Report | Question ID | Question | Discussion | Answer | Year |
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20170077 | First Course Treatment: Should the definition in the 2016 SEER Coding Manual be revised for first course of treatment following disease progression for patients who complete the initial first course treatment plan without alteration but had one or more treatment modalities given after disease progression was identified? See Discussion. |
The FORDS Manual (pg. 22) states: The first course of treatment includes all methods of treatment recorded in the treatment plan and administered to the patient before disease progression or recurrence. The instructions in the FORDS Manual and clarification from multiple CAnswer Forum posts indicates the planned first course treatment stops following disease progression, even when the first course treatment plan is not altered or changed. SEER, on the other hand, instructs registrars to do the opposite. The SEER Manual instructs registrars to code all completed treatment given as part of the initial first course treatment plan, even after disease progression, provided the treatment plan is not changed or altered. (See 2016 SEER Manual, Section VII First Course of Therapy, Treatment Timing, Rule 1 and Example 1.) For consistency in data collection, shouldnt the standard setters use the same guidelines to define first course treatment? Given that the majority of cases are reported to SEER by registrars in CoC facilities, who may not be abstracting treatment modalities that occur after progression, the SEER expectation is likely not able to be performed consistently. Wont this difference in standard setter data collection expectations negatively impact the treatment data reflected on our files? |
The example cited above will not be included in the 2018 edition of the SEER manual. Removing this example will improve the consistency in recording first course of treatment for cases diagnosed 2018 and later. |
2017 |
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20170061 | MP/H Rules/Histology--Thyroid: What is the correct histology when final diagnosis of a thyroidectomy includes the descriptor "papillary and follicular architecture?" See Discussion. |
Total thyroidectomy Final Diagnosis: Papillary carcinoma, classical type, with papillary and follicular architecture. The 2007 MP/H rules state that the term architecture is reserved for coding subtype of in situ primaries only. However, SINQ 20130165 appears to indicate this should be coded for invasive thyroid subtypes as well. Can you confirm the addition of the term architecture for determining an invasive histologic subtype for thyroid? |
Assign code 8260/3, papillary carcinoma per Multiple Primaries/Histology Rule H14. Architecture is reserved for coding subtype of in situ primaries only. SINQ 20130165 is not intended to indicate this should be coded for invasive thyroid subtypes. |
2017 |
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20170022 | MP/H Rules/Histology--Brain and CNS: What is the code for an embryonal tumor with multilayered rosettes. WHO shows the code as 9478/3, but this code is not available for use in the United States. |
Assign ICD-O-3 code 9392/3 until code 9478/3 is implemented in 2018. Per our expert neuropathologist, embryonal tumor with multilayered rosettes was previously called ependymoblastoma. |
2017 | |
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20170019 | MP/H Rules/Histology--Testis: How should histology be coded for a mixed germ cell tumor that also includes choriocarcinoma now that non-seminomatous mixed germ cell tumors (9065) and seminomatous mixed germ cell tumors (9085) are collapsed for analysis? See Discussion. |
The MP/H Rules (Other Sites Terms and Definitions, Table 2) currently lists a separate mixed germ cell tumor code (9101) for germ cell tumors with choriocarcinoma plus teratoma, seminoma or embryonal carcinoma. Is this separate mixed germ cell tumor code still to be used now that all mixed germ cell tumors (9065 and 9085) have been collapsed into code 9085 for analysis per SINQs 20160056 and 20110013? The current WHO Classification for testis tumors does not list code 9101, but also collapses all seminomatous and nonseminomatous mixed germ cell tumors of more than one histologic type under code 9085. |
While WHO 4th Ed Tumors of Urinary and Male Genital System does not include 9101/3, this code has not been made obsolete. Follow the 2007 MP/H rules and code histology to 9101/3 per Other sites rule H16, Table 2. |
2017 |
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20170011 | MP/H Rules/Multiple primaries--Breast: Can we accession two breast primaries when imaging is "suspicious for malignancy" on both breasts but only one biopsy is taken and is histologically confirmed, and assume bilateral complete response to neoadjuvant chemotherapy with bilateral mastectomies negative for residual cancer? See Discussion. |
The patient is diagnosed by bilateral mammograms suspicious for malignancy in both breasts. A biopsy is done on one breast and is positive. The physician states that he will not biopsy the contralateral breast, as the patient has consented to bilateral mastectomy. The patient receives neoadjuvant chemo, follow by bilateral mastectomies. Both breasts are negative for residual cancer, stated as a complete response. Based on "suspicious for malignancy" can we accession two primaries and assume bilateral complete response? |
Accession two breast primaries, one right and one left, rule M7. "Suspicious" is reportable ambiguous terminology. |
2017 |
