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20190026 | Solid Tumor Rules (2018)/Multiple primaries--Bladder: Does Rule M11 in the 04/2019 Solid Tumor Rules Urinary update apply to synchronous/simultaneous tumors only or to multiple tumors with any timing? See Discussion. |
Rule M11 states: Abstract a single primary when there are urothelial carcinomas in multiple urinary organs, but neither the Rule nor the Notes describe the timing of these multiple urinary organ carcinomas. Timing requirements for other rules are clearly stated. Does Rule M11 have a timing requirement or is it intended to apply to all urothelial carcinoma tumors regardless of timing (and not already qualifying for application of a previous M rule)? |
The revised Urinary Solid Tumor Rules 2018 Rule M11, updated April 2019, removed the requirement of synchronous. This applies to urothelial carcinoma (8120) and its corresponding subtypes, regardless of behavior, that occur in more than one urinary site in a patient's lifetime. See change log for the April 2019 update to urinary rules.This is the same M/PH rule for multiple sites. Timing does not factor in to this rule. |
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20190086 | EOD 2018/Primary tumor--Melanoma: The code and level translations in the Note 4 of Extent of Disease (EOD) Primary Tumor for Melanoma Skin seem incorrect. Please advise. * Code 000: In situ * Code 100: Level I (should be level II) (< 0.75 mm Breslow's Depth) * Code 200: Level II (should be level III) (0.76 mm to 1.50 mm Breslow's Depth) * Code 300: Level III (should be level IV) (> 1.50 mm Breslow's Depth) |
Please see the corrected levels below for the note. Note 4: If a Breslow's depth is given in the pathology report and there is no other indication of involvement, the following guidelines may be used (Note: If a physician documents a different Clark's Level than provided by these guidelines, go with the physician's Clark Level) Code 000: Level I (In situ) Code 100: Level II (< 0.75 mm Breslow's Depth) Code 200: Level III (0.76 mm to 1.50 mm Breslow's Depth) Code 300: Level IV (> 1.50 mm Breslow's Depth) Thank you for bringing this to our attention. |
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20190106 | Tumor Size--Esophagus: Can information from the endoscopy procedure that implies a size of 3 cm for Tumor Size--Clinical be used for Esophagus? See Discussion. |
1-28-2018 CT Scan: 2.4 cm mass 2-15-2018 Endoscopy: Mass was present 22 to 25 cm. Biopsies were taken with cold forceps for histology; biopsy positive. |
For the case you describe, we would record the clinical tumor size stated on the CT report. The priority order for clinical tumor size is as follows. 1. Biopsy or operative (surgical exploration) report 2. Imaging 3. Physical exam We do not recommend coding tumor size based on an inferred tumor size from a description such as "Mass was present 22 to 25 cm." Look for an actual measurement of the mass, or a stated tumor size. Use text fields to record details. |
2019 |
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20190021 | Sequence Number Central--Brain and CNS: How is Sequence Number--Central coded for current/recent benign brain/CNS tumors when the patient has a history of an additional non-malignant CNS tumor diagnosed prior to 2004 (when these tumors became reportable to SEER)? See Discussion. |
We are confused by the SEER Program Coding and Staging Manual 2018 instruction that states: This sequence number counts all tumors that were reportable in the year they were diagnosed even if the tumors occurred before the registry existed or before the registry participated in the SEER Program. Does this rule apply to benign and borderline CNS tumors? Does this mean that any non-malignant CNS tumor diagnosed prior to 2004 should NOT be included in the sequencing (in the 60s range) if we were collecting non-malignant CNS per our State Registry reporting requirements prior to 2004? Example: Patient has a March 2017 diagnosis of right sided vestibular schwannoma (C724-1, 9560/0) and a prior history of left sided acoustic neuroma (c724-2, 9560/0) diagnosed in 1991. How should sequence be coded for each primary in our file? |
