Report | Question ID | Question | Discussion | Answer | Year |
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20190037 | Solid Tumor Rules/Multiple Primaries--Breast: How many primaries should be abstracted for simultaneously diagnosed non-contiguous invasive duct carcinoma and mucinous carcinoma? Does rule M12 apply since the two histologies are on different rows of Table 3 of the Breast Solid Tumor Rules? See Discussion. |
Core biopsy of left breast at 2:00: Invasive ductal carcinoma, Nottingham score 6/9. Core biopsy of left breast at 4:00: Invasive mucinous carcinoma (variant of ductal carcinoma), Nottingham score 5/9. Post neo-adjuvant mastectomy: Main (largest tumor): Invasive ductal carcinoma, upper outer quadrant grade 2. Secondary tumor: mucinous carcinoma, grade 1 at 4:00. |
Abstract multiple primaries when separate, non-contiguous tumors are on different rows in Table 3 of the Breast Solid Tumor Rules. Use Rule M14 as each row in the table reflects a distinctly different histology, in this case, invasive ductal carcinoma (8500) and mucinous carcinoma (8480). |
2019 |
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20190074 | First course treatment/Scope of Reg LN Surgery--Breast: How is Scope of Regional Lymph Node Surgery coded when there is a sentinel lymph node biopsy (SLNBx) and intra-mammary nodes removed for a single primary? See Discussion. |
Example: Operative report documents a left breast skin sparing mastectomy and sentinel node biopsy procedure. Pathology report lists left axillary sentinel nodes in specimen A) with 0/2 nodes positive, and left breast mastectomy without axilla in specimen B) yielding an additional 0/2 intramammary nodes positive. Would the Scope of Regional Node Surgery be coded as 2 (SLN biopsy) to capture the intent of the sentinel node procedure only, or 6 (code 2 + 4) to capture the actual type and number of nodes removed? SEER Coding and Staging Manual includes Scope of Regional Lymph Node Surgery instruction 4.b. which mentions assigning code 4 to intra-organ node removal. Similarly, there is instruction for coding SLN biopsy as code 2 and SLN biopsy with axillary dissection at the same time (code 6) or during separate procedures (code 7). However, it is not clear this combination code is how we should also capture an incidental intra-organ node removal. |
Revised answer 07/11/2023 Assign code 6, Sentinel node biopsy and code 3, 4, or 5 at same time or timing not noted. There were two sentinel lymph nodes removed (code 2) plus two intramammary nodes removed in a separate specimen from the mastectomy (code 4). Assign code 6 when nodes are removed from a sentinel lymph node procedure at the same time as removal of intra-organ lymph nodes which were not part of the sentinel lymph node procedure. |
2019 |
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20190013 | Laterality--Head and Neck: Were the topography codes C090 and C091 intentionally left off of the Sites for Which Laterality Codes Must Be Recorded table in the 2018 SEER Manual? The codes were also removed from Table 10 in the 2018 Solid Tumor Rules for Head and Neck but appear under coding instructions 1b. and 6b. in the manual. |
Thank you for bringing this to our attention. C090 and C091 were intentionally removed from the list of sites for which laterality must be coded. They should have also been removed from coding instructions 1b and 6b. We will make that correction in the next version of the manual. |
2019 | |
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20190051 | Update to current manual/Solid Tumor Rules (2018)/Histology--Lung: What is the histology code and what M Rule applies when there are multiple specific subtypes identified using various equivalent lung terms but only one is stated to be predominant? See Discussion. |
Example: Lung resection final diagnosis is Lung adenocarcinoma, see Summary Cancer Data, and the Summary Cancer Data (CAP Synoptic Report) states Histologic type: Invasive adenocarcinoma, solid predominant. Other Subtypes Present: 20% acinar and <5% micropapillary components. Instruction 1B and Note 1 for Coding Multiple Histologies (Lung Histology Rules) indicates type, subtype, component, and predominantly are all terms that may be used to code the most specific histology. In this case, the multiple specific histologies were documented using all of those terms. Note 2 for instruction 1B states predominantly describes the greatest amount of tumor and when it is used for the listed subtypes of adenocarcinoma, that subtype should be coded. However, Note 2 does not indicate that the other subtypes are ignored when one is identified to be predominant and the others are identified as subtype or component only. |
Code to invasive adenocarcinoma, solid predominant (8230/3), based on the example, using Lung Solid Tumor Rules Coding Multiple Histologies instruction #1 that says to code the specific histology where the most specific histology may be described as component, majority/majority of, or predominantly, in this case, 75%. Apply Rule M2 as this appears to be a single tumor with multiple histologies based on the information provided. The rules will be updated to add a new H rule and to reviseTable 2 when two or more histologies described as predominant are present. |
2019 |
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20190018 | Histology--Thyroid: Should any mention of encapsulated be included in the histology coding (8343/3 vs. 8260/3) for papillary thyroid carcinoma cases? See Discussion. |
Example: Left thyroid lobectomy with final diagnosis When the only mention of encapsulation is included in the tumor characteristics of the College of American Pathologists (CAP) summary, not the pathologist's choice of histologic type, what is the preferred histology? |
Assign 8343/3 for encapsulated variant of papillary thyroid carcinoma. If the pathology report is not available, use the histologic type in addition to other information in the CAP Protocol. |
