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Report Produced: 02/10/2026 00:09 AM

Report Question ID Question Discussion Answer Year
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
20091055 Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion. On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008.

For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence.

2009
20091084 Primary site--Colon: How do you determine the correct subsite when there is conflicting information in different reports? Are there priority rules for coding subsite for sites other than Head and Neck? See Discussion. The path report for a hemicolectomy says, " Specimen: left colon..." and the microscopic says, "...received in formalin designated left colon..." The Operative procedure report says, "Postoperative diagnosis - splenic flexure tumor." The text of this report says, "Mobilizing the splenic flexure mass was incredibly difficult..." and then goes on to describe exactly how and where it was resected. The discharge summary says adenosquamous carcinoma of the splenic flexure. SINQ20051010 says to use the pathology report first, but this was written before the new MP/H rules.

Use the operative report information to code primary site in this case. It is more accurate.

The operative report is usually a better source of location information compared to the pathology report. The pathologist can only reiterate the location as it was reported to him/her.

The 2007 SEER manual states "Unless otherwise instructed, use all available information to code the site," page 69.

 2009
20091020 MP/H Rules/Histology--Breast: How do you code histology for a breast tumor when the comment section of the pathology report compares the current resected specimen with a previous needle biopsy? See Discussion. A single tumor is described on the breast needle biopsy as "infiltrating lobular carcinoma and ductal carcinoma in situ" and on the lumpectomy specimen as "infiltrating duct carcinoma." Per the COMMENT section on the pathology report: "Tumor resection was compared to previous needle biopsy. The appropriate designation is probably a terminal duct/lobular lesion." For cases diagnosed 2007 or later, assign code 8522 [Infiltrating duct and lobular carcinoma] according to Breast MP/H rule H16. The comment on the lumpectomy pathology report takes both the lumpectomy information and the biopsy information into consideration. "Probable" is an ambiguous term used to code histology. 2009
20091129 Primary Site--Breast: What subsite is to be coded for a case of invasive Paget disease of the nipple with an infiltrating ductal carcinoma of the lower inner quadrant? Code C50.9 [Breast, NOS]. Code the last digit of the primary site to '9' for single primaries when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. Nipple [C50.0] and LIQ [C50.3] fit this rule. This is a single primary per MP/H Breast Rule M9. 2009
20091058 MP/H Rules/Histology--Kidney: How is histology coded when it is described in the pathology report as "Histologic type: Clear cell (conventional) renal cell carcinoma. Percent of sarcomatoid component: 10%"? See Discussion. MP/H rules for kidney, Table 1 lists both clear cell and sarcomatoid as specific types of renal cell carcinoma. The MP/H terms and definitions for kidney state that clear cell is architecturally diverse. For this case, does the sarcomatoid component represent a subtype of clear cell that has not been assigned an ICD-O code, and thus histology should be coded to 8310? Or does the sarcomatoid component represent a specific type of renal cell carcinoma for which rule H6 would apply? Should histology be coded 8255 for this case? For cases diagnosed 2007 or later, assign code 8310 [clear cell adenocarcinoma] according to rule H5. Renal cell, clear cell and sarcomatoid are mentioned in the diagnosis. Sarcomatoid is referred to as a component. Component is not one of the terms listed in rule H5 that indicate a more specific type. Ignore sarcomatoid in this case. Use table 1 to identify clear cell as a specific renal cell type. Code the specific type (clear cell) according to rule H5. 2009
20091009 MP/H Rules/Histology--Kidney: How do you code histology for a renal cell carcinoma when pathologists disagree as to whether or not the tumor is consistent with thyroid-like follicular carcinoma of the kidney? See Discussion. Final diagnosis states 'left radical nephrectomy, renal cell carcinoma.' The CAP Histologic Type is listed as: Unclassified, most consistent with primary thyroid-like follicular carcinoma of the kidney.' Because of the unusual histology it was sent for a consult to a genitourinary pathology specialist. His response was: 'histologic features not typical for any of the known subtypes of renal cell carcinoma and are not consistent with primary thyroid-like follicular carcinoma of the kidney, a distinct renal tumor that we have recently published in the literature.' The tumor was TTF-1 negative, arguing against metastasis from a thyroid primary. For cases diagnosed 2007 or later, assign code 8312 [renal cell carcinoma, NOS]. The diagnosis is renal cell carcinoma, but the specific type is in question. 2009
20091007 CS Extension--Lung: How is this field coded for a tumor in the right middle lobe with extension to the bronchus intermedius?

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 extension code 20

[Extension from other parts of lung to main stem bronchus, NOS

(EXCLUDES superficial tumor as described in code 11)

Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus)].

A right middle lobe tumor that extends to the bronchus intermedius is one that is extending to the main stem bronchus from another part of the lung. The bronchus intermedius is the lower part of the main stem bronchus on the right. It is more than 2.0 cm away from the carina.

 2009
20091092

MP/H Rules/Histology--Lung: How should Diagnosis Date, Diagnostic Confirmation and Histology be coded for the LEFT lung mass in the following case?

PET shows a 3 cm mass in the left lung and a 2.9 cm mass in the right lung. No reportable terminology in PET. The right mass is biopsied and shows adenocarcinoma. The left mass is not biopsied. Based on rule M6, this should be reported as two primaries. No additional information in medical record. Patient expired.

For cases diagnosed 2007 or later:

For date of diagnosis, use the date of the PET scan for both primaries. For the left tumor, assign diagnostic confirmation code 8 [Clinical diagnosis only] and assign histology code 8000/3 [malignant neoplasm].

The left lung mass is reported as a separate primary because there is one tumor in each lung. According to Rule M6, when there is one tumor in the left lung and one tumor in the right lung, each tumor is a separate primary. Tumor and mass are equivalent terms for purposes of the multiple primary rules.

 2009
20091123

Reportability: Is a tumor reportable if the pathology report indicates a non-reportable diagnosis at the time the specimen is removed but subsequent clinical statements state the patient had a reportable tumor? See Discussion.

The 2007 SEER Manual (page 3) states that cases diagnosed clinically are reportable. Exception 2 states if enough time has passed that it is reasonable to assume the physician has seen the negative pathology report, but the clinician continues to call this a reportable disease, accession the case.

SEER reporting guidelines state that severe dysplasia is not reportable, however, many clinicians regard it to be equivalent to carcinoma in situ.

Example 1: In 09-2007 the pathology report for excisional biopsy of right floor of mouth states the final diagnosis is severe dysplasia. At the time, the case is not accessioned based on non-reportable pathology. Patient is subsequently admitted in 3-09. According to the clinical history the patient was diagnosed with squamous cell carcinoma in 2007 and treated with laser. Is this reportable? If yes, how is behavior to be coded? How is "Ambiguous Terminology at Diagnosis" to be coded?

Example 2: In 2-08, the pathology report for a punch biopsy of a skin lesion states the final diagnosis is atypical melanocytic hyperplasia. In 3-08, patient is admitted for re-excision. The clinical diagnosis states re-excision being done for melanoma in situ.

Reference: SINQ 20061123

A tumor that is non-reportable based on the pathology report diagnosis should not be accessioned if later clinician statements mistakenly refer to it as a reportable tumor. The exception in the 2007 SEER manual on page 3 is intended to allow the registrar to accession a case when the clinician actually disagrees with the pathology report and clinically diagnoses a reportable tumor.

 2009