Report | Question ID | Question | Discussion | Answer | Year |
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20170024 | Reportability/Histology--Colon: Is tubular adenoma with high grade dysplasia and focal invasion from a pathology report of a colon biopsy reportable?; if so, what is the histology code? |
Tubular adenoma with high grade dysplasia and focal invasion is reportable. Assign the histology code and behavior as 8210/3 (Adenocarcinoma in tubular adenoma). NAACCR Guidelines for ICD-O-3 Implementation discuss the term high grade dysplasia (without invasion). High grade dysplasia and related terms are under review and study for consideration as a reportable neoplasm. Registries should check with their state reporting legislation to see if included in the reporting requirements. |
2017 | |
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20170063 | Reportability/Behavior--Ovary: Is adult granulosa cell tumor a reportable malignant tumor if the primary ovarian tumor ruptured intraoperatively, the peritoneum was contaminated, and the patient underwent adjuvant treatment with chemotherapy given the increased risk of recurrence due to intraoperative tumor spill? See Discussion. |
Per SINQ 20130176 and 20140034, adult granulosa cell tumors of the ovary are reportable malignant tumors when there are peritoneal implants or metastases. The SINQ responses describe how these adult granulosa cell tumors are different from low malignant potential (LMP) epithelial ovarian tumors. Would these SINQ scenarios apply to a case with intraoperative tumor rupture that resulted in peritoneal tumor? In this case, the pathologist indicated these excised peritoneal specimens were favored to be intraoperative contamination with adult granulosa cell tumor. However, the oncologist went on to treat this patient as high risk with chemotherapy. The oncologist only described one of the pelvic peritoneal implants as possibly contamination due to the rupture. The oncologist never indicated the tumors were definitely peritoneal implants. Should the behavior of this tumor be /1 because the peritoneal tumor appears to be contamination, or /3 because the oncologist treated this patient as high risk? |
If the "implants" were due to intraoperative contamination and were not present prior to surgery, do not interpret them as indicative of malignancy. The behavior of this tumor is /1. |
2017 |
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20170030 | Surgery Primary Site--Melanoma: How should Surgery of Primary Site be coded for a melanoma diagnosed on punch or shave biopsy followed by a wide excision that shows no residual disease and the gross wide excision specimen size showing no residual is greater than 1 cm in all dimensions (length, width and depth)? See Discussion. |
Discussion: Example: Shave biopsy with superficial spreading melanoma, Breslow 0.25 mm, Clark level II. Excision with no residual melanoma and gross description of specimen size is 4.0 x 1.6 cm skin ellipse excised to a depth of 1.8 cm. We have differing opinions in our registry. Opinion 1: We can assume margins are greater than 1 cm based on the excision specimen size when there is no residual tumor on excision and all dimensions of the excision specimen are more than 1 cm. Surgery would be coded in 40s range. Opinion 2: We should assume the melanoma defect was in the middle of the excision specimen, so for a skin ellipse that is 4.0 x 1.6 cm, there would be a 2 cm and 0.8 cm margin (respectively) from the middle of the specimen, thus margins are not > 1 cm. Surgery would be coded in 30s range. |
Assign code 30: Biopsy of primary tumor followed by a gross excision of the lesion. The margins are unknown. The registrar should not try to determine the margins when they are not specified. See the SEER Note at the top of page 2 in the Skin Surgery Codes section of Appendix C of the SEER manual "If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30." https://seer.cancer.gov/manuals/2016/AppendixC/Surgery_Codes_Skin_2016.pdf |
2017 |
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20170065 | MP/H Rules/Histology--Thyroid: How should histology be coded for a single tumor with final diagnosis undifferentiated (anaplastic) carcinoma arising in association with papillary thyroid carcinoma and the Summary Cancer Data states Histologic type: Undifferentiated (anaplastic) carcinoma only? See Discussion. |
The Summary Cancer Data does not seem to describe a more specific histology, but it does describe the tumor histology with the worst outcome and the most extensive tumor. The anaplastic carcinoma grossly extended into skeletal muscle and gave rise to multiple regional lymph node metastases. The more appropriate histology seems to be 8021. However, current MP/H Rules for a single tumor indicate the histology should be coded to the numerically higher histology code (8260). Coding the histology to 8260 does not account for the more aggressive tumor. Should this histology be 8260 or 8021? |
Code the most specific histologic term, 8260, for papillary carcinoma of the thyroid using Multiple Primary/Histology Rule H13 for Other Sites (single tumor, invasive section). Use text fields to describe the complete histology. |
2017 |
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20170023 | Reportability/Date of Diagnosis--Prostate: Is PI-RADS 5 diagnostic of prostate cancer, and if so, can we use the date of the impression on the scan that states PI-RADS category 5 as the diagnosis date? See Discussion. |
We are seeing more use of PI-RAD categories on scans. The final impression on the scan will be PI-RADS Category 5, with no specific statement of malignancy. The scans include a blanket statement with the definitions of the PI-RADS categories as below. PI-RADS (v2) categories: PI-RADS 1 - Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 - Low (clinically significant cancer is unlikely to be present) PI-RADS 3 - Intermediate (the presence of clinically significant cancer is equivocal) PI-RADS 4 - High (clinically significant cancer is likely to be present) PI-RADS 5 - Very high (clinically significant cancer is highly likely to be present) A previous SINQ 20010094 indicates that we cannot use BI-RADS categories for breast cancer diagnosis, and SINQ 20160008 indicates we can use LI-RADS for HCC diagnosis, but those definitions are slightly different. Most often there will be a subsequent biopsy diagnosis of carcinoma, so the question is also in reference to Diagnosis Date. Can we use the date of the scans impression, which states PI-RADS category 5, as the Diagnosis Date? |
