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Report Produced: 08/03/2024 10:20 AM

Report Question ID Question Discussion Answer Year
20061120 Surgery of Primary Site--Bladder: Should a TURB be coded to 27 [Excisional biopsy; SEER Note: Code TURB as 27] when there is obvious extravesicular extension demonstrated because the 2004 SEER Manual states "Do not code an excisional biopsy when there is macroscopic residual disease"? Assign code 27 [excisional biopsy]. The site-specific instructions have priority over the general instructions. According to the instructions for coding surgery of the bladder, use code 27 for TURB. 2006
20061142 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Skin: How many cases are to be abstracted and how is the histology field(s) coded for cases in which a fibrosarcoma arises in or transforms from a dermatofibrosarcoma protuberans? See Discussion.

1. If the fibrosarcoma occurs after DFP, and is called metastatic, is it a recurrence or is it a new primary? Example: Pt diagnosed in 7/05 with a high grade fibrosarcoma arising in a dermatofibrosarcoma protuberans. The path indicated "The presence of high grade fibrosarcoma, the extent of the tumor necrosis and the mitotic rate are all adverse prognostic findings that indicate a significant risk for mets." The patient had a recurrence in 8/06 called a low grade fibrosarcoma mets from prev." The DFP code is 8832/3 and a fibrosarcoma code is 8810/3. Our pathologist feels that the fibrosarcoma is a more aggressive tumor so should the case be coded to the 8810/3.

2. If DFSP has areas of fibrosarcoma, should it be coded to the latter because it is more aggressive? Example: Skin and subcutaneous tissue reads: Low grade sarcoma - tumor extends to margin. Comment: "Although the predominant pattern of this tumor is consistent with dermatofibrosarcoma protuberans, focal presence of hypercellularity and increased mitotic figures suggest transformation to Grade I fibrosarcoma. This progression, although focal, carries an increased risk of mets over classic DFSP. Code to 8810/31?

For tumors diagnosed prior to 2007:

Code histology to 8832/3 [Dermatofibrosarcoma protuberans] for both cases. DFSP with transformation to fibrosarcoma and DFSP with areas of fibrosarcoma are coded to 8832/3.

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.

 2006
20061141 Reportability--Leukemia: Is the diagnosis "a minority abnormal T-cell population (2-3%) with phenotypic features of large granular lymphocyte leukemia cells" reportable if it is from a flow cytometry procedure performed on a non-diagnostic bone marrow biopsy specimen? See Discussion.

Pt had only a bone marrow Bx done at the hospital.

Bone marrow biopsy and aspirate:

Peripheral blood showing mild relative lymphocytosis and mild relative neutropenia.

Normocellular bone marrow (50%) with mild eosinophilia. No conclusive morphologic evidence of a neoplastic process.

Flow cytometry of the marrow shows a minority abnormal T-cell population (2-3%) with phenotypic features of large granular lymphocyte leukemia cells. PCR is positive for a clonal T-cell population. The significance of these findings is unclear.

COMMENT: Flow cytometry, PCR and morphologic correlation were performed at [names removed]. The significance of a minimal, clonal, large granulocyte leukemia population absent absolute lymphocytosis is unclear. Positive results for a T-cell receptor PCR study in the setting of mild leukopenia alone is reportedly relatively common and usually regarded as nonspecific. In essence, this could be characterized as a small, monoclonal T-cell proliferation of uncertain significance associated with mild leukopenia. Appropriate follow up is suggested.

For cases diagnosed prior to 1/1/2010:Do not report this type of case until there is a definitive reportable diagnosis. Based on the information provided, this case is not yet reportable. It could develop into a reportable case in the future.

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.

 2006
20061061 CS Lymph Nodes--Breast: Clarify the use of code 25 [Movable axillary lymph node(s), ipsilateral, positive with more than micrometastasis (i.e., at least one metastasis greater than 2 mm)] vs code 60 [Axillary/regional lymph node(s), NOS; Lymph nodes NOS] when surgically removed lymph nodes are positive but the size of the metastasis is not stated. See Discussion.

Note 2 in CS manual states: "If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2mm and code LNs as positive in this field. Use code 60 in the absence of other information about regional nodes."

1. If the LNs are known to be axillary LNs, note 2 seems to imply the size can be assumed to be greater than 0.2mm. Would you code 25 or 60?

2. Both codes 25 and 60 map to N1, node involvement. Do they each mean something else in the evaluation process?

3. What would constitute "absence of other information"?

4. Is the use of 60 over 25 specific to SEER registries or all users?

5. Abstractors are trained to assume LNs are mobile if there is no contrary information. Is this appropriate?

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.

