Report | Question ID | Question | Discussion | Answer | Year |
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20051046 | Reportability/Diagnostic Confirmation--Leukemia: What is the diagnostic confirmation if a positive BCR/ABL result is diagnostic of a malignancy in a patient suspected to have chronic myelogenous leukemia? See Discussion. |
Example 1: Peripheral smear states: "No morphologic evidence of chronic myelogenous leukemia." Addendum: Molecular diagnostic studies showed a positive rearrangement for the BCR gene with the M-bcr (CML type) and of bcr-abl transcript expression". Example 2: Hematopathology is negative. Molecular diagnostic study: "fluorescent in situ hybridization (FISH) studies exceeded the limits established by the XXX Cytogenetics Laboratory for this probe set, and thus, demonstrated statistical evidence of BCR/ABL fusion." |
For cases diagnosed prior to 1/1/2010: Do not determine reportablility using cytogenetics or molecular studies alone. Since these are not routine screening tests, we suggest that you query the physician and review the medical record to see what prompted the study and what is being done with the result, but the test alone is not in and of itself sufficient to report the case. 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. |
2005 |
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20051129 | Reportability/Behavior--Thyroid: Does the term "invasion" indicate the presence of a malignant tumor? See Discussion. | Left thyroid lobectomy showed microfollicular neoplasm with evidence of minimal invasion. Micro portion of path report stated, "The capsular contour is focally distorted by a finger of the microfollicular nodule which appears to penetrate into the adjacent capsular and thyroid tissue." | We recommend that you contact the pathologist for further information. If no further information is available, do not accession this case based on the information provided. There is no definitive statement of malignancy. If the case was sent to a consultant, there may be another opinion available. If there is information in the record, or the treating physician can be contacted, find out whether the tumor was benign or malignant and whether there was any further treatment. According to our pathologist consultant, based only on the information above and nothing else, do not report since there is no diagnosis of malignancy. |
2005 |
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20051040 | Primary Site--Sarcoma: What is the correct topography code for a partial lung lobectomy with pathology diagnosis of "pulmonary sarcoma with smooth muscle differentiation"? See Discussion. | Operative report: palpable 2x2cm mass in the mediastinal surface of the rt middle lobe and the contiguous upper lobe together.
Path comment after partial lung lobectomy: In all likelihood this is a malignant process occurring in smooth muscle changes surrounding vessels within the lung versus an undifferentiated epithelial tumor.
ADDENDUM DX: low grade pulmonary sarcoma with smooth muscle differentiation.
Consultant's report concurs with that of the original pathologist's report of malignant neoplasm compatible with smooth muscle origin. |
This case is unique. Assign topography code C493 [Connective, subcutaneous and other soft tissue of thorax]. Based on the information provided, this sarcoma has smooth muscle differentiation and originated in the muscle. Code the primary site to muscle. | 2005 |
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20051140 | CS Reg LN Pos/Exam--Breast: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Discussion. | A breast cancer patient had an FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases. Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection. Example 2: Patient received no neoadjuvant therapy. This question is answered for EOD in SINQ 20031059. What is the answer for Collaborative Stage? |
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.Include all nodes examined by the pathologist in Regional lymph nodes positive and Regional lymph nodes examined, unless there is disease progression. These fields are cumulative -- record the total number of regional nodes positive and examined during first course of treatment. Preoperative treatment does not affect the coding of these fields. An FNA alone, positive for regional lymph node metastasis is coded as 95 for number positive and 95 for number examined. For the case examples above, assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Code number of regional nodes positive as 01, number examined as 07 for both examples. |
2005 |
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20051033 | CS Site Specific Factor--Melanoma: What is the correct code for measured thickness in SSF 1 for a melanoma of the choroid without an enucleation? See Discussion. | CS Site Specific Factor 1 for melanoma of the choroid codes "Measured Thickness (Depth), Breslow's Measurement." The note for this field states "Record actual measurement in millimeters from the pathology report." For melanoma of the eye, there is often only an eye exam report stating the thickness. Can PE thickness (clinical statement only) be coded for SSF 1 or is this field coded only from pathology? (i.e., all cases treated without enucleation would have this field coded to 999) | 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. Code SSF 1 999 [Unknown] when there is no enucleation, and therefore, no pathology report for a choroid melanoma. |
2005 |
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20051119 | CS Eval--Colon: When the surgical resection occurs after radiation or chemo, how is the tumor size/extension evaluation field coded when there is no mention of the tumor size or extension in the surgical resection pathology report? See Discussion. | 6/30/04 CT Scan abd/pelvis: 7.5x7.2 cm large rectal mass with l cm nodular densities in perirectal region probably adenopathy; irregularity of perirectal soft tissue which could be due to tumor infiltration. 7/26/04 Patient has radiation therapy and 5FU. 10/19/04 LAR: MD Adenoca rectum with regional node mets (3/8). | 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.Based on the information provided above, code CS Tumor Size and Extension from CT scan. Code CS TS/Ext eval 5 [Surgical resection performed with pre-surgical treatment...size based on clinical evidence]. Code CS lymph nodes using information from resection. Code CS Reg Nodes eval 6 [Regional LN removed...with pre-surgical treatment...based on pathologic evidence]. |
2005 |
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20051011 | CS Lymph Nodes/CS Site Specific Factor--Breast: When there are no lymph nodes removed and none palpable for an inflammatory breast cancer and the physician stages the case Nx, is the CS Lymph Node field code to 00 [None, no regional lymph nodes involved] or 99 [Unknown, not stated] and would SSF 4 and 5 be coded to 000 [Regional lymph nodes negative...] or 888 [Not applicable]? | 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. Code CS Lymph Nodes 00 [clinically negative]. See note 3 for CS Lymph Nodes. Code SSF 4 and 5 000 [Nodes clinically negative]. |
2005 | |
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20051017 | CS Lymph Nodes--Breast: Is it better to code to 26 [Stated as N1, NOS] or 28 [Stated as N2, NOS] instead of 60 [Axillary/regional lymph nodes, NOS; Lymph nodes, NOS] when the only information in the medical record is the TNM N1 or N2 physician stage? | 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. Yes. When the only indication of lymph node involvement is the physician's N category from TNM, code the numerically lowest equivalent CS Lymph Nodes code for that N category. In the breast schema, CS Lymph Nodes code 26 corresponds to N1, NOS and code 28 corresponds to N2, NOS. |
2005 | |
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20051054 | CS Eval--Ovary: How is CS Mets Eval coded when the patient has positive pleural effusion confirmed by cytology? | 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.Code CS Mets Eval for the example above 3 [path exam of metastatic tissue] assuming there has been no pre-treatment. Positive cytology is required for confirmation of pleural effusion for an ovarian primary. |
2005 | |
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20051035 | Reportability--Brain and CNS: Does a case of astrogliosis meet the criteria for gliomatosis cerebri? See Discussion. | Case clinically stated to be a glioma of the brain. Pathology from resection states astrogliosis. Anderson's Pathology defines astrogliosis as astrocytic proliferations. Gliomatosis cerebri is defined as diffuse neoplastic transformation of poorly differentiated astrocytes over a wide area; predominantly invovles hemispheric white matter. |
The pathologic diagnosis for this case, astrogliosis, is not reportable to SEER. Take the definitive diagnosis for this case from the pathology report from the resection. The pathology report takes precendence over the clinical diagnosis. | 2005 |