Report | Question ID | Question | Discussion | Answer | Year |
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20230062 | Update to current manual/EOD 2018/EOD Primary Tumor--Appendix: Is it correct to code Extent of Disease (EOD) Primary Tumor as code 500 (Invasion of/through serosa (mesothelium) (visceral peritoneum)) and EOD Mets as code 30 (Intraperitoneal metastasis (peritoneal carcinomatosis) WITH or WITHOUT peritoneal mucinous deposits containing tumor cells), when the resection pathology report for a low-grade appendiceal mucinous neoplasm (LAMN) proves “Tumor Extent: Acellular mucin invades visceral peritoneum (serosa)” as well as metastatic LAMN within the right lower quadrant peritoneum? See Discussion. |
This patient had serosal involvement and the pathologist and managing physician staged this as pT4a disease. This extension seems best captured by EOD Primary Tumor code 500. Additionally, the patient had discontinuous metastatic involvement of the peritoneum, and this was staged by the pathologist and managing physician as pM1b (Intraperitoneal metastasis only, including peritoneal mucinous deposits containing tumor cells). Although this peritoneal involvement was present in the right lower quadrant, it was staged as distant metastatic disease and not as part of the primary tumor category. However, currently EOD Primary Tumor code 600 would seem to apply since the peritoneal tumor was in the right lower quadrant. Code 600 is defined as mucinous tumors with peritoneal involvement confined within right lower quadrant. This EOD Primary Tumor code and the physician’s M category assignment do not align; the physician has staged this as distant metastasis (M category, not the T category). Should the peritoneal metastasis (even limited to the right lower quadrant) be included in the EOD Mets field and not in the EOD Primary Tumor field? In other words, should the peritoneal involvement included in EOD Primary Tumor code 600 be reclassified in EOD Mets code 30 (Intraperitoneal metastasis (peritoneal carcinomatosis) WITH or WITHOUT peritoneal mucinous deposits containing tumor cells)? |
Assign code 500 for EOD Primary Tumor and code 30 for EOD Mets. This will correctly derive the T4aM1b stage based on AJCC 8th edition. Abstraction of peritoneal metastasis changed from the T category in the AJCC 7th edition to the M category in the 8th and 9th AJCC editions. As a result, for cases diagnosed in 2018 and later, peritoneal deposits in the right lower quadrant should be abstracted as EOD Primary Tumor code 500 and EOD Mets code 30. However, the EOD Primary Tumor code of 600 has not yet been updated to align with the 8th and 9th AJCC editions. The 2025 updates will correct for this via a conversion for cases diagnosed in 2018 and forward where EOD Primary Tumor = 600 and EOD Mets = 00 or 10 to EOD Primary Tumor = 500 and EOD Mets = 30. Effective immediately, abstract peritoneal deposits in the right lower quadrant as EOD Primary Tumor code 500 and EOD Mets code 30, even though you will still have the ability to assign EOD Primary Tumor code 600 in your abstraction software until the 2025 updates are deployed. |
2023 |
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20190065 | Update to current manual/EOD 2018/Summary Stage 2018--CLL/SLL: Can chronic lymphocytic leukemia (CLL) be staged when diagnosed by peripheral blood and no bone marrow biopsy, and observation is employed? See Discussion. |
The physicians do not use the Lugano system as we are instructed to stage chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) as lymphomas. I had always been instructed that this qualifies as "bone marrow involvement," or "diffuse disease," and therefore is a Stage IV. Our experts advise that there is not enough information to code it to bone marrow, but do not elaborate as to whether you can actually code Extent of Disease (EOD), SEER Summary Stage, and AJCC Staging? |
For EOD and Summary Stage: Peripheral blood involvement for CLL (or any lymphoma-but most commonly for CLL) can be coded. This is code 800 for 2018 EOD Primary Tumor, and code 7 for Summary Stage 2018. We have recently received confirmation that peripheral blood involvement only is not enough information to assign AJCC stage; assign code 99 for AJCC Stage Group. We will correct in the 2021 release of EOD so that peripheral blood involvement only will have its own code to derive the appropriate AJCC TNM Stage Group (99). |
2019 |
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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 |
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20210038 | Update to current manual/First course treatment--Neoadjuvant treatment: How are the 2021 neoadjuvant therapy fields coded when neoadjuvant therapy and surgery were part of first course plans but treatment was never completed. See Discussion. |
Example: Breast case where first course treatment plan is neoadjuvant therapy and surgery after. The patient was hospitalized during neoadjuvant therapy, elected hospice, and later died, so the neoadjuvant therapy was never completed, surgery not done. How are the 2021 neoadjuvant therapy fields coded in this situation as neoadjuvant therapy and surgery were part of first course plans. I coded neoadjuvant therapy to 2 - started but not completed, but there are no codes to properly explain the clinical response and therapy treatment effect as the patient did not complete neoadjuvant therapy. Should I use code 9 for clinical response and treatment effect or should this be left blank for this particular case? |
Assign code 8 for Neoadjuvant Therapy--Clinical Response in this case. We will update the SEER manual to allow code 2, in addition to code 1, in Neoadjuvant therapy when Clinical Response is coded 8. We will also add instructions covering a case such as this one. Assign code 7 for Neoadjuvant Therapy--Treatment Effect and use text fields to record the details. We will add instructions to the manual for this scenario. |
