DOC

Collaborative Stage Manual Part II

By Jill Andrews,2014-04-26 07:18
5 views 0
Collaborative Stage Manual Part II

    SEER Program Coding and Staging Manual 2004

    SEER Site-Specific Coding Guidelines BREAST

    C500C509

Primary Site

C500 Nipple (areolar)

    Paget disease without underlying tumor

C501 Central portion of breast (subareolar) area extending 1 cm around areolar complex

    Retroareolar

    Infraareolar

    Next to areola, NOS

    Behind, beneath, under, underneath, next to, above, cephalad to, or below nipple

    Paget disease with underlying tumor

C502 Upper inner quadrant (UIQ) of breast

     Superior medial

     Upper medial

     Superior inner

C503 Lower inner quadrant (LIQ) of breast

     Inferior medial

     Lower medial

     Inferior inner

C504 Upper outer quadrant (UOQ) of breast

     Superior lateral

     Superior outer

     Upper lateral

C505 Lower outer quadrant (LOQ) of breast

     Inferior lateral

     Inferior outer

     Lower lateral

C506 Axillary tail of breast

     Tail of breast, NOS

     Tail of Spence

C508 Overlapping lesion of breast

     Inferior breast, NOS

     Inner breast, NOS

     Lateral breast, NOS

     Lower breast, NOS

     Medial breast, NOS

     Midline breast NOS

     Outer breast NOS

     Superior breast, NOS

     Upper breast, NOS

     3:00, 6:00, 9:00, 12:00 o‘clock

C509 Breast, NOS

     Entire breast

     Multiple tumors in different subsites within breast

     Inflammatory without palpable mass

     ? or more of breast involved with tumor Appendix C Site-Specific Coding Modules C-469

    SEER Program Coding and Staging Manual 2004

Diffuse (tumor size 998)

Additional Subsite Descriptors

The position of the tumor in the breast may be described as the positions on a clock

    O'Clock Positions and Codes

    Quadrants of Breasts

    UOQ UIQ UOQ UIQ

    C50.2 C50.2 C50.4 C50.4 12 12 11 1 11 1

    10 2 10 2

    C50.0

    9 3 9 3

    C50.1

    8 4 8 4

    7 5 7 5 6 6

    LOQ LIQ LIQ LOQ

    C50.5 C50.3 C50.3 C50.5

    RIGHT BREAST LEFT BREAST

Priority Order for Coding Subsites

Use the information from reports in the following priority order to code a subsite when the medical record contains

    conflicting information:

1 Pathology report

    2 Operative report

    3 Physical examination

    4 Mammogram, ultrasound

If the pathology proves invasive tumor in one subsite and insitu tumor in all other involved subsites, code to the

    subsite involved with invasive tumor

When to Use Subsites 8 and 9

    A. Code the primary site to C508 when there is a single tumor that overlaps two or more subsites, and the subsite

    in which the tumor originated is unknown

    B. Code the primary site to C508 when there is a single tumor located at the 12, 3, 6, or 9 o’clock position on the

    breast

    Code the primary site to C509 when there are multiple tumors (two or more) in at least two quadrants of the breast

Laterality

Laterality must be coded for all subsites.

    C-470 Site-Specific Coding Modules Appendix C

    SEER Program Coding and Staging Manual 2004

Single Tumor with Complex Histology

    If the diagnosis is both lobular and ductal (insitu or invasive, or a combination of insitu and invasive) use code 8522

    Example 1: Code duct carcinoma and lobular carcinoma insitu to the combination code 8522/3

Example 2: Code LCIS and DCIS to the combination code 8522/2

If the diagnosis is mixed invasive and insitu, code the invasive diagnosis

    Example 1: Code ductal carcinoma with extensive cribriforming DCIS to the invasive ductal carcinoma (8500/3)

    Example 2: Code mucinous carcinoma in a background of ductal carcinoma insitu to the invasive mucinous carcinoma (8480/3)

    Example 3: Code infiltrating ductal carcinoma with DCIS, solid, cribriform, and comedo type to the invasive infiltrating ductal carcinoma (8500/3)

    Use a combination code if the diagnosis is either ductal carcinoma OR lobular carcinoma mixed with another type of carcinoma. Look for the words ―and‖ or ―mixed‖ in the diagnosis.

