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Report Produced: 02/11/2026 08:39 AM

Report Question ID Question Discussion Answer Year
20081090 MP/H Rules: Does the presence of metastases affect the application of the MP/H rules? See Discussion. Single lung tumors presenting in each lung but the patient also presents with bone mets? Would rule M6 apply? Or do the bone mets represent additional tumors?

For cases diagnosed 2007 or later, the MP/H rules do not apply to metastases. Ignore metastases when applying the rules.

For the case above, use rule M6 and abstract as two primaries (right lung and left lung). The bone mets are ignored.

 2008
20071051 MP/H Rules/Multiple Primaries--Lung: Please clarify the multiple primary rule M6 and the explanatory note that states when there is a single tumor in each lung, they are to be reported as multiple primaries unless stated or proven to be metastasis. See Discussion. Single tumor in left lung, single tumor in right lung. The rules take you to M6. Suppose the tumor in left lung is biopsied and there is a physician statement that right lung tumor is metastatic from left lung tumor. The note under M6 is "When there is a single tumor in each lung, abstract as multiple primaries unless stated or proven to be metastatic." In this case, is it a single primary or multiple primaries?

For cases diagnosed 2007 or later:

When there is a single tumor in one lung and a single tumor in the other lung, apply rule M6 and abstract as multiple primaries. Use this rule whenever there is a single tumor in each lung, even when neither tumor is biopsied or resected.

This rule is unique to lung. Our physician advisors emphasized that it is very unlikely that a single tumor in one lung could be metastatic from a single tumor in the opposite lung. Therefore, the default is to abstract as multiple primaries.

The note at M6 means that there must be proof that one tumor is metastatic in order to abstract as a single primary. For example, a biopsy of the tumor proving that it is metastatic. An opinion or belief that one tumor is metastatic is not sufficient. In the absence of proof, use rule M6 and abstract as multiple primaries.

A list of MP/H clarifications will be available. This issue will be included on the list.

 2007
20061123 Reportability--Colon: Is a pathologically confirmed "tubulovillous adenoma with high grade dysplasia" reportable if clinical diagnosis at the time of the subsequent re-biopsy states "follow-up for colon polyps with ca in situ"? See Discussion. SINQ 20000245 states that high grade dysplasia is not synonymous with behavior code 2 (in situ). However, the 2004 SEER manual states that "cases clinically diagnosed are reportable. If the physician treats a patient for cancer in spite of the negative biopsy, accession the case." A pathologic diagnosis has priority over a clinical diagnosis. According to the pathologist, this case is not reportable. A re-biopsy is not treatment. 2006
20091073 Grade: Can FIGO grade be used to code Grade/Differentiation? See Discussion. SINQ 20020059 says not to use FIGO grade to code differentiation. It also says SEER is evaluating whether the ICD-O-3 sixth digit differentiation codes accurately represent the FIGO grade. For the time being, do not code FIGO grade. What is the result of the evaluation? Any new information regarding FIGO grade?

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.Do not code FIGO grade in the grade field. The conversion from a three-grade system to a four-grade system does not work for FIGO grade three. Since FIGO G3 includes both Poorly differentiated and undifferentiated, it cannot be converted.

FIGO grade may be captured in a CS site specific factor in the future.

 2009
20081132 MP/H Rules--Breast: What is the histology code for a breast tumor that is ductal ca with focal squamous differentiation? See Discussion. SINQ 20021062 states for cases Dx'd prior to 2007, use 8570. Is 8570 also used when the squamous differentiation is focal? For cases diagnosed 2007 or later, use rule H14 and code the histology 8500 [duct carcinoma]. Ignore histologies described as "focal," "focus," or "foci." This instruction will be added to the histology rules in the upcoming revision of the MP/H manual. 2008
20061053 Diagnostic Confirmation: How is this field coded for a case with a cytology that is suspicious for ductal carcinoma and the clinical diagnosis is carcinoma? See Discussion. SINQ 20031152 states that histology for this type of case is to be coded per the clinical diagnosis of "carcinoma." Does it follow then that Diagnostic Confirmation is to be coded 8 (clinical diagnosis only)? Would we code Diagnostic Confirmation differently if the clinician stated that the diagnosis of malignancy was confirmed by the suspicious cytology?

Code diagnostic confirmation as 8 [clincial diagnosis] when there is a suspicious cytology and a physician's clinical diagnosis. Do not accession cases with only suspicious cytology.

Code diagnostic confirmation as 8 when the clinician's diagnosis of malignancy is confirmed by the suspicious cytology. It is still a clinical diagnosis made by the physician using the information available for the case.

 2006
20140014 First course treatment/Surgery of Primary Site--Anus: Would infrared coagulation be coded as treatment for AIN III of the anus/anal canal? See discussion. SINQ 20051064 indicates infrared coagulation is not treatment for cancer. Internet search explains that infrared coagulation delivers heat to destroy the tissue so it can be removed. In our region it is currently used to treat internal and external anal low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL). While it is understandable that this wouldn't be coded as treatment for an invasive anal primary, could it be treatment for an in situ tumor? If it is treatment, should it be coded under Surgery code 15 The answer to SINQ 20050164 still applies. Do not code infrared coagulation as cancer treatment. It is used to coagulate blood vessels and not to destroy cancer tissue. 2014
20140002 Reportability--Appendix: Is a pathologic final diagnosis of an appendix with "well-differentiated neuroendocrine tumor (carcinoid)" reportable? See discussion. SINQ 20130027 states that "well-differentiated neuroendocrine tumor" of the appendix is reportable (8240/3) while "carcinoid" tumors of the appendix are not reportable (8240/1). Please explain the difference between "well-differentiated neuroendocrine tumor" of the appendix and a "carcinoid" of the appendix.

Well-differentiated neuroendocrine tumor of the appendix is reportable. The difference is terminology. "Carcinoid" is listed in ICD-O-3 as a /1 for appendix making it non-reportable.

When both terms are used, ask for clarification from the pathologist. Failing that, accept the reportable terminology and report the case.

 2014
20031145 EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description. Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]? For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall. 2003
20021077 Histology (Pre-2007)/Primary Site/EOD-Extension--All Sites: How do you code these fields for a resected thyroid that is negative for any diagnostic abnormality and a left ovary that demonstrates "papillary thyroid carcinoma arising in a cystic teratoma"? See discussion. Teratomas occurring in the ovaries frequently contain various types of fully differentiated tissue that normally occur in other body parts. Should the primary be coded to the ovary or to the organ in which that type of tissue normally occurs?

For tumors diagnosed prior to 2007:

Code the Primary Site field to the organ in which the cancer arose. For this tumor, code the Primary Site field to C56.9 [ovary] and Histology to 8260/3 [papillary carcinoma of thyroid]. Use the ovary EOD for tumors diagnosed 1998-2003.

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.

 2002