This issue will be revisted based on the 4th Ed WHO Endocrine Tumors and updated if needed. |
2020 |
|
20240043 | Reportability/Histology--Digestive Sites: Is a diagnosis of “tubulovillous adenoma with high grade dysplasia” in the duodenum equivalent to a diagnosis of “tubulovillous adenoma, high grade” and, therefore, non-reportable, or is this a reportable non-colorectal high grade dysplasia? See Discussion. |
The 2022 ICD-O-3.2 Implementation Guidelines indicate “Tubulovillous adenoma, high grade” is 8263/2 and is not SEER reportable. However, the 2024 SEER Manual and clarification from recent SINQs (20240021 and 20240025) confirm high grade dysplasia in the esophagus, stomach, and small intestine is reportable (8148/2). Which reportability reference applies to a diagnosis of a tubulovillous adenoma with high grade dysplasia in non-colorectal sites? |
A diagnosis of “tubulovillous adenoma with high grade dysplasia” in the duodenum is not equivalent to a diagnosis of “tubulovillous adenoma, high grade.” Tubulovillous adenoma, high grade (8263/2) is not reportable as of 2022. High grade dysplasia (glandular intraepithelial neoplasia, grade III) is reportable in the esophagus, stomach, and small intestine (8148/2). |
2024 |
|
20220002 | Solid Tumor Rules (2018, 2021)/Histology--Cervix: For cases diagnosed 1/1/2022 and later, how is histology coded for the following three cervix cases relating to p16? See Discussion. |
The 2022 SEER Manual indicates the p16 status (positive or negative) can be used to code more the specific histology for squamous cell carcinoma, human papilloma virus (HPV) positive (8085) and squamous cell carcinoma, HPV negative (8086). However, the histology coding instructions in the Other Sites schema have not been updated and the 2022 SEER Manual does not cover all situations commonly encountered in the registry. Does the clarification regarding p16 apply to these other situations?
|
For cases diagnosed beginning 1/1/2022, assign histology based on new codes and terms for the examples of cervical cancer using the available p16 results as follows. 1. Adenocarcinoma, HPV-independent, NOS (C53._) (8484/3) 2. Carcinoma, squamous cell, HPV-associated (C53._) (8085/3) 3. Carcinoma, squamous cell, HPV-independent (C53._) (8086/3) The 2022 SEER Manual states: Beginning with cases diagnosed 01/01/2022 forward, p16 test results can be used to code squamous cell carcinoma, HPV positive (8085) and squamous cell carcinoma, HPV negative (8086). Use the available results as the rules for Other Sites have not been updated yet. The SSDI Manual data item p16 for Cervix schema also states that p16 is based on testing results and not a physician statement. We can address these situations in a future version of the Solid Tumor Rules. The Other Sites rules will provide document priority when coding hsitology: biopsy vs. resection, cytology vs. histology, primary site vs. mets or regional site. |
2022 |
|
20230005 | SEER Manual/First Course Treatment--Radiation Treatment Modality: How is Peptide Receptor Radionuclide Therapy (PRRT), a form of molecular therapy, coded when used to treat neuroendocrine tumors? See Discussion. |
The 2023 SEER Manual indicates PRRT should be coded in the Other Therapy field per coding instruction 2.d. Likewise, SINQ 20180106 instructs to code PRRT as Other Therapy, while the discussion portion clearly outlines the radioactive nature of this modality. Would PRRT be best coded as a radioisotope in the Radiation Treatment Modality--Phase I, II, III field rather than in the Other Therapy field? |
For cases diagnosed in 2023 and later, Update to the current manual: Assign code 13 (Radioisotopes, NOS) in Radiation Treatment Modality--Phase I, II, III for PRRT. We will make this change in the next version of the SEER Manual. |
2023 |
|
20230006 | SEER Manual/First Course Treatment--Hematologic Transplant And Endocrine Procedures: How are Surgery of Primary Site and the Hematologic Transplant And Endocrine Procedures data items coded when patient has total abdominal hysterectomy and bilateral oophorectomy for an endometrial primary during the same procedure? Also, how would these data items be coded for a vaginal primary in a surgical scenario? See Discussion. |
The 2023 SEER Manual instructions contain a new note in Hematologic Transplant And Endocrine Procedure, Coding Instruction 6, regarding bilateral salpingo-oophorectomy (BSO) when performed for hormonal effect for breast, endometrial, vaginal, and other primary cancers. While we have observed BSO being performed for breast primaries, we do not recall ever seeing a statement for endometrial or vaginal primaries regarding a “BSO being done as hormonal manipulation” when scheduled either with or without a hysterectomy being performed simultaneously. As a result, we are not clear exactly when a BSO would be captured in the Hematologic Transplant And Endocrine Procedure field for these gynecologic primary sites. Also, if these types of procedures are Hematologic Transplant And Endocrine Procedures, are they also captured and coded in the Surgery of Primary Site codes that directly relate to those same organs? Does timing have any effect on the coding of either field? |
For a primary endometrial or ovarian cancer, record the oophorectomy/BSO procedure using the appropriate Surgery of Primary Site code that includes oophorectomy/BSO when done as part of first course of treatment (surgical resection). If performed for hormone effect, also record in the Hematologic Transplant and Endocrine Procedures data item. For other primary sites whose Surgery of Primary Site codes do not include oophorectomy/BSO, record it in the Hematologic Transplant and Endocrine Procedures data item when performed for hormone effect. Document information in the appropriate text fields. Candidates for risk-reducing BSO may include those with hereditary syndromes (such as BRCA mutations) or genes that carry a substantially increased lifetime risk of ovarian malignancy or hormone-sensitive cancers including estrogen-dependent cancers, like breast cancer, ovarian cancer and endometrial (uterine) cancer that rely on estrogen to develop and grow. |
2023 |
|
20230008 | SEER Manual/Surgery of Primary Site 2023--Breast: What instructions should be followed when the 2023 SEER Manual Appendix C 2023 Breast Surgery Codes advise to code 1 in Surgical Procedure of Other Site for a simple bilateral mastectomy but the 2023 STORE Manual does not. See Discussion. |
The 2023 SEER Manual, Appendix C 2023 Breast Surgery Codes, note reads: SEER Note: Assign code A760 for a more extensive bilateral mastectomy. Assign code 0 in Surgical Procedure of Other Site (NAACCR #1294). For a simple bilateral mastectomy, assign code A410 with code 1 in Surgical Procedure of Other Site (NAACCR #1294). In the 2023 STORE Manual, these notes are not mentioned and we are instructed not to code surgery to other site. Other education related to 2023 breast coding provided by NAACCR states to not code surgery to other site. |
Assign code 1 in Surgical Procedure of Other Site (NAACCR #1294) when a simple bilateral mastectomy is performed for a single tumor involving both breasts. This statement was inadvertently omitted from the STORE manual and will be added back in: For single primaries only, code removal of contralateral breast under the data item Surgical Procedure/Other Site (NAACCR Item #1294) or Surgical Procedure/Other Site at This Facility (NAACCR Item #674). The information presented by NAACCR was intended to be consistent with what is in the SEER manual. It may have been misuderstood. |
2023 |