Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20190025 | 2018 Solid Tumor Rules/Histology--Colon: What is the histology code of a diagnosis of well differentiated neuroendocrine tumor (NET), grade 2 of the appendix? See Discussion. |
SINQ 20160023 and the Solid Tumor Rules indicate NET G1 (or well differentiated NET) is coded as 8240 and NET G2 is coded as 8249. Clarification regarding grade coding in the CAnswer Forum indicates well differentiated neuroendocrine tumor refers to the histologic type, and not the grade. Therefore, the term well differentiated is ignored for the purpose of grade coding. Neither of these sources clarifies how to code histology for a tumor diagnosed as well differentiated neuroendocrine tumor, grade 2. |
Assign histology code 8249 for histology described as well differentiated NET G2. A synonym for NET of the appendix includes well-differentiated endocrine tumor/carcinoma according to WHO Classification of Tumors of the Digestive System, 4th edition. "Well differentiated" could apply to either NET G1 or NET G2. |
2019 |
|
20190014 | Reportability--Behavior: Is reportable if it shows invasion or microinvasion pathologically? See Discussion. |
The SEER Manual states, Generally, this rule is invoking the Matrix principle in the ICD-O-3. We are aware this is not the same as a VIN III or an adenoma with microinvasion because those tumors have a valid histology code listed in the ICD-O-3. The terms or or do not have a valid ICD-O-3 code to apply the Matrix principle. If severe dysplasia is felt to be consistent with a carcinoma in situ, then a severe dysplasia with microinvasion would be reportable as 8010/3. But in the U.S., we do not accession severe dysplasia as equivalent to carcinoma in situ unless the pathologist also states the severe dysplasia is equivalent to carcinoma in situ (e.g., ). |
Severe dysplasia alone is not reportable. No further instructions apply because this term is not reportable.In order to use the instructions for behavior, you must first have a reportable neoplasm. If carcinoma in situ is mentioned and there is microinvasion, code the behavior as /3 according to the instructions in the SEER manual. You are correct, do not accession severe dysplasia as equivalent to carcinoma in situ unless the pathologist also states the severe dysplasia is equivalent to carcinoma in situ (e.g., ). |
2019 |
|
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 |
|
20190033 | Update to current manual/Neoadjuvant therapy/Pathologic tumor size--Breast: When a patient with invasive breast cancer is started on neoadjuvant therapy and at surgery is found to have only residual in-situ disease, do we record the size of the in-situ tumor for Pathologic Tumor Size? See Discussion. |
I understand that we are to record the Clinical Tumor Size in Tumor Size Summary because of the neoadjuvant therapy, but the SEER manual does not address what to record in the Pathologic Tumor Size after neoadjuvant therapy. Would we record 999 or the size of the in-situ tumor in the Pathologic Tumor Size field? Will there ever be a new data item added or changes to this current data item? By recording the Patholigic Tumor Size this way, there currently will not be any way to compare tumor size clinically versus after neoadjuvant therapy and assessing the response. |
Note: this is an update to the 2018 SEER manual. Assign 999 in Pathologic Tumor Size when neoadjuvant therapy has been administered. We can explore the possibility of another data item in the future. |
2019 |
|
20190020 | Solid Tumor Rules (2018)/Histology--Head & Neck: What table in the Head and Neck Solid Tumor Rules applies to tumors of the lip (C000-C009)? The rules apply to all tumors in sites C000-C148, C300-C339, C410, C411, C442 and C479, but none of the histology tables include the lip. See Discussion. |
Example: Patient has a secretory carcinoma of minor salivary gland tissue (mammary analogue secretory carcinoma [MASC]) of the mucosal lower lip; it is unclear which table to use and how to arrive at the correct histology using the H Rules. Rule H1 (code the histology when only one histology is present) states, Note 1: Use Tables 1-9 to code histology. There is no table that includes the lip. The correct histology should be 8502 which is listed in Table 6 (Tumors of Salivary Glands) however this does not correspond to minor salivary glands of the mucosal lip (site C003 per ICD-O-3 coding instruction). The 2018 ICD-O-3 Update table does not include this histology, however Table 6 indicates code 8502 (secretory carcinoma) is a new code that was approved by IARC/WHO. The ICD-O-3 only includes this histology as secretory carcinoma of breast. Therefore, in order to arrive at the correct histology, one must be aware of previous SINQ entries 20160036 and 20130003 that indicate secretory carcinoma (or MASC) is histology 8502. However, these are related to MP/H Rules, so registrars may be hesitant to apply this guideline to cases coded using Solid Tumor Rules. |
Assign 8502/3 using Table 6 of 2018 Solid Tumor Rules for Head and Neck. Table 4 notes that there is no ICD-O site code for minor salivary glands. Many minor salivary glands are located in the lips, inner cheek (buccal mucosa), and there are extensive minor salivary glands in the linings of the mouth and throat. Code to the site in which the salivary gland is located. Mammary analog secretory carcinoma (MASC), also called secretory carcinoma, is a rare, generally low-grade salivary gland carcinoma characterized by morphological resemblance to mammary secretory carcinoma and ETV6-NTRK3 gene fusion. Common sites are of the parotid gland, oral cavity, submandibular gland, and the axilla with rare sites being the face including the lips, trunk, and limbs according to WHO Classification of Head and Neck Tumors, 4th edition and WHO Classification of Skin Tumors, 4th edition. This histology is usually associated with primary site of breast and you may get an edit that you can override. |
