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Report Produced: 01/18/2025 07:26 AM

Report Question ID Question Discussion Answer Year
20061063 CS Extension--Lung: Do notes 6A and 6B in the 2004 SEER manual offer conflicting instruction for determining the significance of pleural effusion for this primary site? See Discussion.

1. Is note B to be used to modify or change what note A states?

Does note B state -- If a pleural fluid bx(s) is negative; but the fluid is bloody and/or is an exudate, and clinical judgment indicates the effusion is related to tumor -- use code 72?

If a pleural effusion is biopsied should the pathology report state the color of the pleural fluid or is an exudate? (Training issue)

2. Do the following clinical findings impact the clinical evaluation of involvement for a pleural effusion? If yes, why? (Training issue(s))

a. Heart problems?

b. The location of the pleural effusion?

i. Bilateral pleural effusion is noted; tumor in Rt or Lt lung only?

ii. Bilateral pleural effusion is noted; tumor in both lungs?

iii. Pleural effusion is noted on the opposite side from the tumor?

iv. Pleural effusion is on same side as the tumor?

SUPPORTING CS MANUAL DOCUMENTATION

Note 6: Pleural Effusion.

A. Note from SEER manual: Ignore pleural effusion that is negative for tumor. Assume that a pleural effusion is negative if a resection is done.

B. Note from AJCC manual: Most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor.

In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be staged T1, or T2, or T3.

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.

1. Note B does not modify or change note A. Note B is explaining when an effusion should not be used to determine the stage. Pleural effusions are evaluated by cytology, not biopsy.

2. If relevant, the clinician should document the fact in the medical record. Heart problems can cause non-malignant pleural effusions (that are disregarded for staging). Pleural effusion will almost always be around the lower lobes due to gravity, but may envelop an entire lung. Pleural effusions can be unilateral or bilateral regardless of the location of the tumor, but are usually on the side where the tumor is.

 2006
20061062 Reportability: Is a "pleomorphic hyalinizing angiectatic tumor of soft parts (PHAT)" reportable if the case has a TNM stage assigned and is stated by the pathologist to be a rare intermediate grade sarcoma?

Pleomorphic hyalinizing angiectatic tumors of the soft parts are not reportable.

According to our pathologist consultant, PHAT is a borderline malignancy (/1). While the true nature of these tumors is under debate (reactive vs. neoplastic), so far none have metastasized.

 2006
20061061 CS Lymph Nodes--Breast: Clarify the use of code 25 [Movable axillary lymph node(s), ipsilateral, positive with more than micrometastasis (i.e., at least one metastasis greater than 2 mm)] vs code 60 [Axillary/regional lymph node(s), NOS; Lymph nodes NOS] when surgically removed lymph nodes are positive but the size of the metastasis is not stated. See Discussion.

Note 2 in CS manual states: "If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2mm and code LNs as positive in this field. Use code 60 in the absence of other information about regional nodes."

1. If the LNs are known to be axillary LNs, note 2 seems to imply the size can be assumed to be greater than 0.2mm. Would you code 25 or 60?

2. Both codes 25 and 60 map to N1, node involvement. Do they each mean something else in the evaluation process?

3. What would constitute "absence of other information"?

4. Is the use of 60 over 25 specific to SEER registries or all users?

5. Abstractors are trained to assume LNs are mobile if there is no contrary information. Is this appropriate?

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.

Assign CS Lymph Nodes code 25 for breast when there are positive axillary nodes without internal mammary nodes. Code 25 is used in a couple of situations: a. when you know the lymph nodes are clinically movable and only the axillary nodes are involved; b. when you know the size of the metastasis in an axillary lymph node is more than a micrometastasis (i.e., > 2 mm). Code 60 can be used for any regional lymph node (internal mammary, infra- or supraclavicular, as well as axillary. So you can code to 25 if you have "regular" metastases in axillary lymph nodes only. If you don't know whether the mets are micro or regular, use code 60. Assign code 60 when there are positive regional nodes not further described.

