SEER Inquiry System - Search

Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.

Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.

The Histology Task Force approved a 60 day time frame for ambiguous terminology.

The majority of cases are first identified by ambiguous terminology; for example, a patient has a mammogram that shows a lesion suspicious for cancer. That first indication of cancer prompts a work-up to either confirm or rule-out the cancer diagnosis.

The data item "Ambiguous terminology" is not intended to capture information on this routine method of detecting and diagnosing cancer. The 60 day time frame should keep these cases out of the ambiguous terminology data item.

The data item is intended to identify those cases where the cancer diagnosis is NOT confirmed during the work-up, but the case is still entered into the database. For example a patient who has a TRUS because of elevated PSA. The pathology from the TRUS says "Suspicious for adenocarcinoma of the prostate." The physician only documents that the patient is to return in 6 months for another PSA and TRUS. The registrar would enter this case into the data base because the word "suspicious" is on the ambiguous terminology list.

Assign 999 for pathologic tumor size when patient has received neoadjuvant therapy, even when neo-adjuvant therapy is not completed. Describe the details in text fields.

Revised answer: Assign surgery code 30 for both examples based on the SEER Note on the top of page 2 in the Surgery of Primary Site Codes for Skin: If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30.

Apply the Multiple Primaries/Histology, Breast Rule H3: DCIS and a more specific in situ are coded to the more specific histology term which in this case is solid. Code the histology to ductal carcinoma in situ, solid type (8230/2). Based on the information provided, there is no invasive component. The term "microca ++" means micro-calcifications are present, not micro carcinoma.

For cases diagnosed 1998-2003:

Note 8 in the EOD scheme does not apply because nodule size does not apply in the 5th or 6th edition of TNM.

For tumors diagnosed prior to 2007:

Code the Histology field to 8500/3 [Infiltrating duct carcinoma, NOS]. Code the EOD-Lymph Nodes field to 6 [Axillary/regional lymph nodes, NOS] and the SEER Summary Stage 2000 field to 3 [Ipsilateral regional lymph nodes(s) involved only].

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.

Code sodium iodine (I 131) therapy in Radiation Treatment Modality as code 13 (Radioisotopes, NOS). Code Radiation External Beam Planning Technique as code 88 (not applicable). Do not code if used in diagnostic procedures.

Radioactive I 131 should be coded when given in therapeutic doses (usually 30-50mCi but could be higher in high risk patients). The same agent is used for diagnostic imaging, but the dose is very small (1-3mCi).

We will update SEER*Rx.

In the absence of information to the contrary, thyroid FNAs designated as Bethesda classification category VI are reportable. Thyroid FNAs designated as Bethesda classification category V are not reportable unless there is additional information confirming a reportable diagnosis. For both Bethesda V and VI, NCCN Guidelines recommend total thyroidectomy or lobectomy (depending on tumor size and nodal involvement) for the purposes of definitive diagnosis/treatment, so additional information should be available.

We will add this to the next version of the SEER manual.

In your example, nodule 1 Bethesda V is not reportable. Nodule 2 Bethesda VI is reportable.