Report | Question ID | Question | Discussion | Answer | Year |
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20091044 | Radiation Therapy: Would tomotherapy, described as targeted IMRT, be coded as external beam? | Code tomotherapy as 1 [Beam radiation]. Tomotherapy is external beam radiation therapy. It is a type of IMRT. Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that utilizes computer-controlled x-ray accelerators to deliver radiation. Tomotherapy is a CT image guided IMRT. |
2009 | |
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20091043 | Multiple primaries--Lymphoma: Should a second primary lymphoma be accessioned if the reporting hospital disagrees with the final diagnosis stated on a review of slides? See Discussion. |
Example: Patient had an original diagnosis of small lymphocytic lymphoma (9670/3) of lung in 1986 and later presents with small B-cell non-Hodgkin lymphoma (9670/3) of small bowel in 2008 at Hospital A. Slides sent for review at Hospital B where patient was also seen. Slides there read as low grade B-cell lymphoma most consistent with extranodal marginal B-cell lymphoma of mucosal associated tissue (MALT Lymphoma). Hospital A's pathology report stated that immunostains would exclude mantle cell lymphoma and MALT lymphoma and the original pathology report has not been amended to match the outside path diagnosis. Is thisĀ a second primary of MALT lymphoma (9699)? |
For cases diagnosed prior to 1/1/2010:The 2008 diagnosis is not a new primary according to the Definitions of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table) using the pathology report diagnosis from the facility where the procedure was performed (Hospital A). Since Hospital A disagreed with the slide review and did not amend their diagnosis based on the slide review, do not use the slide review diagnosis in this case. For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ. |
2009 |
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20091042 | Multiple primaries--Hematopoietic, NOS: How many primaries should be coded when a patient has multiple occurrences of plasmacytoma followed by a diagnosis of multiple myeloma? See Discussion. | Example: Patient had a diagnosis on February 2003, plasmacytoma of the sinus; June 2003, plasmacytoma of the alveolar ridge; July 2003, plasmacytoma of the skin; and June 2004, multiple myeloma.
If this represents a transformation of plasmacytomas to multiple myeloma, will the information on multiple myeloma be available for statistical and research purposes? |
For cases diagnosed prior to 1/1/2010:Accession this case as plasmacytoma diagnosed in Feb. 2003. Each of the subsequent diagnoses are not abstracted as new primaries. They are the "same," one primary only, according to the Definition of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table). The 2003 diagnosis is a classic example of extraosseous plasmacytoma (9734/3). Plasmacytoma and multiple myeloma would be two primaries in the new hematopoietic rules taking effect in 2010. For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ. |
2009 |
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20091041 | CS Lymph Nodes--Ovary: Are positive lymph nodes removed from "colon tissue" during a modified posterior pelvic debulking regional or distant? If regional, what is the appropriate CS LN code? |
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.Pericolonic lymph nodes are "regional" lymph nodes for an ovarian primary. If you do not have enough information to assign codes 12-30, assign code 50 [Regional lymph nodes, NOS]. |
2009 | |
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20091040 | MP/H Rules/Histology--Breast: How is histology coded for an "infiltrating papillary carcinoma" of the breast when there is no mention of ductal or adenocarcinoma in the pathology report? | For cases diagnosed 2007 or later, assign histology code 8503 [Papillary adenocarcinoma]. Rule H14 applies. ICD-O-3 code 8050 does not apply in this case. Refer to the numeric listing in ICD-O-3. 8050 is a squamous cell neoplasm. Papillary carcinoma of the breast is NOT a squamous cell neoplasm. It is a neoplasm of the breast parenchyma - ducts, lobules or connective tissue. 8503 is the correct code in this case. |
2009 | |
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20091039 | CS Tumor Size--Lung:. Does code 997 (diffuse, entire lobe) for lung and main stem bronchus take precedence over a stated tumor size? See Discussion. | Per SPCSM 2007 'Coding Instructions for CS Staging Data Items-CS Tumor Size' item 5c states that code 998 (diffuse, entire lung) for lung and main stem bronchus takes precedence over any mention of size. Does this apply to code 997 as well? | 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 the stated tumor size rather than 997. Code 997 does not take precedence over tumor size at this time. According to CoC, the instructions in the CS Manual, Part I-27, rule 5c are to alert the user to special circumstances. Code 997 is not included because it is not diffuse for all of the sites listed. The site-specific rules and codes in the schema always take precedence. Further instructions and clarifications will be added to the lung schema, CS Manual Part II-317 in the next version of CS. |
2009 |
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20091038 | CS Tumor Size--Breast: Do the tumor size instructions in the CS Manual take priority over those in the SEER manual? See Discussion. | In regards to priority order of sources to be used in coding size for breast and lung, we are instructed to use the site-specific instructions in the 2004 SEER Manual over the general instructions in the CS Manual (see SINQ 20061109). Thus, physical exam size would be used over an imaging size. I&R question 2389 instructs registrars to use an imaging size over a physical exam size. This inconsistency creates confusion for them. Do the answers given in I&R not take into account the information in the SEER Manual? As a SEER Registry, which rules do we tell our hospitals to use? Are ACoS accredited hospitals required to use I&R over SINQ? | 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.The current SEER instructions and the CS instructions for source of tumor size information are the same. The tumor size priority source instruction in the 2004 SEER manual is not included in the 2007 SEER manual. SINQ 20061109 has been updated for clarification. There is no conflict between SEER instructions and I&R instructions at this time. SEER and the CoC collaborate, endeavoring to provide consistent instructions and to resolve inconsistencies. |
2009 |
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20091037 | MP/H Rules/Histology--Brain: How is histology coded for a "low grade neuroglial tumor" of the fourth ventricle? | For cases diagnosed 2007 or later, assign histology code 9505/1 [Ganglioglioma, NOS].
According to our pathologist consultant, low grade neuroglial tumor of the fourth ventricle correlates best to the "rosette-forming glioneuronal tumor of the 4th ventricle" which is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1. |
2009 | |
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20091036 | CS Mets at DX/CS Extension--Ovary: Is carcinomatosis always captured in the CS Mets field? Can the term carcinomatosis be used to describe peritoneal implants as well? See Discussion. | 1/18/06 CT guided biopsy of abdominal mass & ant peritoneum nodule: Extensive carcinomatosis affecting the paracolic gutters, liver surface & pelvis. 6 cm tumor mass was visibly engulfing the small bowel & tube; poorly differentiated adenoca, mullerian derived, shows attributes of clear cell carcinoma, high grade (FIGO III), 2.5 cm size, does not involve fallopian tube. R&L abdominal wall & mesentery, mets adenoca. 5/31/06: tumor debulking with right salpingo-oophorectomy. Final DX: Poorly differentiated adenocarcinoma, clear cell type, right ovary (FIGO III), stage IV per MD. |
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.In the case of ovarian cancer, the term carcinomatosis may refer to peritoneal implants, especially when the implants are numerous. It does not refer to distant metastases in this context. This issue has been forwarded to the CS version 2 committee. |
2009 |
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20091035 | CS Extension--Ovary: What code is used to capture omental caking? | 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.The term "omental caking" refers to a thickened omentum. In the case of ovarian cancer, omental caking is always indicative of involvement of the omentum. The omentum is an abdominal structure for the purposes of CS extension. Assign the appropriate code between 70-73.
When the size of implants is not stated, but operative report and scans state omental caking, code 71 would be best. When there are no size measurements on the operative report or scan or elsewhere, there is not enough information to assign 72. The choice of code between 70 and 73 will depend on the details of the specific case. |
2009 |