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.
MP/H Rules/Multiple primaries--Lung: How many primaries should be accessioned if patient has a LUL lung biopsy with squamous cell carcinoma and subsequently a station 4L node biopsy with small cell carcinoma? See Discussion.
Patient has only a LUL tumor on imaging. The tumor board initially states, possibly a mixed tumor, likely IIIA SCC and/or IIIA or B small cell. Later, the physician refers to it as "Stage III lung cancer, mixed histology with small cell in the lymph node and squamous cell in the LUL mass." Patient has no further workup and has declined therapy.
Accession the case as a single lung primary since there is only a mixed tumor noted by the tumor board. Code the histology as 8045, combination/mixed small cell carcinoma and squamous cell carcinoma, per Table 1 of the Multiple Primaries/Histology Rules.
Histology--Ovary: What is the correct ICD-O-3 histology code for sertoliform endometrioid carcinoma of the ovary?
Assign 8380/3. Sertoliform endometrioid carcinoma is a variant of endometrioid carcinoma according to the WHO Classification of Tumors of Female Reproductive Organs, 4th edition. There is no specific ICD-O-3 code for this variant.
Reportability--Brain and CNS: Are tuberous sclerosis cancers found in the brain reportable? See Discussion.
I have searched ICD-O-3 for a histology listing but could not locate. I also searched the SEER Inquiry database for possible answers, but none were found. The patient underwent a pediatric MRI of the brain of which final impression was: 1) Subependymoma nodules, cortical tubers, and SEGAs are seen bilaterally consistent with tuberous sclerosis.
SEGA (Subependymal giant cell astrocytoma) is reportable if diagnosed in 2004 or later. Tuberous sclerosis complex (TSC) is not a neoplasm and is not reportable. SEGA is a neoplasm that commonly occurs in TSC patients.
Solid Tumor Rules (2018)/Histology--Lung: The Histology coding guidelines for lung cancer state to code histology when stated as type or subtype but not to code when described as pattern. How should the histology be coded (Adeno, NOS or Adeno, Mixed subtypes) if the College of Americal Pathologists Protocol of the pathology report lists the following: Histologic type: Adenocarcinoma, papillary (90%), lepidic (8%), and solid (2%) patterns?
The term/modifier "patterns" is no longer allowed to code a specific histology according to the Lung Solid Tumor H rules. Disregard the papillary, lepidic, and solid patterns and code histology to adenocarcinoma, NOS (8140/3).
Reportability--Vulva: Is a biopsy showing high grade squamous intraepithelial lesion (VIN II) in the vulva reportable for cases diagnosed in 2018? See Discussion.
In comparison to SINQ 20180022, this case does not mention VIN III anywhere in the final diagnosis. Is any mention of HGSIL in the final diagnosis reportable, even if it is qualified with a non-reportable term in parenthesis or CAP protocol?
Since this HSIL diagnosis is specified as VIN II, do not report it.
WHO includes both VIN II and VIN III as synonyms for HSIL of the vulva. HSIL is reportable and VIN III is reportable. VIN II is not reportable.
First Course of Treatment/Other Therapy: Where do you code Optune TTF therapy? What needs to be included in the text portion to document this treatment?
If OPTUNE was administered for recurrence, be sure NOT to record it in the first course of treatment fields. Check with CoC if you have questions about coding treatment for recurrence.
MP/H Rules/Multiple primaries--Urinary: Is a renal pelvis diagnosed 5/2016 a separate primary when the first invasive bladder was 12/2011? Per rule M7, the 5/2016 renal pelvis is more than 3 years later. Does Multiple Primary/Histology (MP/H) rule M7 refer back to the original diagnosis date or to the last occurrence? See Discussion.
12/30/11 Bladder Biopsy: Diffuse carcinoma in situ of bladder, urothelial cancer at trigone (Stage T1)
1/30/2012 Transurethral resection of the bladder was non-papillary, urothelial carcinoma, focal invasion of lamina propria, staged T1
11/10/14, 9/28/15, 9/26/16, 10/19/17 all had positive bladder cytology of urothelial carcinoma
5/16/16 Left renal pelvis aspirate: positive for malignant cells, urothelial carcinoma
9/26/16 Left renal pelvis aspirate: positive for malignant cells, urothelial carcinoma
10/18/16-11/7/16 Bacillus Calmette-Guerin (BCG) x3 administered into the renal collecting system via ureteral catheter
For cases diagnosed prior to 2018
This case is a single primary. This patient has not had a disease-free interval as demonstrated by the positive cytologies from 2014 through 2017. The MP/H rules cannot be applied in this case.
To answer your question about the timing of rule M7, please see slide 6 in the Beyond the Basics MP/H advanced training, General Instructions, https://seer.cancer.gov/tools/mphrules/training_adv/SEER_MPH_Gen_Instruc_06152007.pdf
First Course of Treatment/Surgery of Primary Site--Melanoma: How do you code UVB therapy treatment for melanoma?
Code UVB therapy for melanoma as photodynamic therapy under Surgery of Primary Site for skin. Assign code 11 [Photodynamic therapy (PDT)] if there is no pathology specimen. Assign code 21 [Photodynamic therapy (PDT)] if there is a pathology specimen. Use text fields to document details.
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