    Code duct carcinoma mixed with another type of carcinoma (excluding lobular) to 8523/_

Example 1: Code duct carcinoma and tubular carcinoma to 8523/3

Example 2: Code DCIS and cribriform carcinoma insitu to 8523/2

    Code lobular carcinoma mixed with another type of carcinoma (excluding ductal) to 8524_

Example 1: Code lobular and adenoid cystic carcinoma to 8524/3

Example 2: Code tubular carcinoma and lobular carcinoma as 8524/3

    Code the infiltrating ductal subtype even if the code is numerically lower than infiltrating ductal (8500/_) when the following terms are used

    Type: Duct carcinoma, _____ type

    Predominantly: Duct carcinoma, predominantly _____

     With features of: Duct carcinoma with features of _____

     Subtype: Infiltrating ductal, _____ subtype

     Variant: Duct carcinoma, _______ variant

     Other terms that indicate the majority of tumor

    Example 1: Duct carcinoma, tubular type. Code the histology as tubular carcinoma, 8211/3

    Example 2: Duct carcinoma with apocrine features. Code the histology as aprocrine carcinoma 8401/3

If the diagnosis includes more than one subtype, use a combination code

    Example 1: Duct carcinoma, cribriform and comedo types. Code the histology to 8523/3

    Example 2: Duct carcinoma insitu showing both solid and cribriforming subtypes. Code the histology as 8523/2

Separate Tumors of Different Histologies in One Breast

    If different histologies occur in separate tumors in the same breast, use the multiple primary rules to determine if

    there is one or more primaries. If, according to the rules, there are two primaries, abstract and stage separately. If,

    according to the rules, there is one primary, abstract and stage as one primary. Use a combination code for combinations of duct and lobular or combinations of duct and Paget disease.

Appendix C Site-Specific Coding Modules C-471

    SEER Program Coding and Staging Manual 2004

Example 1: Lobular carcinoma insitu in the upper inner quadrant of the right breast and duct carcinoma in the lower

    inner quadrant of the right breast. Code the histology as 8522/3

Example 2: Paget disease of nipple and intraductal carcinoma, upper outer quadrant. Code the histology as 8543/3

Grade

Priority Rules for Grading Breast Cancer

Code the tumor grade using the following priority order:

    Bloom-Richardson (Nottingham) scores 3-9 converted to grade (see conversion table below) Bloom Richardson grade (low, intermediate, high)

     Nuclear grade only

     Terminology

    Differentiation (well differentiated, moderately differentiated, etc)

     Histologic grade

     Grade i, grade ii, grade iii, grade iv

Bloom-Richardson (BR)

BR may also be called: modified Bloom-Richardson, Scarff-Bloom-Richardson, SBR grading, BR grading, Elston-

    Ellis modification of Bloom Richardson score, the Nottingham modification of Bloom Richardson score,

    Nottingham-Tenovus, or Nottingham grade

BR may be expressed in scores (range 3-9)

    The score is based on three morphologic features of ―invasive no-special-type‖ breast cancers (degree of tubule formation/histologic grade, mitotic activity, nuclear pleomorphism of tumor cells) Use the following table to convert the score into SEER code

BR may be expressed as a grade (low, intermediate, high)

    BR grade is derived from the BR score

    For cases diagnosed 1996 and later, use the following table to convert the BR grade into SEER code (Note that the

    conversion of low, intermediate, and high is different from the conversion used for all other tumors)

Convert BR Score to SEER Code

Use the table below to convert BR score to SEER code.

    BR Combined Score Differentiation Grade SEER Code

    3, 4, 5 Well differentiated I 1

    6, 7 Moderately differentiated II 2

    8, 9 Poorly differentiated III 3

Convert BR Grade to SEER Code

Use the table below to convert BR grade to SEER code.

    BR Grade Differentiation Grade SEER Code

    BR low grade Well differentiated I 1

    BR intermediate grade Moderately differentiated II 2

    BR high grade Poorly differentiated III 3

C-472 Site-Specific Coding Modules Appendix C

    SEER Program Coding and Staging Manual 2004

Three-Grade System (Nuclear Grade)

    There are several sites for which a three-grade system is used. The patterns of cell growth are measured on a scale of 1, 2, and 3 (also referred to as low, medium, and high grade). This system measures the proportion of cancer cells that are growing and making new cells and how closely they resemble the cells of the host tissue. Thus, it is similar to a four-grade system, but simply divides the spectrum into three rather than four categories (see comparison table above). The expected outcome is more favorable for lower grades.

    If a grade is written as 2/3 that means this is a grade 2 of a three-grade system. Do not simply code the numerator. Use the table below to convert the grade to SEER codes.

    Term Grade SEER Code

    1/3, 1/2 Low grade 2

    2/3 Intermediate grade 3

    3/3, 2/2 High grade 4

    Laterality

Laterality must be coded for all subsites.