2021 |
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20210035 | Update to current manual/Lymphovacular invasion--Thyroid: Are psammoma bodies only recorded as vascular invasion in papillary thyroid cancer cases? See Discussion. |
For example, total thyroidectomy specimen shows right lobe papillary thyroid carcinoma, 4.2 cm, unencapsulated, with numerous psammoma bodies in non-tumoral thyroid parenchyma, without angioinvasion; left lobe with papillary thyroid carcinoma, 0.6 cm, encapsulated, with capsular invasion, with intralymphatic psammoma bodies in non-tumoral thyroid parenchyma, without angioinvasion. The synoptic summary documents vascular invasion present (psammoma bodies only). |
If you are collecting lymphovascular invasion (LVI) for thyroid cases, record "vascular invasion present (psammoma bodies only)" as vascular invasion (code 1, Lymphovascular Invasion Present/Identified) in the LVI data item. Use a text field to specify that this is vascular invasion by psammoma bodies. |
2021 |
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20210036 | Update to current manual/Lymphovascular invasion: Are lymphvascular invasion and lymphvascular space invasion on a pathology report the same thing or do they describe different things? |
We confirmed with our expert pathologist consultant that lymphovascular invasion and lymphovascular space invasion are synonymous. |
2021 | |
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20210017 | Update to current manual/Mets at diagnosis fields--Lymphoma: Are distant metastases possible for a lymphoma with a primary site of lymph nodes? The instructions in the SEER manual tell us to assign code 8 in each of the Mets at Dx fields for a lymphoma originating in lymph nodes. |
This is a correction to the SEER manual. Lymphomas originating in lymph nodes (C77) could have distant metastases to any site except lymph nodes. The following corrections to the manual apply now and will appear in the next version of the manual. Remove C770-C779 from the instruction for assigning code 8 on the following pages. Page 135 Mets at Dx--Bone Page 137 Mets at Dx--Brain Page 139 Mets at Dx--Liver Page 141 Mets at Dx--Lung Page 145 Mets at Dx--Other Example Biopsy of axillary lymph node: Diffuse Large B-Cell lymphoma. Lymph nodes involved above and below the diaphragm, multiple nodules seen in lung, lesions in liver. Bone marrow biopsy positive for DLBLC. Per Hematopoietic manual, primary site would be C778 for multiple lymph node regions involved. Mets at Dx--Bone-0 Mets at Dx--Brain-0 Mets at Dx--Liver-1 Mets at Dx--Lung-1 Mets at Dx--Distant Lymph Nodes-8 Mets at Dx--Other-1 |
2021 | |
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20190033 | Update to current manual/Neoadjuvant therapy/Pathologic tumor size--Breast: When a patient with invasive breast cancer is started on neoadjuvant therapy and at surgery is found to have only residual in-situ disease, do we record the size of the in-situ tumor for Pathologic Tumor Size? See Discussion. |
I understand that we are to record the Clinical Tumor Size in Tumor Size Summary because of the neoadjuvant therapy, but the SEER manual does not address what to record in the Pathologic Tumor Size after neoadjuvant therapy. Would we record 999 or the size of the in-situ tumor in the Pathologic Tumor Size field? Will there ever be a new data item added or changes to this current data item? By recording the Patholigic Tumor Size this way, there currently will not be any way to compare tumor size clinically versus after neoadjuvant therapy and assessing the response. |
Note: this is an update to the 2018 SEER manual. Assign 999 in Pathologic Tumor Size when neoadjuvant therapy has been administered. We can explore the possibility of another data item in the future. |
2019 |
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20190016 | Update to current manual/SS2018--Breast: Should Code 3 of the Summary Stage 2018 (SS2018) for Breast designate the intramammary and infraclavicular lymph nodes as being ipsilateral? Similarly, should Code 7 designate infraclavicular lymph nodes as contralateral/bilateral? Laterality (ipsilateral, contralateral/bilateral) is included for axillary and internal mammary nodes in the respective codes. |
Based on your question, a review of the AJCC manual was done to clarify how these nodes would be coded. A review of Extent of Disease (EOD) Regional Nodes and EOD Mets was also done. That information is correct and in line with AJCC 8th edition. We apologize that SS2018 was not updated accordingly and thank you for bringing this issue to our attention. Per AJCC, infraclavicular and intramammary nodes are ipsilateral for the N category. Contralateral or bilateral involvement are included in the M category. The following will be applied to the planned 2020 update of the SS2018 manual. Code 3 Ipsilateral will be added to Infraclavicular and Intramammary Infraclavicular (subclavicular) (ipsilateral) Intramammary (ipsilateral) Code 7 The following will be added under Distant lymph nodes Infraclavicular (subclavicular) (contralateral or bilateral) Intramammary (contralateral or bilateral) |
2019 | |
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20190054 | Update to current manual/Solid Tumor Rules (2018)/Histology--Brain and CNS: Table 6 (Non-Malignant CNS Equivalent Terms and Definitions) lists as a subtype/variant of craniopharyngioma 9350/1. This is not a valid histology per the ICD-O-3 or the 2018 ICD-O-3 Update Table. Is this actually supposed to read, ? |
Adamantinomatous craniopharyngioma (9351/1) is a subtype of craniopharygioma. We will correct the Non-Malignant CNS Solid Tumor Rules in the next update. |
2019 |