Report | Question ID | Question | Discussion | Answer | Year |
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20031177 | EOD-Lymph Nodes--Colon: Are deposits of carcinoma in the pericolic fat still coded as lymph nodes when the pathology report states, "there is a high likelihood that these represent foci of venous invasion"? See Description. | Patient underwent resection for adenocarcinoma of the rectum. Path final diagnosis stated: "Regional lymph nodes: met carcinoma in 18 of 43 lymph nodes. Pathologic stage (AJCC/UICC 6th edition): pT3, V2, pN2, pMx. See comment." Path comment: "There are additional macroscopic stellate deposits of carcinoma in the pericolic soft tissue. According to the 6th edition of the AJCC staging manual, these should be designated as "V2," indicating that there is a high likelihood that these represent foci of venous invasion." |
For cases diagnosed 1998-2003: Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node. When the number of deposits is not mentioned, code Number of Regional Nodes Positive as 97 [Positive nodes but number of positive nodes not specified]. Unless the procedure is documented as a dissection, code Number of Regional Nodes Examined as 98 [Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as samping or dissection; nodes examined, but number unknown]. |
2003 |
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20021184 | EOD-Lymph Nodes--Head & Neck: When a physician provides only "Stage IV" (i.e., an abbreviated stage) for a right posterior tongue primary with lateral extension into the oropharynx and hypopharynx, can you assume "palpable" level 2, 3 and 5 lymph nodes are involved? | For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 9 [Unknown], based on the information provided.
The physician's statement of an N category from a TNM may be used to determine lymph node involvement in the absence of other information. However, you cannot assume nodal involvement based on the incomplete staging information of "Stage IV" for a base of tongue primary. For this primary site, extension into the hypopharynx from this primary is equivalent to T4/Stage IV. Therefore you cannot assume the clinician's assessment of the case as Stage IV represents his assessment of lymph node involvement. |
2002 | |
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20031010 | EOD-Lymph Nodes--Lung: Are positive "neck nodes" coded to 7 [Distant lymph nodes, other than above (including cervical lymph nodes)] in this field because we do not have a specific lymph node chain named or are they coded to 6 [Contra lateral hilar or mediastinal (incl. bilateral); supraclavicular (transverse cervical), ipsilateral or contralateral; scalene, ipsilateral or contralateral] because this code represents the lowest possible code for involved neck nodes? | For cases diagnosed 1998-2003: Code EOD-Lymph Nodes as 7 [Distant lymph nodes, other than above (incl. cervical neck nodes)]. Lymph nodes in the "neck" are distant, rather than regional, for lung. | 2003 | |
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20021115 | EOD-Lymph Nodes--Testis: In coding lymph node involvement for a testicular primary, should we use code 5 (Size not stated) when there is not a pathologic size of the lymph node provided? See discussion. | Should Note 1 in the testis EOD be changed to "Metastases in lymph nodes are now measured by the size of the lymph node as stated in pathology report"? The SEER EOD-88, 3rd Edition, states that "when size of regional lymph nodes is required, code from the pathology report." | For cases diagnosed 1998-2003:
For testis cases only, "metastasis in lymph nodes" is measured by the size of the lymph node or the lymph node mass. It is acceptable to code the size of this metastasis from a CT scan or other imaging when a pathology specimen is not available for testicular primaries. |
2002 |
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20031115 | EOD-Lymph Nodes/EOD-Extension: Does extracapsular lymph node extension into adjacent tissue or organs affect EOD coding? See Description. | For a lung primary a PET scan showed marked uptake in the right hilum consistent with metastatic disease. A radical pneumonectomy was performed and the operative findings showed that the pulmonary artery was involved with a mass. Pathology: Small cell carcinoma in the lung parenchyma. The distal bronchi showed obstructive pneumonitis. There were mets found on 02/05 on the hilar lymph nodes and 00/02 peribronchial nodes. The mets in the hilar nodes extended beyond the lymph node capsule into the pulmonary artery. |
For cases diagnosed 1998-2003: Extracapsular lymph node extension does not affect the extent of disease. Code the extent of regional lymph node involvement in EOD lymph nodes. | 2003 |
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20020018 | EOD-Lymph Nodes/EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Cervix: What codes are used to represent these fields for a cervix primary when the only information on lymph nodes is a CT of the pelvis showing "pelvic adenopathy" (no surgery was done)? | Code the EOD-Lymph Nodes field to 9 [unknown]. Code the Pathologic Review of Number of Regional Lymph Nodes Positive field to 98 [No nodes examined] and the Lymph Nodes Examined to 00 [No nodes examined] because there was no resection of the primary organs. Adenopathy, NOS, per SEER guidelines, is not coded as lymph node involvement | 2002 | |
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20010143 | EOD-Lymph Nodes/EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Lung: How do you code these fields for clinically positive lymph nodes when the result of neoadjuvant treatment is that the lymph nodes are pathologically negative? See discussion. | The pt presents with "mediastinal adenopathy" for a lung primary and was treated with pre-operative radiation therapy. After two months, he was treated with surgery. The 10 lymph nodes removed were all negative. How does SEER code these three EOD fields?