Tumor Markers

    Estrogen and progesterone receptors (ERA and PRA) are positive in most breast cancers. A positive ERA and PRA indicates a better prognosis and response to estrogen therapy.

Size of Primary Tumor

General Coding Guidelines

If multiple masses are present, code the diameter of the largest invasive mass. Ignore the insitu even if it is larger

    than the invasive.

    If the patient had neoadjuvant treatment, code the largest tumor size documented, clinical or pathologic.

Tumors That Are Purely Invasive or Purely Insitu

    For purely invasive or purely insitu tumors, record the size of tumor based on the following priority of reports.

Priority in which to use Reports to Code Tumor Size

1. Pathology report

    2. Operative report

    3. Physical examination

    4. Imaging (mammography)

    5. Imaging (ultrasound)

Single Tumors with Both Invasive and Insitu Components

Record the size of the invasive component, if given.

    If both an insitu and an invasive component are present, and the invasive component is measured, record the size of the invasive component even if it is smaller.

    Example: Tumor is 37 mm mixed insitu and invasive adenocarcinoma. Pathology documents that 14 mm is invasive. Record tumor size as 014.

Appendix C Site-Specific Coding Modules C-473

    SEER Program Coding and Staging Manual 2004

General Staging Guidelines

DO NOT USE the following to determine tumor extension:

A. Dimpling of the skin, tethering, nipple retraction, nipple involvement or skin changes other than those listed in

    CS extension code 51 (See also CS Extension, Note 1)

    B. Microscopic satellite skin nodules

    (macroscopic or gross nodules in skin of primary breast are used in staging)

    C. Microscopically proven invasion of lymphatic vessels within the breast C-474 Site-Specific Coding Modules Appendix C

    SEER Program Coding and Staging Manual 2004

Collaborative Staging Codes

    Breast

    C50.0-C50.6, C50.8-C50.9

    C50.0 Nipple

    C50.1 Central portion of breast

    C50.2 Upper-inner quadrant of breast

    C50.3 Lower-inner quadrant of breast

    C50.4 Upper-outer quadrant of breast

    C50.5 Lower-outer quadrant of breast

    C50.6 Axillary Tail of breast

    C50.8 Overlapping lesion of breast

    C50.9 Breast, NOS

    Note: Laterality must be coded for this site.

    CS Tumor Size CS Site-Specific Factor 1 - Estrogen The following tables are available CS Extension Receptor Assay (ERA) at the collaborative staging CS TS/Ext-Eval CS Site-Specific Factor 2 - Progesterone website:

    CS Lymph Nodes Receptor Assay (PRA) Histology Exclusion Table

    CS Reg Nodes Eval CS Site-Specific Factor 3 - Number of AJCC Stage

    Positive Ipsilateral Axillary Lymph Reg LN Pos Extension Size Table

    Reg LN Exam Nodes Extension Behavior Table

    CS Mets at DX Lymph Nodes Positive Axillary CS Site-Specific Factor 4 -

    CS Mets Eval Immunohistochemistry (IHC) of Regional Nodes Table

    Lymph Nodes IHC MOL Table

    CS Site-Specific Factor 5 - Molecular

    Studies of Regional Lymph Nodes

    CS Site-Specific Factor 6 - Size of

    Tumor--Invasive Component

Breast

    CS Tumor Size

    Note 1: For tumor size, some breast cancers cannot be sized pathologically. Note 2: When coding pathologic size, code the measurement of the invasive component. For example, if there is a

    large in situ component (e.g., 4 cm) and a small invasive component see Site-Specific Factor 6 to code more

    information about the reported tumor size. If the size of invasive component is not given, code the size of the entire

    tumor and record what it represents in Site-Specific Factor 6. Note 3: Microinvasion is the extension of cancer cells beyond the basement membrane into the adjacent tissues

    with no focus more than 0.1 cm in greatest dimension. When there are multiple foci of microinvasion, the size of

    only the largest focus is used to classify the microinvasion. (Do not use the sum of all the individual foci.)

    Code Description

    000 No mass/tumor found

    001-988 001 - 988 millimeters (code exact size in millimeters)

    989 989 millimeters or larger

    990 Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm

    991 Described as less than 1 cm

    992 Described as less than 2 cm

    993 Described as less than 3 cm

    994 Described as less than 4 cm

    Appendix C Site-Specific Coding Modules C-475

    SEER Program Coding and Staging Manual 2004

995 Described as less than 5 cm

    996 Mammographic/xerographic diagnosis only, no size given; clinically not palpable

    997 Paget's Disease of nipple with no demonstrable tumor

    998 Diffuse

    999 Unknown; size not stated

    Not documented in patient record

Breast

    CS Extension

    Note 1: Changes such as dimpling of the skin, tethering, and nipple retraction are caused by tension on Cooper's ligament(s), not by actual skin involvement. They do not alter the classification.

