April 2019 Revision History for the Solid Tumor Rules

Terms and Definitions (Breast)

• Table 2 Histology Combination Codes
  • 8522/3 Row, Note 2 clarified: Carcinoma NST includes all subtypes/variants of carcinoma NST.
• Table 3 Specific Histologies, NOS/ NST, and Subtypes/Variants
  • Metaplastic Carcinoma Row, Note added: Squamous cell carcinoma of the breast is extremely rare. Carefully check the pathology report to verify the squamous cell originated in the breast parenchyma, rather than the skin of the breast.
  • Myoepithelial carcinoma 8982 Row deleted (myoepithelial carcinoma is a subtype of metaplastic carcinoma)

Multiple Primary Rules (Breast)

Minor Changes

• Rule M8: Abstract a single primary when the diagnosis is Paget disease with synchronous/simultaneous underlying in situ or invasive carcinoma NST (duct/ductal) or subtypes of duct.
  • Clarified that Paget and underlying are synchronous
  • Note added: If the underlying tumor is any histology other than duct or subtypes of duct, continue through the rules.
• Rule M11: Abstract a single primary when a ductal carcinoma occurs after a combination code in the same breast.
  • Use of "Other in situ" code 8523/2 clarified for diagnosis year prior to 2018
• Rule M13: Abstract a single primary when synchronous, separate/non-contiguous tumors are on the same row…
  • Note 1 deleted: The tumors must be the same behavior.

Major Changes

• NEW RULE:
  Rule M9: Abstract multiple primaries when the diagnosis is Paget disease with synchronous/simultaneous underlying tumor which is NOT duct.
• Rule M10: Abstract a single primary when synchronous/simultaneous multiple tumors are carcinoma NST/duct and lobular.
  • Note 1 deleted: Histologies must be the same behavior.
  • Note 2: List of ductal carcinoma subtypes updated

Histology Rules (Breast)

• Coding Multiple Histologies
  • #1A modified: Code the subtype/variant (specific histology) ONLY when documented to be greater than or equal to 90% of the tumor.
  • #1B: “Differentiation and features” instructions simplified and note added: A NOS with features or differentiation is a single histology. Go directly to the rules.
• Priority Order for Using Documentation to Identify Histology
  • Important Note #2 Modified: Code the histology assigned by the physician by using the following priority list and Histology Rules
  • #2: Tissue or pathology report from primary site
    • #2B: “Synoptic report as required by CAP” added to Final Diagnosis
  • #6: Code the histology documented by the physician when none of the above are available
    • #6A: “Treatment Plan” added

Terms and Definitions (Urinary)

• Equivalent Terms And Definitions
  • Added: Multifocal; multicentric
  • Added: Noninvasive may describe either in situ papillary carcinoma or flat urothelial cell carcinoma
• Terms that are Not Equivalent or Equal
  • Deleted: Component is not equivalent to subtype/variant
    Note: Component is only coded when the pathologist specifies the component as a second carcinoma.
  • Staging information removed from the note
• Priority for Coding Primary Site
  • Coding instructions clarified
• Table 2: Specific Histologies, NOS, and Subtypes/Variants
  • 8140 Row, Note added: Urachal carcinoma NOS is coded 8010/3. Urachal adenocarcinoma is coded 8140/3.

Multiple Primary Rules (Urinary)

Major Changes

• Rules have been renumbered
• Rule M6: Abstract multiple primaries when an invasive tumor occurs more than 60 days after an in situ tumor.
  • Moved up in hierarchy (formerly M17)
• Rule M7: Abstract a single primary when the patient has multiple occurrences of /2 urothelial carcinoma in the bladder.
  • Clarified that any combination of 8120/2 and 8130/2 in the bladder is a single primary
• Rule M8: Abstract multiple primaries when the patient has micropapillary urothelial carcinoma 8131/3 of the bladder AND a urothelial carcinoma 8120/3 (including papillary 8130/3) of the bladder.
  • Moved up in hierarchy (formerly Rule M12)
  • 8120/3 added to the rule
  • Removed non-synchronous tumors requirement
• Rule M9: Abstract a single primary when the patient has multiple invasive urothelial cell carcinomas in the bladder.
  • Clarified that an occurrence of micropapillary and an occurrence of urothelial carcinoma would be multiple primaries
• Rule M11: Abstract a single primary when there are urothelial carcinomas in multiple urinary organs.
  • "Synchronous" removed
• Rule M13 (Former): Abstract multiple primaries when the original tumor and subsequent tumor occur in different urinary sites.
  • Rule deleted
• NEW RULE
  Rule M14: Abstract multiple primaries when the ICD-O site code differs at the second (CXxx) and/or third (CxXx) character.
• Rule M15: Abstract a single primary when synchronous, separate/non-contiguous tumors are on the same row in Table 2 in the Equivalent Terms and Definitions.
  • Behavior restriction removed; behavior is now irrelevant
  • Note 3 deleted (simplifying the text)

Minor Changes

• Multiple Tumors Module
  • Note 2 clarified: Non-synchronous tumors other than urothelial carcinoma and urothelial carcinoma subtypes in multiple urinary sites (see Rule M14)
• Rule M18: Abstract a single primary when tumors do not meet any of the above criteria.
  • Example removed; would be caught in earlier rule
• Rule M16: Abstract a single primary (the invasive) when an in situ tumor is diagnosed after an invasive tumor AND tumors occur in the same urinary site.
  • Bullets removed
• Rule M17: Abstract a single primary (the invasive) when an invasive tumor is diagnosed less than or equal to 60 days after an in situ tumor AND tumors occur in the same urinary site.
  • Bullets removed

Histology Rules

• Priority Order for Using Documentation to Identify Histology
  • Important Note #2 Modified: Code the histology assigned by the physician by using the following priority list and Histology Rules.
  • #2: Tissue or pathology report from primary site
    • #2B: "Synoptic report as required by CAP" added to Final Diagnosis
  • #5: Code the histology documented by the physician when none of the above are available
    • #5A: "Treatment Plan" added
• Coding Multiple Histologies
  • Instructions clarified
  • "Configuration" added to the "DO NOT CODE" section
• Rule H5: Code mixed urothelial carcinoma as follows…
  • Rule clarified