For your example, code the Sequence Number--Central as 61 for the 1991 diagnosis if this was a state registry requirement in 1991 and code 62 for the 2017 diagnosis. |
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20190072 | Solid Tumor Rules (2018)/Histology--Lung: What is the correct histology code for minimally invasive adenocarcinoma in the lung, 8140/3 or 8256/3? See Discussion. |
For example, 9/12/18 left lung upper lobe lobectomy: 1.5 cm, 0.8 cm invasive component, lepidic predominant adenocarcinoma with acinar and lepidic patterns, G2, no visceral pleural invasion, no LVI, 0/14 LNS positive. An additional minimally invasive adenocarcinoma, 1 mm, was seen away from the main tumor. The correct coding of the minimally invasive adenocarcinoma will ultimately determine if we have one tumor (using rule M7) versus two primaries (using rule M6). |
Updated answer: Code minimally invasive adenocarcinoma, NOS as 8140/3. This is a new term and code in the 2018 ICD-O-3 New Codes, Behaviors, and Terms-Updated 8/22/18 list. See Solid Tumor Lung Table 3, and Solid Tumor Lung rules H1 and H10. |
2019 |
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20190013 | Laterality--Head and Neck: Were the topography codes C090 and C091 intentionally left off of the Sites for Which Laterality Codes Must Be Recorded table in the 2018 SEER Manual? The codes were also removed from Table 10 in the 2018 Solid Tumor Rules for Head and Neck but appear under coding instructions 1b. and 6b. in the manual. |
Thank you for bringing this to our attention. C090 and C091 were intentionally removed from the list of sites for which laterality must be coded. They should have also been removed from coding instructions 1b and 6b. We will make that correction in the next version of the manual. |
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20190075 | Sex: How should the sex field be coded for the newly allowable non-binary gender designation ? See Discussion. |
Washington State added to birth certificates, which allows people to have their certificates changed to this non-binary gender designation. Gender X is defined as a gender that is not exclusively male or female, including, but not limited to: intersex, agender, amalgagender, androgynous, bigender, demigender, female-to-male, genderfluid, genderqueer, male-to-female, neutrois, nonbinary, pangender, third sex, transgender, transsexual, Two Spirit, and unspecified. |
Code Gender X as 9 when that is the only information available. Use text fields to document the details. Also refer to coding instruction #7. When gender is not known Assign code 1 when the primary site is C600 'C639 Assign code 2 when the primary site is C510 'C589 Assign code 9 for primary sites not included above |
2019 |
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20190005 | Primary Site--Bladder: Does instruction #4 in the Urinary Sites Solid Tumor Rules Instructions for Coding Primary Site apply to a mix of in situ and invasive urothelial tumors? Instruction #4: Code Urinary System NOS C689 when there are multiple non-contiguous tumors in multiple organs within the urinary system. See Discussion. |
Example: Patient has multiple biopsies with final diagnosis of in situ papillary urothelial carcinoma in the prostatic urethra and invasive papillary urothelial carcinoma in the bladder. How should primary site be coded in this type of mixed in situ and invasive situation? |
Code Urinary System NOS C689 for this case since there are two separate urinary sites involved. Apply instruction #4 when there is a mix of in situ and invasive urothelial tumors. |
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20190074 | First course treatment/Scope of Reg LN Surgery--Breast: How is Scope of Regional Lymph Node Surgery coded when there is a sentinel lymph node biopsy (SLNBx) and intra-mammary nodes removed for a single primary? See Discussion. |
