| Report | Question ID | Question | Discussion | Answer | Year |
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20200046 | Reportability--Vulva: Is well differentiated vulvar intraepithelial neoplasm (dVIN) reportable? See Discussion. |
Is this histologic terminology synonymous with 8071/2 Differentiated-type vulvar intraepithelial neoplasia? Per the 7/20/2018 updates to the 2018 ICD-O-3 Histology list, the reportability flag was changed from N to Y for Differentiated-type vulvar intraepithelial neoplasia as well as Differentiated penile intraepithelial neoplasia, both 8071/2. It appears that both SINQ 20180020 and the second half of SINQ 20160069 are no longer valid and should be deleted. |
Report well-differentiated vulvar intraepithelial neoplasm (8071/2). Our expert pathologist consultant regards this as reportable. Well-differentiated is synonymous with differentiated in this context. The older SINQ questions have been removed. |
2020 |
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20200063 | Solid Tumor Rules (2021)/Laterality--Melanoma: Will the table called Site for Which Laterality Code Must Be Recorded be updated in the 2021 SEER Program Coding and Staging Manual as C444 is not included? The 2021 Cutaneous Melanoma Solid Tumor Rules say that C444 requires laterality; it says (new) beside it on the new Solid Tumor Rules for 2021. |
The laterality table in the 2021 SEER manual will not be updated. Please follow the 2021 Cutaneous Melanoma Solid Tumor Rules and assign a laterality for C444. |
2020 | |
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20210043 | Reportability/Histology--Fallopian Tube: Is a diagnosis of serous tubal intraepithelial neoplasm (neoplasia) (STIN) equivalent to serous tubal intraepithelial carcinoma (STIC)? Does the designation of high or low grade have any effect on potential reportability? See Discussion. |
Patient has left salpingo-oophorectomy showing fallopian tube with focal high grade serous intraepithelial neoplasm. In reviewing some journal articles, the term STIN is being used to describe both STIC and serous tubal intraepithelial lesion (STIL). We will likely continue to see this term used, so it would be nice to have some clarity. |
Serous tubal intraepithelial neoplasm (neoplasia) (STIN) is not equivalent to serous tubal intraepithelial carcinoma (STIC). Report STIN only when stated to be high grade. STIC is reportable. Do not report STIL. According to our expert pathologist consultant, STIL and STIN are broad descriptive terms that reflect proliferation of epithelial cells with varying degrees of atypia, with the most developed, STIC, reflecting convincing neoplastic change. |
2021 |
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20210015 | Solid Tumor Rules (2007/2021)/Multiple Primaries--Anus: Have the disease free interval criteria been met for the following case scenario. A patient was diagnosed with anal intraepithelial neoplasia (AIN) III in 7/2018 that was treated with local tumor destruction, followed by Pap smears and biopsies that prove AIN I or AIN II through 2020, before being diagnosed with a reportable AIN II or AIN III in 2021. See Discussion. |
Since AIN I is not reportable and AIN II is not reportable until 2021, we are not sure if we can say the patient was disease free because there was no intervening reportable tumor (AIN III), or was never disease free because there was evidence of related disease (lower grade dysplasia). |
The 2021 AIN III is not a new primary. According to our GI pathology expert, findings of AIN I and/or AIN II following a diagnosis of AIN III indicates the patient was never NED and indicates persistent disease. . |
2021 |
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20210066 | 2021 SEER Manual/Surgery of Primary Site--Lung: What is the correct surgery code for a left upper lobe (LUL) wedge resection (confirming adenocarcinoma) followed by a lingular-sparing LUL lobectomy and mediastinal lymph node dissection? Is the correct Surgery Code 22 since the lingula was not resected (not the whole LUL Lung)? Or should the appropriate surgery code be 33 (this surgery suffices to code to a lobectomy with the mediastinal lymph node dissection)? |
Assign code 22 for LUL wedge resection followed by a lingular-sparing LUL lobectomy and mediastinal lymph node dissection. Code the lymph node surgery in Scope of Regional Lymph Node Surgery. We obtained input from an expert who agrees with this code. He states a lingula-sparing lobectomy is best coded as a segmentectomy because it is the same as an apical trisegmentectomy. |
2021 | |
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20210069 | EOD 2018/Summary Stage 2018--Intrahepatic Bile Duct: How should Extent of Disease (EOD) Primary Tumor (PT) be coded for invasion of or into (but not through) the visceral peritoneum for an intrahepatic bile duct primary? See Discussion. |
Invasion of the visceral peritoneum is Regional (code 2) in Summary Stage. EOD PT code 500 is for invasion BEYOND the visceral peritoneum into adjacent connective tissues, and maps to T3 and Regional Summary Stage, but that code seems too extensive. All lower EOD codes map to Localized Summary Stage. |