Will an error be triggered in SEER Edits if you code lymph nodes as clinically positive in the EOD lymph node involvement field and yet pathologically negative in the number of regional nodes positive and number of regional nodes examined fields? |
For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 2 [Mediastinal, NOS]. Code the EOD-Regional Lymph Nodes Positive and Examined fields to 00/10. You will not have a problem with the SEER Edits. The EOD field is coded using clinical and pathologic information. All information gathered within four months of the date of diagnosis (in the absence of disease progression) or through completion of surgery(ies) can be used to code EOD. The clinically positive nodes justify the radiation therapy. |
2001 |
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20031012 | EOD-Lymph Nodes/Extension: How does one code these fields if the clinical level of disease extension prior to neoadjuvant treatment is greater than demonstrated on pathology at time of resection? See discussion. | Breast case described clinically as a "breast mass and nodal metastases" which is treated with neoadjuvant chemotherapy and at surgery the lymph nodes are pathologically negative. | For cases diagnosed 1998-2003:
Use the combination of clinical and pathologic information to code EOD for primary site, extension and lymph nodes. Code the more extensive disease. If lymph nodes are positive clinically and not positive after neoadjuvant treatment, code lymph node involvement. If lymph nodes are negative clinically and positive on path, code lymph node involvement. When neoadjuvant treatment is administered because of a clinical statement of stage or involvement, code EOD based on this clinical information, even if later pathologic information would lead to a lesser EOD. General guideline number 6 (page 1 of SEER EOD-88 3rd ed.) points out that clinical information must be considered when coding EOD. However, do not code EOD based on clinical information disproved by pathologic findings in the absence of intervening treatment. The scenario above: The clinical involvement of the nodes justifies the neoadjuvant chemotherapy. Therefore, code EOD based on the clinical lymph node involvement. |
2003 |
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20000542 | EOD-Lymph Nodes/TNM--Breast: Do we code these lymph nodes fields for a breast primary that describes ipsilateral axillary lymph node involvement as "extending through the lymph node capsule and into perinodal soft tissue/fat" as "fixed/matted"? | For cases diagnosed 1998-2003:
Code the EOD-Lymph Nodes field to 6 [Axillary regional lymph nodes, NOS], if the size of the metastasis within the lymph node is not known. "Extension into perinodal soft tissue" does not imply that the lymph nodes are fixed to one another or to other structures. AJCC stage for lymph nodes is coded to N1 [Metastasis to moveable ipsilateral axillary lymph nodes].
In order to code the EOD-Lymph Nodes field to 5 [Fixed/matted ipsilateral axillary nodes] which is the equivalent to AJCC equivalent N2, there must be some clinical or pathologic statement of fixation or matting. There can be extension through the capsule without fixation or matting. "Fixation" is a clinical term and "matting" can be either clinical or pathologic. A pathologist can recognize two or more lymph nodes stuck together by tumor. |
2000 | |
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20021048 | EOD-Lymph Nodes: If chemotherapy or radiation is given prior to the excision of an involved lymph node, should the size of the metastasis within the lymph node be coded from the subsequent surgical pathology report? See discussion. | For several sites, the size of the metastasis in an involved lymph node is integrated into the EOD-Lymph Node field. Should the size of the metastasis mentioned on the pathology report be ignored if the patient received radiation or chemotherapy prior to having the lymph node removed? | For cases diagnosed 1998-2003:
Record the size of a lymph node metastasis described in the pathology report for cases that had pre-surgical treatment. However, if both the pre-treatment and post-treatment size of the lymph node metastases are available, use the larger size when coding the EOD-Lymph Node field. |
2002 |