1. Assign code 25 for positive axillary lymph nodes.

2. Codes 25 and 60 may map to N1, N1a, N2a or N3a depending on the coding of SSF3.

3. Assign code 60 when there is not enough information to assign a code from 13 to 50.

4. CS instructions are the same for all users. There are no CS instructions specific to SEER registries.

5. Yes, assume lymph nodes are moveable (not matted, not fixed) when there is no information to the contrary.

 2006
20061060 CS Site Specific Factor--Prostate: How are SSF 5 (Gleasons Primary and Secondary Pattern Value) and SSF 6 (Gleasons Score) coded when there is a higher Gleason's pattern in less than 5% of the tumor? See Discussion.

Radical prostatectomy pathology states prostate adenocarcinoma "combined Gleasons score 3+3=6, with a small portion of Gleasons pattern 4 component comprising less than 5% of tumor volume."

The WHO Classification of Tumors of the Urinary System and Male Genital Organs refers to "tertiary" Gleasons patterns in addition to the primary and secondary patterns. On prostatectomy, when this tertiary pattern is 4 or 5, WHO recommends that it should be reported in addition to the Gleasons score even when it is less than 5% of the tumor.

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.

Record Gleason's pattern and score from the largest specimen, even if this is a lower number. Ignore the tertiary pattern for now.

This may change when the AJCC 7th Edition is published, as there is much discussion regarding the tertiary patterns and when they should be utilized. If there is a change in AJCC, at that time there will be a change to CS.

 2006
20061059 Histology--Breast: Does "cancerization" mean invasive for a breast tumor described as "DCIS with lobular cancerization"? No, cancerization is not a synonym for invasive. Cells of DCIS can extend not only along the duct but also into the terminal lobules. This extension is referred to as lobular cancerization. 2006
20061058

CS Site Specific Factor--Prostate: Can autopsy results also be used when coding SSF3, pathologic extension, given that the instructions only address the use of prostatectomy findings when coding this field?

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.

If the prostate cancer was diagnosed on autopsy, or the autopsy was performed within the staging timeframe (See 2004 SEER Manual, page 112), code SSF3 using the autopsy information.

 2006
20061057 CS Extension--Lung: Can extension be coded to 10 (Tumor confined to one lung) when either an autopsy or a CT scan describes the tumor as a mass of a specified size located in one lobe of the lung without any description of extension and no available TNM provided? See Discussion.

Example 1: Lung primary within the right lower lobe described clinically as greater than 3 cm on scan but was found to be 3 cm at autopsy.

Example 2: CT scan February shows 2 cm mass in RUL.

In both cases, the only tumor description was the size of tumor without any information regarding extension.

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.

Yes, assign code 10 [Tumor confined to one lung] for a mass in one lobe when none of the descriptions in codes 11 to 80 are documented.

 2006
20061056 CS Lymph Nodes--Colon: Are positive paracecal lymph nodes for cecal primaries coded to 10 [paracolic] or code 20 [cecal: anterior (prececal), posterior (retrocecal); NOS]?

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.

Assign code 20 [Regional lymph node(s) for specific subsites]. Paracecal means near the cecum. Paracecal lymph nodes are regional nodes for the cecum and not for other colon subsites.

 2006
20061055 CS Lymph Nodes--Colon: What criteria is used to distinguish between code 30 [Regional lymph nodes, NOS] and 80 [Lymph nodes, NOS] when positive lymph nodes are removed during a colon resection but the lymph node location is not stated? See Discussion.

Example 1: Descending colon excision: Metastatic adenocarcinoma in 8 of 9 lymph nodes.

Example 2: Hepatic flexure and en bloc resection of liver. Adenocarcinoma in 3 of 10 lymph nodes.

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.

Code positive nodes included with the resected specimen as regional lymph nodes, NOS when the location is not stated. See number 3.e under the general instructions for coding CS lymph nodes.

Based only on the information provided, code CS lymph nodes 30 [Regional lymph nodes, NOS] for both examples.

 2006
20061054 First Course Treatment/Chemotherapy: Is adriamycin used in a chemoembolization procedure coded as chemotherapy? Code as chemotherapy only when a chemotherapeutic agent is used, such as adriamycin. Do not automatically code chemoembolization as chemotherapy. 2006