Updated answer PI-RADS categories 4 and 5 are reportable, unless there is other information to the contrary. PI-RADS 4: high (clinically significant cancer is likely to be present) PI-RADS 5: very high (clinically significant cancer is highly likely to be present) Use the date of the scan as the date of diagnosis. |
2017 |
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20170006 | Diagnostic confirmation--Heme & Lymphoid Neoplasms (Lymphoma): To code "3" in Diagnostic Confirmation, does the genetic testing need to confirm a specific histology or is it enough that is simply rules out others? See Discussion. |
For example, pathology states: Right axillary lymph node, excision: Diffuse large B-cell lymphoma (DLBCL) (see note). COMMENT: FISH studies were performed that were negative for BCL-6, c-Myc/IgH, CCND1/IgH and IgH/BCl-2 gene rearrangement, ruling out the most common forms of double-hit lymphoma. Flow cytometry studies demonstrated positivity for CD45, CD20, HLA-Dr, CD19, CD11c, CD22, CD30, CD38, CD79b, and FMC7. Low positivity was seen for CD5. No reactivity was seen for CD10, CD23, CD25, CD103 or CD123. |
Both histologic plus immunophenotyping or genetic testing should be positive to assign code 3 for Diagnostic Confirmation. The Hematopoietic and Lymphoid Neoplasm Coding Manual Diagnostic Confirmation instructions state, assign 3 for Cases positive for neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis) AND Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme DB AND a.) Confirms the neoplasm OR b.) Identifies a more specific histology (not preceded by ambiguous terminology). Because the patient was diagnosed with DLBCL by histology, and flow cytometry was positive for CD antigens (immunophenotyping) 20, 22, and 30 for DLBCL, code 3 is appropriate. |
2017 |
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20170036 | Grade--Prostate: How are the prostate-related fields completed when documentation in pathology reports only includes one of the new grade groups? See Discussion. |
Our pathologists have starting to use a new prostate cancer grading system that was adopted by WHO in 2016. The new grading scheme correlates with the prior Gleason grading scheme as follows: Grade Group 1 = Gleason score 6 or less Grade Group 2 = Gleason score 3+4=7 Grade Group 3 = Gleason score 4+3 = 7 Grade Group 4 = Gleason score 8 Grade Group 5 = Gleason score 9-10 Our pathologists are no longer dictating the Gleason Primary and Secondary Pattern values nor the Gleason's Score. Reverse correlation from the new grade groups to the required patterns and score are difficult with Grade Groups 2 and 3 needing to be distinguished from one another and Grade Group 5 including two unique scores. The prostate-related fields include: Collaborative Site Specific Factor 7: Gleason's Primary Pattern and Secondary Pattern Values on Needle Core Biopsy/TURP Collaborative Site Specific Factor 8: Gleason's Score On Needle Core Biopsy/TURP Collaborative Site Specific Factor 9: Gleason's Primary Pattern and Secondary Pattern Values on Prostatectomy/Autopsy Collaborative Site Specific Factor 10: Gleason's Score on Prostatectomy/Autopsy |
When all you have is the grade group, you may use the following table to convert the Prostate Grade Groups to the appropriate code for the indicated fields. Grade Group Gleason Score Gleason Pattern SSF7 SSF8 SSF9 SSF10 Grade/diff Grade Group 1 6 or less <=3+3 099 999 099 999 1 Grade Group 2 7 3+4 034 007 034 007 2 Grade Group 3 7 4+3 043 007 043 007 2 Grade Group 4 8 4+4, 3+5, 5+3 999 999 999 999 3 Grade Group 5 9-10 4+5, 5+4, 5+5 099 999 099 999 3 |
2017 |
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20170039 | Histology--Heme & Lymphoid Neoplasms: How should histology be coded for final bone marrow diagnosis of myelodysplastic syndrome with excess blasts? See Discussion. |
This terminology is not specifically included in either alternate names list for myelodysplastic syndrome, NOS (9989/3) or refractory anemia with excess blasts (9983/3). Example: Bone Marrow Biopsy, Final Diagnosis: Consistent with involvement by myelodysplastic syndrome with excess blasts-2 (MDS EB-2). |
Assign code 9983/3 refractory anemia with excess blasts. Refractory anemia is a type of myelodyplastic syndrome. We will add this to the Heme & Lymphoid database during the next update. |
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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20170057 | Grade: If the biopsy site is a higher grade, is the grade of the biopsy used over the grade of the surgical resection? See Discussion. |
When coding tumor grade, our pathologists have told us to code grade based on the specimen from the most definitive surgery or with the most amount of tissue, and that coding grade from the biopsy would not be appropriate even if it is a higher grade than from the surgical resection. Coding of solid tumors Instruction 5 states: If there is more than one grade, code the highest grade within the applicable system. Code the highest grade even if it is only a focus. Code grade in the following priority order using the first applicable system. |
For cases diagnosed prior to 2018: Use the Grade Coding Instructions to code grade. The instructions are intended to standardize coding of grade across the U.S. and to eliminate differences in opinion between pathologists. Standardized coding ensures that data can be combined and used for statistical analysis. You may code grade based on the biopsy when following the grade coding instructions. |
2017 |