CS Site Specific Factor/Melanoma: How is CS SSF1 (depth of invasion) coded for a melanoma that demonstrates dermal invasion to a depth of "less than .2 mm" be coded to 999 [unknown]? See Discussion.
The path report says "superficial spreading malignant melanoma; 2 areas of papillary dermal invasion to depth of less than .2mm."
The revised CS pages include codes for "less than" a certain tumor size, but these are not included in the depth of invasion SSF. Using 999 results in an unstageable melanoma, when we know it is "less than .2mm".
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 SSF1 (depth of invasion) to 019 [.19mm]. For any case with an SSF1 code in the range of 001-100 mm, the T category will be determined using CS extension and SSF2 [ulceration]. All cases with an SSF1 code in the range of 001-100 mm will map to a T1 (either T1NOS, T1a or T1b).
Ambiguous Terminology: Why do the instructions for this field use the term "accession" rather than "abstract"?
The purpose of the new data item "Ambiguous Terminology" is to identify cases that were put into the cancer registry database without a conclusive diagnosis. The decision to accession the case was influenced by ambigous terminology. The emphasis is on accessioning the case rather than abstracting it.
CS Eval/Surgery of Primary Site--Colon: When the only procedure performed is a polypectomy, if there is NO tumor at the margins, should CS TS/EXT-Eval be coded as 3 and the surgery coded as a polypectomy?
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 eval code 3. A polypectomy with no tumor at the margin meets the criteria for pathologic staging.
Code polypectomy in Surgery of Primary site in this case.
MP/H Rules/Histology--Colon: How is histology coded when the final pathology diagnosis is "adenocarcinoma with extensive mucinous features" and the percent of mucinous features is not stated?
Code 8140 using rule H6. Rule H6 applies because the percent of mucinous is not specified.
MP/H rules/Histology--Lung: How is histology coded for a path diagnosis of "pleomorphic carcinoma with adenocarcinoma, squamous, clear cell and spindle components"? Please see discussion.
Path diagnosis of lung tumor is pleomorphic carcinoma, with adenocarcinoma, squamous, clear cell, and spindle cell components. Path comment states: "While the majority of tumor displays usual adenocarcinoma-type features, elsewhere the tumor shows varying differentiation, including squamous, clear cell and spindle cell differentiation. Therefore the tumor is best categorized as pleomorphic carcinoma."
This tumor is best described by a non-specific histology. However, the MP/H rules guide the abstractor to identify a more specific histology. If we work through the lung rules, would we end up using rule H7 and code the histology with the numerically highest ICD-O-3 code?
For cases diagnosed 2007 or later, assign histology code 8022 [pleomorphic carcinoma] based on the pathologist's assessment and rule H3. He/she reviewed all of the histologic components and rendered a final diagnosis of pleomorphic carcinoma.
"Components" is not a term indicative of a more specific histology. See note under rule H5.
MP/H Rules/Multiple Primaries--Melanoma: Is there a difference between multiple primary rules M6 and M7 because both rules state that tumors occurring more than 60 days apart are to be reported as multiple primaries? See Discussion.
Rule M6 clearly states that an invasive melanoma occurring more than 60 days after an in situ melanoma is a multiple primary. However M7 states that any melanomas diagnosed more than 60 days apart are multiple primaries. Since M7 does not state malignant melanomas diagnosed more than 60 days apart, this implies that any scenario:
in situ following an invasive,
invasive following an in situ,
in situ following an in situ,
or invasive following an invasive
are all multiple primaries if more than 60 days apart. If that is the intent of M7, then M6 is totally unnecessary. If the intent of M7 is only for an invasive following an invasive, then the word malignant needs to be inserted as the first word of rule M7.
For cases diagnosed 2007 or later, M7 is intended to apply to in situ and invasive melanomas. Therefore, M6 and M7 are repetitive.
This will be corrected when revisions are made to the MP/H rules. In the meantime, both M6 and M7 result in multiple primaries so it does not matter which rule is used.
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.
Reportability/Diagnostic Confirmation: If a diagnosis based solely on positive flow cytometry is reportable even if a bone marrow biopsy is negative, how is diagnostic confirmation coded?
For cases diagnosed prior to 2010
The case is reportable if a recognized medical practitioner says the patient has cancer.
A flow cytometry alone is not diagnostic but it may be supported by either a positive bone marrow or a clinician's statement. If the clinicians statement is based only on flow cytometry, code diagnostic confirmation to 8 [Clinical diagnosis only].
Date of Diagnosis: Can the phrase "suspicious for a primary lung tumor" from a CT be used to code date of diagnosis? See Discussion.
Thorax CT on 4/18/05 states 'enlarged RUL nodular opacity suspicious for a primary lung tumor.' Biopsy confirmation was not done until 8/4/05 because patient declined further work-up until then. Would date of diagnoses be 4/18/05 or 8/4/05?
Code the diagnosis date 08/04/2005 based on the biopsy.
The statement "suspicious for a primary tumor" is not a clinical diagnosis of cancer or malignancy.
Ambiguous Terminology: Why was 60 days chosen for ambiguous terminology?
The Histology Task Force approved a 60 day time frame for ambiguous terminology.
The majority of cases are first identified by ambiguous terminology; for example, a patient has a mammogram that shows a lesion suspicious for cancer. That first indication of cancer prompts a work-up to either confirm or rule-out the cancer diagnosis.
The data item "Ambiguous terminology" is not intended to capture information on this routine method of detecting and diagnosing cancer. The 60 day time frame should keep these cases out of the ambiguous terminology data item.
The data item is intended to identify those cases where the cancer diagnosis is NOT confirmed during the work-up, but the case is still entered into the database. For example a patient who has a TRUS because of elevated PSA. The pathology from the TRUS says "Suspicious for adenocarcinoma of the prostate." The physician only documents that the patient is to return in 6 months for another PSA and TRUS. The registrar would enter this case into the data base because the word "suspicious" is on the ambiguous terminology list.
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