2019 |
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20190004 | Systemic/Surgery Sequence: Does the Systemic/Surgery Sequence field apply to only the first surgery performed (Date of First Surgical Procedure) or does it apply to the most definitive surgery (Date Most Definitive Surgery) as well? See Discussion. |
Example: Bladder primary with transurethral resection of the bladder tumor (TURBT) on 2/17/2017 (Date of First Surgical Proc) followed by a second TURBT on 3/24/2017 (Date Most Definitive Surgery) with mitomycin C instilled on the second, most definitive TURB procedure. There is an edit failure (IFX166) when Systemic/Surgery Sequence is coded 5 (intra-operative systemic) and Systemic Date does not match Date of First Surgical Procedure. How should we capture the intra-operative systemic treatment during the second, most definitive TURB? Is the correct Surgery/Systemic Sequence code 3 (systemic after surgery) for this case because (intra-operative) chemo was technically given after the first surgery? |
Assign code 3 to Systemic/Surgery Sequence and document the intraoperative treatment in the text field. Surgery is defined as a Surgical Procedure to the Primary Site (codes 10-90), Scope of RLN Surgery (codes 1-7), or Surgical Procedure of Other Site (codes 1-5) in the 2018 SEER Manual. In this case, the treatment was after the first surgical procedure. |
2019 |
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20190090 | Update to current manual/Extent of Disease/Summary Stage 2018--Fallopian Tube: How are behavior, EOD Primary Tumor, and Summary Stage 2018 coded for a diagnosis of serous tubal intraepithelial carcinoma (STIC) of the fallopian tube? See Discussion. |
The 2018 ICD-O-3 Histology Updates table lists serous tubal intraepithelial carcinoma (C57.0) with a behavior code of 2. The EOD Primary Tumor schema for Fallopian Tube shows STIC has an extension code of 100. It also maps code 100 to Summary Stage 2018 L (localized). Summary Stage 2018 for fallopian tube only documents that intraepithelial tumors are summary stage 0 (in situ). |
We are aware of the issue and have been in discussion with standard setters (SEER, NPCR, AJCC, and NAACCR). At this time, we recommend coding: Histology: 8441/2 Extent of Disease (EOD) Primary Tumor: 000 Summary Stage: 0 AJCC Clin/Path T would be 88, since all in situ lesions are not applicable. Edits will not allow you to have a 8441/2 with a T1. Also, EOD is not currently set up to derive the correct T value, unless you code 100. The change to address the issue will take effect in 2021. |
2019 |
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20190050 | Reportability/Melanoma: Is evolving melanoma reportable with a Clark's level and Breslow's thickness are cited in the pathology report? See Discussion. |
How do we interpret the reportability of the following: The histological and immunohistochemical findings are most consistent with an early-evolving malignant melanoma, superficial spreading type, with Clark's level II and maximal Breslow thickness 0.33 mm, arising in association with an atypical nevus. Since a Clark's level and Breslow's thickness are included, is this reportable? Is this really an evolving melanoma? |
As of 01/01/2021, early or evolving melanoma in situ, or any other early or evolving melanoma, is reportable. |
2019 |
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20190045 | Solid Tumor Rules (2018)/Multiple Primaries--Head & Neck: How many primaries are accessioned and what M Rule applies when a patient is diagnosed with a right lateral tongue (C023) tumor in 2016 that was verrucous carcinoma (8051), followed by a new left tongue border (C021) tumor in 2019 that was squamous cell carcinoma, NOS (8070)? See Discussion. |
According to the Multiple Primaries/Histology Rules in place at the time of the 2016 diagnosis, verrucous carcinoma was listed as a specific type of squamous carcinoma (Chart 1). However, in the current Solid Tumor Rules, verrucous carcinoma is not listed in Table 4 (Tumors of Oral Cavity and Mobile Tongue) either as a specific histology or as a specific subtype/variant of squamous carcinoma. The only subtype/variant listed for these sites is acantholytic squamous cell carcinoma (8075). Verrucous carcinoma is not listed in Table 4, making it unclear if it should be a different histology for these specified sites. However, verrucous carcinoma is listed as a specific subtype/variant of squamous carcinoma for other sites (e.g., Table 3). |
Accession a single primary based on the 2018 Head and Neck Solid Tumor Rule M13 as none of the other rules apply to the situation. Not all histology codes are contained in the tables in the Solid Tumor Rules as they list the more common histologies. Verrucous carcinoma is a subtype of squamous cell carcinoma according to Table 3 of the Rules. Solid Tumor rule tables are based on 4th Ed WHO Blue Books. Verrucous SCC is not included in oral cavity/mobile tongue chapter. |
2019 |
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20190082 | Primary site/Histology--Peritoneum: What is the correct primary site code for peritoneal mesothelioma in a female? When I use C482, it seems that the fields are all geared towards primary peritoneal carcinoma with FIGO staging, etc. |
For mesothelioma, NOS (9050) and epithelioid mesothelioma (9052) of the peritoneum for females, assign C481, C482, or C488 as appropriate based on the site of origin in the medical documentation. The Primary Peritoneal Ca schema is assigned and you will need to complete the SSDIs for FIGO staging, CA-125 PreTx Interpretation, and Residual Tumor Volume Post Cytoreduction. If the histology is 9051 or 9053 with primary site of C481, C482, or C488 for females, the Retroperitoneum schema is assigned. The only SSDI for this schema is Bone Invasion. |
2019 |