Grade/Histology--Digestive System: What is the grade for neuroendocrine tumor (NET) or neuroendocrine carcinoma (NEC) of gastrointestinal morphologies described as: 1) NET G1 (M8240/3) and NET G2 (M8249/3) or 2) neuroendocrine carcinoma, low grade (M8240/3) and neuroendocrine carcinoma, well differentiation (M8240/3) and neuroendocrine carcinoma, moderate differentiation (M8249/3)? The SEER Instructions for Coding Grade for 2014+, Coding for Solid Tumors section, #3 state: Code the grade shown below (6th digit) for specific histologic terms that imply a grade. NET and NEC are not included in the specific terms.
You may code grade as follows.
Grade 1 – NET G1 (M8240/3)
Grade 2 – NET G2 (M8249/3)
Grade 1 – neuroendocrine carcinoma, low grade (M8240/3) or neuroendocrine carcinoma, well differentiation (M8240/3)
CS Site Specific Factor--Prostate: Explain the difference among SSF4 prostate codes 150 [No clinical involvement of prostatic apex & prostatectomy apex extension unknown], 510 [Clinical involvement of prostatic apex unknown & No prostatectomy apex extension], and 550 [Clinical involvement of prostatic apex unknown & prostatectomy apex extension unknown].
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.Site Specific Factor 4 captures the status of clinical apex involvement and prostatectomy apex involvement. The first digit in codes 110-550 indicates the clinical status of apex involvement. The second digit indicates apex involvement found at prostatectomy. The third digit is always zero. For both first and second digits, the codes and definitions are the same:
1 - No involvement of prostatic apex
2 - Into prostatic apex/arising in prostatic apex, NOS
3 - Arising into prostatic apex
4 - Extension into prostatic apex
5 - Apex extension unknown
Code 150 = No clinical involvement of prostatic apex & prostatectomy apex extension unknown
Code 510 = Clinical involvement of prostatic apex unknown & No prostatectomy apex extension
EOD-Clinical Extension--Prostate: How do you distinguish between clinical extension codes of 10, 13, 14, and 20 for cases with a benign prostate per digital rectal exam that appear localized after TURP/prostatectomy? Can the clinical extension code of 10 be used if the term "microscopic carcinoma" is noted in the pathology report without also mentioning "foci" or "Stage A" for clinically inapparent tumors?
For cases diagnosed 1998-2003:
When the prostate feels benign and the cancer is found incidentally at the time of the microscopic exam, code the EOD-Extension field to 10 [number of foci or % of involved tissue not specified]. Code as 13 (less than or equal to 5%) or 14 (greater than 5%) if percentage involved is given in the tissue resected. If the path report states "solitary focus of carcinoma" without mentioning the total amount of tissue resected, code extension to 13. If there is more than one focus, code extension to 10. Don't assign a code of 20 unless the tumor is clinically apparent.
EOD-Extension--Breast: If the pathology report states "infiltrating duct carcinoma...measuring 7mm in diameter...focal areas of intraductal carcinoma," do we code this field to 14 [Invasive and in situ components present, size of entire tumor coded in Tumor Size and in situ described as minimal] or to 16 [Invasive and in situ components present, size of entire tumor coded in Tumor Size and proportions of in situ and invasive not known]?
For cases diagnosed 1998-2003: If 7mm is the measurement of the infiltrating duct portion of this cancer, assign extension code 13 [Invasive and in situ components present, size of invasive component stated and coded in Tumor Size].
If 7mm is the size of the whole malignancy and the size of the invasive portion cannot be determined, assign extension code 14 [Invasive and in situ components present, size of entire tumor coded in Tumor Size (size of invasive component not stated) and in situ described as minimal (less than 25%)]. "Focal areas of in situ carcinoma" qualifies as minimal.
Histology (Pre-2007)--Breast: What code is used to represent the histology "invasive ductal carcinoma, mucinous type and invasive lobular carcinoma"?
For tumors diagnosed prior to 2007:
Code the Histology field to 8522/3 [infiltrating duct and lobular carcinoma] per rule 1 of the Coding Complex Morphologic Diagnoses, because the tumor is both lobular and ductal.
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.
Reportability/Date of diagnosis--Thyroid: Is category Thyroid imaging reporting and data system (TI-RADS) 4 (4a/4b) or TI-RADS 5 on imaging diagnostic of thyroid cancer, and if so, can we use the date of the impression on the scan that states either of these categories as the diagnosis date?
Answer revised 3/31/2022
Do not report cases based only on the TI-RADS category. The most recent information from ACR on TI-RADS indicates that neither TI-RADS 4 nor TI-RADS 5 is clearly defined as malignancy. TI-RADS 4 is "moderately suspicious" and TI-RADS 5 is "highly suspicious" but they do not specify what they are suspicious for. We need more information to determine reportability.
Primary Site--Breast: What subsite is to be coded for a case of invasive Paget disease of the nipple with an infiltrating ductal carcinoma of the lower inner quadrant?
Code C50.9 [Breast, NOS]. Code the last digit of the primary site to '9' for single primaries when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. Nipple [C50.0] and LIQ [C50.3] fit this rule. This is a single primary per MP/H Breast Rule M9.
Date of Diagnosis: How do you code this field when the pathologic confirmation is delayed for 2 months because the clinician decides to "watch and see what happens" to a CT identified mass thought to be either a "metastasis from a previously diagnosed malignancy or a new primary"?
Code the Date of Diagnosis field to the date of the scan. This is the earliest date that a recognized medical practitioner said the patient had cancer. The diagnosis on the CT scan was a malignancy. The only question was whether the mass on the scan was metastatic or a primary.
Histology--Heme & Lymphoid Neoplasms: Is histology coded to 9684/3 [malignant lymphoma, diffuse large B-cell, immunoblastic NOS] for a biopsy that reveals "diffuse large B-cell lymphoma, immunoblastic variant"?
Code histology to 9680/3 [diffuse large B-cell lymphoma]. Code 9684/3 [malignant lymphoma, diffuse large B-cell, immunoblastic NOS] is obsolete for cases diagnosed 2010 and later per the Heme DB.
Under the Definitions section in the Heme DB, it states that this is a lymphoma with diffuse proliferation of large neoplastic B lymphoid cells with nuclear size exceeding macrophage nuclei, more than twice size of normal lymphocytes. Normal architecture of node or extranodal tissue replaced in diffuse pattern. Morphologic variants: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
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