Assign CS Lymph Nodes code 25 for breast when there are positive axillary nodes without internal mammary nodes. Code 25 is used in a couple of situations: a. when you know the lymph nodes are clinically movable and only the axillary nodes are involved; b. when you know the size of the metastasis in an axillary lymph node is more than a micrometastasis (i.e., > 2 mm). Code 60 can be used for any regional lymph node (internal mammary, infra- or supraclavicular, as well as axillary. So you can code to 25 if you have "regular" metastases in axillary lymph nodes only. If you don't know whether the mets are micro or regular, use code 60. Assign code 60 when there are positive regional nodes not further described.

1. Assign code 25 for positive axillary lymph nodes.

2. Codes 25 and 60 may map to N1, N1a, N2a or N3a depending on the coding of SSF3.

3. Assign code 60 when there is not enough information to assign a code from 13 to 50.

4. CS instructions are the same for all users. There are no CS instructions specific to SEER registries.

5. Yes, assume lymph nodes are moveable (not matted, not fixed) when there is no information to the contrary.

 2006
20061101 CS Site Specific Factor--Colon: If the patient has a polypectomy followed by definitive surgery, can a higher CEA reported after the polypectomy but before the colon resection be coded?

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.If the tumor was in the polyp, do not use the post-polypectomy CEA even if it is higher than CEA's prior to the polypectomy. In this situation, the polypectomy would be treatment.

Conversely, if this is a frank adenocarcinoma or the tumor was so invasive that the polyp removed only a portion, use the post-polypectomy CEA because the polypectomy would not be treatment in this situation.

 2006
20061004

CS Site Specific Factor--Breast: If the tumor is described as being a 1 cm poorly differentiated pleomorphic lobular carcinoma with scattered LCIS in breast tissue, for SSF6, do we use the breast tumor or all of the breast tissue removed when coding SSF6?

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.

Site Specific Factor 6 in the breast scheme describes the relationship of invasive and in situ tumor in the tumor size coded. Code SSF6 for the same tumor used to code tumor size.

For this example, code SSF6 for the 1 cm tumor. In this case, the entire tumor is reported as invasive; use code 000 [Entire tumor reported as invasive].

 2006
20061055 CS Lymph Nodes--Colon: What criteria is used to distinguish between code 30 [Regional lymph nodes, NOS] and 80 [Lymph nodes, NOS] when positive lymph nodes are removed during a colon resection but the lymph node location is not stated? See Discussion.

Example 1: Descending colon excision: Metastatic adenocarcinoma in 8 of 9 lymph nodes.

Example 2: Hepatic flexure and en bloc resection of liver. Adenocarcinoma in 3 of 10 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.

Code positive nodes included with the resected specimen as regional lymph nodes, NOS when the location is not stated. See number 3.e under the general instructions for coding CS lymph nodes.

Based only on the information provided, code CS lymph nodes 30 [Regional lymph nodes, NOS] for both examples.

 2006
20071059 CS Site Specific Factor--Prostate: Given that the CS Manual instruction is to code the highest PSA value recorded in the medical record, can a PSA value obtained a year prior to admission be used to code the SSF 1 and SSF2 fields?

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.

The PSA recorded in CS SSF 1 and 2 must be documented in the medical record. Record the highest PSA value prior to diagnostic biopsy or treatment. If the highest PSA value documented in the medical record is from the previous year, record it.

 2007
20071078 Scope of Regional Lymph Node Surgery/CS Reg LN Pos/Exam: How are these fields coded if the operative report does not mention a separate lymph node procedure at the time of the surgery to the primary site? See Discussion.

LUL lobectomy: 1.7 cm apical tumor, diagnosis: moderately well differentiated subpleural squamous cell carcinoma, with involvement of pleural surface. 3 peribronchial LN neg and 2 AP window LNs neg. Stage T2N0.

1. No lymph node dissection or sampling was stated to be done

2. The lobectomy specimen contained the LNs

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 the Scope of Regional LN Surgery, Regional Nodes Positive and Regional Nodes Examined fields using the available information on the case. The lymph nodes can be obtained or biopsied during any procedure within the first course of treatment. A separate lymph node surgery is not required to complete these data items.

 2007
20071019 CS Lymph Nodes--Melanoma: If the primary site is coded to C449 because no primary skin lesion is identified for a melanoma case, are any positive lymph nodes assumed to be regional?

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 the CS Lymph Nodes field to 80 [Lymph Nodes, NOS].

Although it is in the CS LN field, use the code for Lymph Nodes, NOT OTHERWISE SPECIFIED when you don't know whether the nodes are regional or distant. There are separate codes to use when you definitely know that the nodes are regional.

 2007