SEER Manual/Surgery of Primary Site--Ovary: Should "(salpingo)" be removed in the SEER Note under Ovary surgery code A280? See Discussion.
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"?
Assign code A280 for current unilateral oophorectomy with hysterectomy or with a previous history of hysterectomy.
We will remove the text ‘(salpingo-)’ from the Ovary surgery code A280 SEER Note in the next release of SEER Manual.
Solid Tumor Rules/Multiple Primaries--Breast: How many primaries and which Breast Solid Tumor Rules (STR) M Rule applies when a patient has synchronous, separate/non-contiguous breast tumors which are a ductal carcinoma and a separate lobular carcinoma? See Discussion.
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.
Accession two primaries when a patient has synchronous, separate ductal and lobular tumors using Rule M13, Breast STRs, 2026 Update. Ductal carcinoma (8500/3) and lobular carcinoma (8520/3) are distinct histology terms and codes that are in different rows in Table 3. This is a modification of Rules M10 and H28 from prior versions of the STR Manual.
First Course of Therapy--Heme & Lymphoid Neoplasms: How is first course of treatment coded for hematopoietic and lymphoid neoplasm (heme) cases who are put on surveillance for years while asymptomatic and then start chemotherapy or other treatment years later once they become symptomatic? See Discussion.
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?
Code the first course of treatment as active surveillance. Chemotherapy is second course of treatment based on this scenario due to progression.
We will add clarification about this type of scenario to the Heme Manual for the 2027 update.
Reportability/Ambiguous Terminology--Heme & Lymphoid Neoplasms: Should "consistent with" be included in the ambiguous terminology for reportability list in the updated Heme Manual? See Discussion.
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?
The 2027 version of the Hematopoietic Manual (release October 2026) will include the following in the Case Reportability Instructions, pg. 40:
4. “Consistent with” for reportability and casefinding is now a definitive diagnosis and is no longer ambiguous terminology. This is for hematopoietic neoplasms ONLY.
a. “Consistent with” has become a very common way for pathologists to document diagnoses for Hematopoietic neoplasms. In order to ensure that hematopoietic cases are being reported, “consistent with” has now become definitive terminology for casefinding and reportability (see Histology Coding Instructions for assigning histology).
b. Do not apply this instruction to casefinding and reportability for Solid Tumors.
5. Report the case when the diagnosis of a hematopoietic neoplasm is preceded by one or more of the ambiguous terms listed below:
a. This instruction pertains to reportability and case finding only. See the Histology Coding Instructions, #3-5 for instructions on assigning histology with ambiguous terminology (note that “consistent with” has been removed. See Note #4) .
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