Example: Operative report documents a left breast skin sparing mastectomy and sentinel node biopsy procedure. Pathology report lists left axillary sentinel nodes in specimen A) with 0/2 nodes positive, and left breast mastectomy without axilla in specimen B) yielding an additional 0/2 intramammary nodes positive. Would the Scope of Regional Node Surgery be coded as 2 (SLN biopsy) to capture the intent of the sentinel node procedure only, or 6 (code 2 + 4) to capture the actual type and number of nodes removed? SEER Coding and Staging Manual includes Scope of Regional Lymph Node Surgery instruction 4.b. which mentions assigning code 4 to intra-organ node removal. Similarly, there is instruction for coding SLN biopsy as code 2 and SLN biopsy with axillary dissection at the same time (code 6) or during separate procedures (code 7). However, it is not clear this combination code is how we should also capture an incidental intra-organ node removal. |
Revised answer 07/11/2023 Assign code 6, Sentinel node biopsy and code 3, 4, or 5 at same time or timing not noted. There were two sentinel lymph nodes removed (code 2) plus two intramammary nodes removed in a separate specimen from the mastectomy (code 4). Assign code 6 when nodes are removed from a sentinel lymph node procedure at the same time as removal of intra-organ lymph nodes which were not part of the sentinel lymph node procedure. |
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20190006 | MP/H Rules/Multiple primaries--Breast: Please confirm Multiple Primaries/Histology Breast Rule M8 applies in this 2017 case. The surgical resection is >60 days past the biopsy date but is it possible treatment plans for breast could span >60 days and this is one primary? See Discussion. |
7/25/17 Part A: Left breast at 8:00, 5 CFN: Specimen type: Stereotactic biopsy. Tumor type: Ductal carcinoma in situ (DCIS), cribriform type. Tumor size: The largest focus of DCIS measures 1 mm in greatest dimension as measured on the slide. Nuclear grade: 2 (Intermediate grade). Microcalcifications: Present. Other findings: Stromal fibrosis, microcalcification and fat necrosis. 11/1/17 A. Sentinel lymph node, left: One lymph node, negative for metastatic tumor on three levels of routine H\T\E and pan cytokeratin immunohistochemical stains. B. Left breast: Procedure: Total mastectomy with skin and nipple. Specimen Laterality: Left. Lymph Node Sampling: Yes, portion A. Specimen Integrity: Intact. Histologic Type: Extensive ductal carcinoma in situ and one focus of Invasive ductal carcinoma with mucinous features. Histologic Grade (Nottingham Histologic Score): Glandular Differentiation: Score 3 Nuclear Grade: Score 2. Mitotic Count: Score 1. Total Nottingham score 6 (grade 2, moderately differentiated). Tumor Size: 3.3 x 2 mm (0.33 x 0.2 cm) measured on slide (B3). Tumor Site: Lower inner quadrant of left breast. Tumor Focality: Unifocal. Ductal Carcinoma In Situ (DCIS): Present, cribriform, solid and micropapillary types with focal necrosis and calcifications. Size of DCIS: Number of blocks examined: Thirty (30). Number of blocks with DCIS: Thirteen (13). Lobular Carcinoma In Situ (LCIS): Not identified, Lymphovascular Invasion: Present. Perineural Invasion: Not identified. Other Findings: Changes consistent with previous biopsy site. Cysts, foci of atypical ductal hyperplasia, focal ductal hyperplasia, adenosis, stromal fibrosis and microcalcifications. Skin (epidermis): Uninvolved. Nipple: Uninvolved. Margins: 1 mm from DCIS to the closest deep margin (slide B12). At least 10 mm (1 cm) from invasive carcinoma to deep margin. Estrogen receptor (ER, clone 1D5) by immunohistochemistry performed on this material: Positive (invasive and in situ carcinoma), high intensity, in greater than 95% of carcinoma cells. Progesterone receptor (PR, clone 16) by immunohistochemistry performed on this material: Positive (invasive and in situ carcinoma), moderate intensity in about 80% of the carcinoma cells. Her 2 by FISH performed on this material: Pending, an addendum to follow. Pathologic staging: pT1aN0(sn)MX (AJCC 7th edition). Dictated by: (Pathologist), MD Intradepartmental review. |
Abstract a single breast primary. Apply MP/H Rule M3 as this is a single tumor identified in the biopsy at 8 o'clock and at the same location in the mastectomy specimen. Code the behavior as invasive according to rule H9. The first course of therapy ends when the documented treatment plan is completed, no matter how long, unless there is progression, recurrence, or treatment failure. |
2019 |
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