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20170068 | MP/H Rules/Histology--Lung: What is the histology of a lung tumor described as solid predominant with mucin production, 8230/3 (Multiple Primaries/Histology (MP/H) Rule 5) or 8255/3 (MP/H Rule 6)? See Discussion. |
Pathology report: Left lower lobe lung, Tumor Size: Greatest dimension: 3.0 cm Additional dimensions: 2.5 x 2.0 cm; Tumor Focality: Unifocal; Histologic Type: Invasive adenocarcinoma Solid predominant with mucin production; Histologic Grade: G3: Poorly differentiated. Is the correct histology for this case 8230/3 (rule H5) or 8255/3 (rule H6)? |
Code histology as 8230/3, solid adenocarcinoma with mucin formation, using MP/H Rule H3 as one histologic type is identified. All of the histologic terms (solid, mucin production) are covered by 8230/3. Therefore, rule H3 applies. Use the first rule that applies, and stop. |
2017 |
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20170049 | MP/H Rules/Histology--Pancreas: What is the histology code of invasive adenocarcinoma, non-mucinous with intraductal tubulopapillary features, moderately differentiated, from the pathology report final diagnosis of the pancreas? Does 'intraductal" refer to a non-invasive/in-situ component or describe the pattern of growth? |
Assign 8503/3, intraductal papillary adenocarcinoma with invasion, to capture the more specific features of the adenocarcinoma. Histology Rule H13 for Other Sites states to code the most specific histologic term. Examples include Adenocarcinoma and a more specific adenocarcinoma. Note: The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ___ differentiation. |
2017 | |
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20170075 | MP/H Rules/Behavior--Breast: How many primaries are to be abstracted for a patient with a history of left breast ductal carcinoma in situ (DCIS) diagnosed in 2014 and bone lesions showing metastatic carcinoma consistent with a breast primary in 2017? See Discussion. |
Patient was diagnosed with DCIS of the left breast in June 2014. The patient had a simple mastectomy with 2 axillary lymph nodes removed. The final diagnosis was intermediate to high grade ductal carcinoma in situ, predominantly micropapillary type, forming a 1.4 cm mass. No invasive carcinoma identified. Margins negative. In April 2017, the patient was found to have parietoccipital bone lesions, which were resected. The resulting diagnosis was metastatic carcinoma, morphologically consistent with breast primary " See Comment: The previous breast lesion is not available for review at the time of signout. However, the tumor is morphologically compatible with a breast primary. SINQ 20110111 would not make this is new primary. However, it seems that rule M8 might apply. An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary. See Note 2: Abstract as multiple primaries even if the medical record/physician states it is recurrence or progression of disease. |
Assuming there were no other breast or any other tumors for this patient, change the behavior code to /3 on the original abstract for the 2014 breast primary. Similar to SINQ 20110111, there was likely a focus of invasion present in the original tumor that was not identified by the pathologist. The behavior code on the original abstract must be changed from a /2 to a /3 and the stage must be changed from in situ to localized. The MP/H rules do not apply to metastases. Therefore, rule M8 cannot be used. |
2017 |
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20170058 | MP/H Rules/Histology--Lung: What is the correct histology code for an initial biopsy of non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma with a subsequent re-biopsy showing poorly differentiated small cell carcinoma after chemotherapy with no response? See discussion. |
Patient had a biopsy in April 2014; pathology was reported as non-small cell carcinoma with neuroendocrine phenotype, possible large cell neuroendocrine carcinoma. The patient had five cycles of cisplatin/etoposide with no response. In May 2015, a re-biopsy at a referral institution reports poorly differentiated small cell carcinoma and states "feels that this could have been the histology all along and why patient has failed multi lines of chemo." |
Code to 8041, small cell carcinoma, because the medical opinon confirms that this was the correct histology from the begining. "Possible" is not an ambiguous term used to code histology. The MP/H rules do not include coding phenotype. That leaves non-small cell (8046/3) at time of diagnosis. Chemotherapy does not alter cell type so its likely the tumor was small cell all along only now proven with additional testing. Page 14 of the SEER Coding Manual gives examples of when to change the abstract's original codes and here is one example: When better information is available later. Example 1: Consults from specialty labs, pathology report addendums or comments or other information have been added to the chart. Reports done during the diagnostic workup and placed on the chart after the registrar abstracted the information may contain valuable information. Whenever these later reports give better information about the histology, grade of tumor, primary site, etc., change the codes to reflect the better information. |
2017 |
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20170035 | MP/H Rules/Histology: What is the histology code of serous tubal intraepithelial (in situ) carcinoma (STIC), bilateral fallopian tubes? |
Assign 8441/2. This is based on the WHO classification for female reproductive system tumors. |
2017 |