Assign code 500 for EOD Primary Tumor for now. We have confirmed with AJCC that "invasion of" but not "through" the visceral peritoneum maps to a T2 and not T3. Involvement of the visceral peritoneum for Summary Stage is Regional and does not make a distinction between "invasion of" or "invasion through." Any involvement of the visceral peritoneum is regional. To correct this situation would require a new code, which would derive a T2/RE. That code will be added to the updates for 2023. Code 500 will derive the appropriate Summary Stage of 2 (Regional). We are aware that this will derive the incorrect T; however, there is no work around at this time that will derive the correct T and Summary Stage, so we are defaulting to deriving the correct Summary Stage. |
2021 |
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20210071 | Solid Tumor Rules (2018/2021)/Histology--Breast: How is histology coded for a diagnosis of invasive mammary neuroendocrine tumor (NET), grade 2/3? See Discussion. |
Table 3 (Breast Equivalent Terms and Definitions) lists “Neuroendocrine tumor, well-differentiated” of the breast as histology 8246/3. There is no entry for a grade 2 neuroendocrine tumor of the breast in Table 3. The pathologist did not indicate the neuroendocrine tumor was poorly differentiated (or it would otherwise be a small cell carcinoma). The pathologist noted “By current WHO criteria, this tumor is characteristic of a mammary neuroendocrine tumor, grade 2. These invasive tumors have similar prognostic and predictive features of invasive ductal carcinoma of the same grade and stage.” |
Assign code 8249/3, neuroendocrine tumor, grade 2 based on the pathologist statement of mammary neuroendocrine tumor grade 2. According to WHO Classification of Tumors of the Breast, 5th edition, neuroendocrine tumor (NET) is an invasive tumor characterized by low/intermediate grade. If the histology term is not listed in the Solid Tumor rules, the instructions state to also check ICD-O and updates. Per ICD-O, NET, grade 2 is coded 8249/3. Breast Table 3 will be updated for 2023. |
2021 |
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20210016 | Solid Tumor Rules (2018, 2021)/Histology--Kidney: What is the correct histology code for a kidney primary described as clear cell papillary renal cell carcinoma"? Should we use H2 and code 8312/3 or H3 and code 8323/3? |
Assign 8323/3, clear cell papillary renal cell carcinoma using the 2018 Kidney Solid Tumor Rules, Rule H1, as this is a single histology, a variant of renal cell carcinoma NOS. |
2021 | |
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20210038 | Update to current manual/First course treatment--Neoadjuvant treatment: How are the 2021 neoadjuvant therapy fields coded when neoadjuvant therapy and surgery were part of first course plans but treatment was never completed. See Discussion. |
Example: Breast case where first course treatment plan is neoadjuvant therapy and surgery after. The patient was hospitalized during neoadjuvant therapy, elected hospice, and later died, so the neoadjuvant therapy was never completed, surgery not done. How are the 2021 neoadjuvant therapy fields coded in this situation as neoadjuvant therapy and surgery were part of first course plans. I coded neoadjuvant therapy to 2 - started but not completed, but there are no codes to properly explain the clinical response and therapy treatment effect as the patient did not complete neoadjuvant therapy. Should I use code 9 for clinical response and treatment effect or should this be left blank for this particular case? |
Assign code 8 for Neoadjuvant Therapy--Clinical Response in this case. We will update the SEER manual to allow code 2, in addition to code 1, in Neoadjuvant therapy when Clinical Response is coded 8. We will also add instructions covering a case such as this one. Assign code 7 for Neoadjuvant Therapy--Treatment Effect and use text fields to record the details. We will add instructions to the manual for this scenario. |
2021 |
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20210009 | Solid Tumor Rules (2018, 2021)/Histology--Melanoma: In what situation will Rule H4 be used to code the histology to regressing melanoma? See Discussion. |
Rule H4 states: Code 8723/3 (malignant melanoma, regressing) when the diagnosis is regressing melanoma. However, if the diagnosis was strictly regressing melanoma or malignant melanoma, regressing, the first rule that applies is Rule H1 because regressing melanoma is a single, specific histologic type and Rule H1 states: Code the histology when only one histologic type is identified. Following the current rules, one would never arrive at Rule H4. Should the H Rules be reordered? Or should an example of when one would use Rule H4 be added to clarify when to use this rule? |
Coding regressing melanoma has been an issue as registrars may not realize it is a reportable histology. Hence, H4 was written to reinforce correct histology. A note will be added to H1 instructing registrars to continue thru rules when the diagnosis is regressing melanoma. |
2021 |
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