EOD-Extension--Small Intestine: How do we interpret a pathology description of "extending through serosa and forming masses in the periserosal tissue" for a jejunum primary?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 55 [Invasion of/through serosa and adjacent connective tissue]. The description states the tumor extended through the serosa into periserosal tissue. The periserosal tissue in this case refers to adjacent connective tissue lying exterior to the intestinal wall and not the (sub)serosal tissue that lies exterior to the muscularis but inferior to the serosa. Analyze each case individually since pathologists are not consistent when using the above terminology.
Histology (Pre-2007)/Grade, Differentiation--Brain and CNS: What code is used to represent the histology and grade for "WHO-II astrocytoma, grade II" of the brain when the WHO-II classification is different from the classification systems previously used? See discussion.
According to the WHO-I classification system, this is a moderately anaplastic astrocytoma. According to the Duke criteria, this is an astrocytoma. By Dauma-Dupont criteria, this is a grade 2 astrocytoma.
For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 9401/34 [anaplastic astrocytoma].
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.
EOD-Size of Primary Tumor--Breast: For breast cancer cases, is code 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)] to be used only when there is no work-up beyond a clinical one? See discussion.
Usually when a mammogram has a malignant diagnosis, the tumor is clinically palpable, but occasionally the tumor is not palpable.
For example, on the mammogram, lesions are identified in the breast. PE--the breasts are palpably normal. Breast biopsies--two ductal carcinomas, no statement of size. Mastectomy--no residual. Should the size be coded to 999 rather than 002?
For cases diagnosed 1998-2003:
In the case you provided, code the EOD-Size of Primary Tumor field to 002 [Mammography/xerography diagnosis only with no size given (tumor not clinically palpable)]. A known code in the size field should always take precedence over 999 [Not stated]. Code size from the records in priority order as stated in EOD, from pathology, op report, PE, mammogram, etc. (See EOD for complete instructions.)
Code size as 999 only when there is a clinically palpable lesion with no size stated in the path, PE, or mammogram.
If there is a lesion seen on mammogram that is not clinically palpable, a stated size taken from the path or mammogram would take precedence over code 002; however, if there is no stated size, use code 002 rather than 999.
Ambiguous Terminology: Should SEER's lists of ambiguous terminology be modified to reflect how pathologists and radiologists actually use these terms? See discussion.
Pathologists and radiologists say the term "suggestive" is used to describe a lesion that may be malignant, and the term "suspicious" is not used to describe lesions that may be malignant. According to the physician director of our Breast Center the FDA governs the use of terminology, and the term "highly suggestive" instead of "highly suspicious" must be used if there is a greater chance that a mass is malignant.
We recognize that the way clinicians and registrars speak is often different, and that the differences vary from region to region.
Our Medical Advisory Board reviewed the lists of ambiguous terminology before they were included in the third edition of the SEER EOD and the SEER Program Coding and Staging Manual 2004. Since that time, specific terminology has been mandated for describing mammography results. We know some of these terms are discrepant with our ambiguous terminology list.
As of 2007, the standard setters (CoC, NPCR, SEER and CCCR) all use the same ambiguous terminology list. Changes to the list must be approved by the NAACCR Uniform Data Standards Committee.
Surgery of Primary Site--Ovary: What code is used to represent this field when a patient has a history of a previous organ removal and has additional surgery/organ removal for a present cancer (e.g., History of a 1984 hysterectomy and in 2003 has ovarian primary treated with BSO)?
For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 52 [Bilateral salpingo-oophorectomy WITH hysterectomy].
Hematologic Transplant and Endocrine Procedures--Breast: Is a bone marrow transplant first course of cancer-directed therapy for breast cancer? If yes, are time guidelines relating to the first "remission" the same as for those used in leukemia primaries?
For cases diagnosed 1/1/2003 and after: A bone marrow transplant can be first course of therapy for cases in which there has been no progression of disease between the initial therapy (e.g., surgery, radiation, chemotherapy) and the bone marrow transplant. Code Hematologic Transplant and Endocrine Procedures field to 10-12 or 40 (depending on the type of bone marrow transplant performed).
Do not use leukemia treatment time guidelines when coding breast cancer treatment.
EOD-Extension/EOD-Lymph Nodes: Can the AJCC TNM/Stage be used to help code these fields when there is limited text information in the medical record that describes the tumor involvement?
For cases diagnosed 1998-2003:
Yes, this staging information can be used to help code the SEER EOD fields but only if a physician does the TNM/Stage at the time of diagnosis and there is limited text information that describes tumor involvement.
EOD Fields--All Sites: Is EOD information limited to what is available exactly two months from the day of diagnosis?
For cases diagnosed 1998-2003:
EOD should include all information available within four months of diagnosis in the absence of disease progression or through completion of surgery(ies) in first course of treatment, whichever is longer.
Mets known to have developed after EOD was established should be excluded.
EOD-Extension: General instructions, page 7, note 3 states: " Extent of disease information obtained after treatment with neoadjuvant chemotherapy, hormone or immunotherapy has begun may be included." Because the SEER manual does not mention radiation treatment, can we use information from a lobectomy to code EOD if a patient has neoadjuvant radiation therapy?
Radiation therapy was inadvertently omitted from the list. Please see SINQ 20031012 answer as to when the surgical information can be used to stage the case.
EOD-Extension--Lung: Is bilateral pleural effusion coded as 72 [malignant pleural effusion] or 85 [metastasis]? See discussion.
Example:
10/30/98 CXR: Widespread malignancy, hilar, superior mediastinal masses, bilateral pleural effusions, fullness in soft tissue right neck.
11/01/98 CT chest/ABD: Extensive infiltrate mediastinum by radiolucent tumor mass that engulfs esophagus/trachea. Pleural effusion extends so low it apes ascites. Normal ABS/pelvis.
11/01/98 Pathology: FNA right supraclavicular lymph node: metastic oat cell ca. Sputum cytology reported to be negative.
For cases diagnosed 1998-2003, code the EOD-Extension field to 72 [malignant pleural effusion; pleural effusion, NOS].
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