Grade, Differentiation: Do we code to the highest grade even when no grade is given at the time of initial diagnosis, but a grade is obtained on tissue removed after non-surgical treatment has occurred? See discussion.
1. In 2000 a pleural fluid aspirate had no grade. Pt treated with chemo. In 2000 a BSO diagnosed high grade papillary serous adenocarcinoma of the ovary.
2. In 1993 a prostate bx had no grade. Pt treated. In 2001 prostate bx revealed a Gleason's 4+3.
Code the grade at the time of initial diagnosis (if the specimen is from the primary site) or to the grade identified as part of a first course of cancer-directed surgery to the primary site. When different grades are specified for tissue pathologically reviewed from the primary site before and after treatment, code the higher grade. This is true even if the higher grade is obtained while the pt is still undergoing first course of cancer-directed therapy.
1. Code the Grade to 4 [high grade], if the grade information from the BSO specimen represents the grade associated with primary site surgical specimen. Even though the grade was obtained after first course of cancer-directed therapy started, it was obtained during first course of cancer-directed therapy.
2. Code the Grade to 9 [Cell type not determined, not stated or not applicable]. Grade was obtained well after the first course of cancer-directed therapy ended.
Grade, Differentiation: How is grade coded for cases using the FNCLCC (Federation Nationale des Centres de Lutte Contre Ie Cancer) system? See Discussion.
Is FNCLCC a recognized system in the United States? Tongue was the primary site for the case we saw that used FNCLCC.
Do not code the data item Grade based on the FNCLCC grade. You may record the FNCLCC grade in a text field.
Grade, Differentiation: Is grade always coded to 4 for a diagnosis of Ewing's sarcoma?
Do not code the ICD-O-3 grade for Ewing sarcoma unless documented in the record.
In the TNM system, grade is required to place Ewing sarcoma into a stage group. For TNM staging purposes, Ewing sarcoma is classified as G4. Do not apply TNM rules to ICD-O coding.
Grade--Brain and CNS: How should grade be coded for a pineal parenchymal tumor of "intermediate differentiation"? See discussion.
Per a web search, the term "pineal parenchymal tumor of intermediate differentiation" refers to a pineal tumor with the histology/behavior that falls somewhere between the category of pineocytoma (9361/1) and pineoblastoma (9362/3). In other words, it is a malignant tumor that is a WHO grade II/III neoplasm because it's histologic features and behavior are not quite equivalent to a pineoblastoma (WHO grade IV). Thus, it appears the expression "intermediate differentiation" is actually referring to a type of WHO classification system rather than the grade field.
Should the type of documentation provided in pathology report be used to imply the grade field is being referenced and thus be coded to 2 for "intermediate differentiation" or should grade be coded to 9 based on the information found during the web search?
Code the grade as 2 based on instruction #8 in the revised grade instructions for 2014.
Do not use WHO grade to code the grade field for CNS tumors.
Grade--Breast: How is this field coded for an "invasive ductal carcinoma, well differentiated, low nuclear grade"?
Assign code 1 [Grade 1, well differentiated]. Use the table in the 2007 SEER Manual on page C-607. Both "low grade" and "well differentiated" are coded 1 in the grade field.
Grade--Heme & Lymphoid Neoplasms: How is grade coded for a malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant?
Code grade to 6 [B-cell] for the histology malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant [9680/3]. Under the Definition section for histology code 9680/3 it states there are morphologic variants of the disease: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.
Rule G3 in the Heme Manual confirms the grade listed in the Heme DB under its Grade section for the histology 9680/3. While the patient presented with a variant of DLBCL that is T-cell/histiocyte rich, it is still a B-cell phenotype. The grade is coded accordingly.
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.
Grade--Heme & Lymphoid Neoplasms: How is grade coded for acute lymphoblastic leukemia, NOS? See Discussion.
The Heme DB indicates histology code 9811/3 [B lymphoblastic leukemia/lymphoma] is the current histology code to use for the now obsolete term of acute lymphoblastic leukemia [9835/3]. The Heme DB entry for histology code 9835/3 states to "Code grade specified by pathologist. If no grade specified, code 9." The Heme DB entry for the current histology code, 9811/3, states to code the grade to 6 [B-cell]. Should grade be coded to 6 [B-cell] for all cases coded to histology code 9811/3?
Code the grade to 6 [B-cell] for all cases of 9811/3 [B lymphoblastic leukemia/lymphoma] per Rule G3 in the Heme Manual.
Acute lymphoblastic leukemia, NOS [9835/3] is an obsolete code and cannot be used for cases diagnosed 2010 and later. The Heme DB indicates the correct histology code is 9811/3 and grade 6 [B-cell] for cases diagnosed 2010 and later.
For cases of acute lymphoblastic lymphoma, NOS [9835/3] diagnosed prior to 2010, use the pathology report information to code the grade. Code the grade as 9 [unknown] if the pathology report does not specify the grade.
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.