Surgery of Primary Site--Breast: How is the surgery field coded when an excisional biopsy that is originally stated to be negative is later determined to be positive on ROS and a mastectomy with negative findings is performed 2 years later? See Discussion.
Hospital 'A' performed a breast biopsy and found only atypia. Two years later Hospital 'B' re-read the first biopsy as multifocal ductal carcinoma in situ, cribriform type. A mastectomy at Hospital 'B' followed and all specimens from this were negative.
Do we report the procedure at Hospital 'A' an excisional biopsy, despite the negative findings at the time?
For hospital A, follow the instructions in the 2004 SEER Manual on page 5, #4. For hospital B, the case is not reportable.
The diagnosis date is the date of first excision. Code the breast excision from Hospital A as surgery, first course treatment. The mastectomy was not part of first course treatment.
CS Lymph Nodes/CS Site Specific Factor 3--Breast: How are positive intramammary lymph nodes reflected in these fields? See Discussion.
Patient with breast cancer underwent mastectomy. No axillary lymph nodes were positive, but 1 out of 2 intramammary lymph nodes were positive for mets (greater than 2 mm). CS Lymph node codes describe axillary and internal mammary nodes, but do not describe intramammary lymph nodes.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Intramammary lymph nodes are coded as axillary lymph nodes for staging purposes. Intramammary node are nodes within the breast tissue. Both staging and treatment suggest these are equivalent to axillary nodes.
Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range?
Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance.
Priorities/CS Extension--Lung: In the absence of a physician TNM, is there a hierarchy associated with coding extension when multiple imaging studies demonstrate different degrees of extension? See Discussion.
CT of the lung showing primary lesion and other nodules in another lobe or contralateral lung, subpleural nodules, etc. The PET scan did not show activity for the other nodules. What is our "hierarchy" for imaging studies when there is no physician staging?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
There is no hierarchy among the various imaging studies. Assign CS extension based on the report documenting the greatest extension.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Lung: How is histology coded for the tumor(s) that exist if a left upper lobe of lung resection final diagnosis states the patient has a moderately differentiated adenocarcinoma and the path indicates there are "multiple carcinoid tumorlets"?
For tumors diagnosed prior to 2007:
Histology is coded 8140/3 [adenocarcinoma]. This is one reportable tumor of the left lung. According to our pathologist consultant, the tumorlets are collections of cells which appear to be of neuroendocrine origin, but are not malignant.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Multiple Primaries--Lymphoma: How many primaries should be reported when there is a marginal zone B-Cell lymphoma [9699/3] diagnosed in 2000, and the clinician states that the diffuse large B-Cell type lymphoma [9680/3] diagnosed in 2004 was a transformation of the prior primary? See Discussion.
The Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table indicates they are most likely "D" different disease processes. As any low grade lymphoma can transform, we suspect this represents a transformation (the clinician is regarding this as transformed).
How many primary/ies should be coded?
And, how?
For cases diagnosed prior to 1/1/2010:
Report this case as one primary according to the physician's opinion. Code the histology as 9699/3 [marginal zone B-Cell lymphoma, NOS] and code the date of diagnosis as 2000.
Code the physicians opinion regardless of whether or not it agrees with the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table. Use the table when the physician does not state whether or not there is a new primary.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Histology (Pre-2007): What is the difference between code 8244/3 composite carcinoid (combined carcinoid and adenocarcinoma) and 8245/3 adenocarcinoid tumor?
For tumors diagnosed prior to 2007:
Assign code 8244/3 [composite carcinoid] when there is a combination of adenocarcinoma and carcinoid tumor.
Assign code 8245/3 [adenocarcinoid] when the diagnosis is exactly "adenocarcinoid."
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
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