2019 |
|
20190047 | Reportability/Liver: If on imaging, there is no statement of the Liver Imaging Reporting and Data System (LI-RADS) score but there is reference that a lesion is in the Organ Procurement and Transplantation Network (OPTN) 5 category, is hepatocellular carcinoma (HCC) reportable based on the OPTN 5 classification? See Discussion. |
SINQ 20160008 discusses the reportabilty and diagnosis date for liver primaries where imaging references the LI-RADS category as LR-5 or LR-5V. The 2018 SEER Coding and Staging Manual, Appendix E Reportable Example #16, demonstrates this concept. According to the LI-RADS categories a value of 5 is "definitely HCC" and is concordant with OPTN 5. Often we see only the OPTN categorization. |
Report HCC based on the OPTN class of 5. OPTN class 5 indicates that a nodule meets radiologic criteria for HCC. Be sure to document in text fields. |
2019 |
|
20190015 | Update to current manual/EOD 2018--EOD Primary Tumor: Should Note 6 in Extent of Disease (EOD) Primary Tumor for the schemas Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma be revised to exclude pelvic sites? See Discussion. |
There is a discrepancy between Notes 3 and 6 in the schemas Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma for EOD Primary Tumor. Note 3 describes extension/discontinuous metastasis to the pelvic sites (code 450) and includes the sigmoid colon, rectosigmoid and rectum since these are all pelvic sites. However, Note 6 also includes rectosigmoid and sigmoid colon. Note 6 is describing extension/discontinuous metastasis to the abdominal sites (600-750), so it should include rectosigmoid or sigmoid colon (since those are pelvic sites). Note 6 indicates, Intestine, large (except rectum). In the previous Collaborative Stage, the corresponding note used to also include: except sigmoid colon, rectosigmoid and rectum. Did sigmoid colon and rectosigmoid get removed from the list here? That is, should Note 6 read, Intestine, large (except sigmoid colon, rectosigmoid, rectum)? Involvement of the sigmoid, rectosigmoid, or rectum via peritoneal seeding/metastasis is consistent with T2b disease and would correlate with code 450 (pelvic sites), not codes 600-750 (abdominal sites). Those codes only correlate with T3 and greater disease (i.e., peritoneal seeding/metastasis of the abdomen). |
Thank you for bringing this issue to our attention. Rectosigmoid and Sigmoid Colon belong in Note 3 and not Note 6 for the following EOD schemas: Fallopian Tube, Ovary, and Primary Peritoneal Carcinoma. Rectosigmoid and sigmoid colon will be removed as separate listings from Note 6. The only mention in Note 6 will be: Intestine, large (except rectum, rectosigmoid, and sigmoid colon) This change will be made for the next update. |
2019 |
|
20190039 | Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes? See Discussion. |
11/01/2018, lung, left upper lobe, wedge resection: Invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes. Would this be 8260/3 since the acinar and lepidic subtypes are described as minor or would this be 8255/3 because there is papillary plus two other subtypes/variants described as subtypes? |
Code as adenocarcinoma, papillary predominant (8260/3) according to the Lung Solid Tumor Rules, Coding Multiple Histologies, which says to code the specific histology. The most specific histology may be described as component, majority/majority of, or predominantly, where predominantly describes the greater amount of tumor. |
2019 |
|
20190058 | Solid Tumor Rules (2018)/Histology--Cervix Uteri: What is the histology code and what H Rule applies for a diagnosis of papillary squamotransitional cell carcinoma of the cervix? See Discussion. |
It appears that the first Other Sites applicable rule is H16 (and Table 2) instructing the use of histology code 8323 (mixed cell adenocarcinoma). However, this really is not an adenocarcinoma tumor but is a mixed squamous and transitional cell carcinoma. The 2018 ICD-O-3 Histology Update Table provides a new term for a but does not indicate whether that new term would also include a papillary squamotransitional cell carcinoma of the cervix. |
Code papillary squamotransitional cell carcinoma (PSCC) as 8120/3 using the 2018 Other Sites Solid Tumor Rules, Rule H11. PSCC is a distinctive subcategory of squamous cell carcinoma of the uterine cervix. WHO Classification of Tumors of Female Reproductive Organs say that squamotransitional cell tumors show papillary architecture with fibrovascular cores lines by multilayered atypical epithelium. |
2019 |
|
20190005 | Primary Site--Bladder: Does instruction #4 in the Urinary Sites Solid Tumor Rules Instructions for Coding Primary Site apply to a mix of in situ and invasive urothelial tumors? Instruction #4: Code Urinary System NOS C689 when there are multiple non-contiguous tumors in multiple organs within the urinary system. See Discussion. |
Example: Patient has multiple biopsies with final diagnosis of in situ papillary urothelial carcinoma in the prostatic urethra and invasive papillary urothelial carcinoma in the bladder. How should primary site be coded in this type of mixed in situ and invasive situation? |
Code Urinary System NOS C689 for this case since there are two separate urinary sites involved. Apply instruction #4 when there is a mix of in situ and invasive urothelial tumors. |
2019 |