    Note 2: Consider adherence, attachment, fixation, induration, and thickening as clinical evidence of extension to skin or subcutaneous tissue, code '20'.

    Note 3: Consider "fixation, NOS" as involvement of pectoralis muscle, code '30'.

    Note 4: If extension code is 00, then Behavior code must be 2; if extension code is 05 or 07, then behavior code may be 2 or 3; and, if extension code is 10, then behavior code must be 3.

    Note 5: Inflammatory Carcinoma. AJCC includes the following text in the 6th edition Staging Manual (p. 225-6), "Inflammatory carcinoma is a clinicopathologic entity characterized by diffuse erythema and edema (peau d'orange) of the breast, often without an underlying palpable mass. These clinical findings should involve the majority of the skin of the breast. Classically, the skin changes arise quickly in the affected breast. Thus the term of inflammatory carcinoma should not be applied to a patient with neglected locally advanced cancer of the breast presenting late in the course of her disease. On imaging, there may be a detectable mass and characteristic thickening of the skin over the breast. This clinical presentation is due to tumor emboli within dermal lymphatics, which may or may not be apparent on skin biopsy. The tumor of inflammatory carcinoma is classified T4d. It is important to remember that inflammatory carcinoma is primarily a clinical diagnosis. Involvement of the dermal lymphatics alone does not indicate inflammatory carcinoma in the absence of clinical findings. In addition to the clinical picture, however, a biopsy is still necessary to demonstrate cancer either within the dermal lymphatics or in the breast parenchyma itself."

    Note 6: For Collaborative Staging, the abstractor should record a stated diagnosis of inflammatory carcinoma, and also record any clinical statement of the character and extent of skin involvement in the text area. Code 72 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement in more than 50% of the breast. All other cases with a stated diagnosis of inflammatory carcinoma but no such clinical description should be coded 71. A clinical description of inflammation, erythema, edema, peau d'orange, etc. without a stated diagnosis of inflammatory carcinoma should be coded 51 or 52, depending on described extent of the condition.

    Code Description TNM SS77 SS2000

    00 In situ: noninfiltrating; intraepithelial Tis IS IS

    Intraductal WITHOUT infiltration

    Lobular neoplasia

    05 Paget Disease of nipple (WITHOUT underlying tumor) Tis ** **

    07 Paget Disease of nipple (WITHOUT underlying invasive carcinoma Tis ** **

    pathologically)

    10 Confined to breast tissue and fat including nipple and/or areola * L L

    Localized, NOS

    C-476 Site-Specific Coding Modules Appendix C

    SEER Program Coding and Staging Manual 2004

    20 Invasion of subcutaneous tissue * RE RE

    Local infiltration of dermal lymphatics adjacent to primary tumor

    involving skin by direct extension

    Skin infiltration of primary breast including skin of nipple and/or

    areola

    30 Attached or fixation to pectoral muscle(s) or underlying tissue * RE RE

    Deep fixation

    Invasion of (or fixation to) pectoral fascia or muscle

    40 Invasion of (or fixation to): T4a RE RE

     Chest wall

     Intercostal or serratus anterior muscle(s)

     Rib(s)

    51 Extensive skin involvement, including: T4b RE RE

     Satellite nodule(s) in skin of primary breast

     Ulceration of skin of breast

    Any of the following conditions described as involving not more

    than 50% of the breast, or amount or percent of involvement not

    stated:

     Edema of skin

     En cuirasse

     Erythema

     Inflammation of skin

     Peau d'orange ("pigskin")

    52 Any of the following conditions described as involving more than T4b RE RE

    50% of the breast

    WITHOUT a stated diagnosis of inflammatory carcinoma:

     Edema of skin

     En cuirasse

     Erythema

     Inflammation of skin

     Peau d'orange ("pigskin")

    61 (40) + (51) T4c RE RE 62 (40) + (52) T4b RE RE 71 Diagnosis of inflammatory carcinoma T4b RE RE

    WITHOUT a clinical description of inflammation, erythema,

    edema, peau d'orange,etc., of more than 50% of the breast,

    WITH or WITHOUT dermal lymphatic infiltration

    Inflammatory carcinoma, NOS

    72 Diagnosis of inflammatory carcinoma T4b RE RE

    WITH a clinical description of inflammation, erythema, edema,

    peau d'orange, etc. of LESS THAN OR EQUAL TO 50% of the

    breast,

    WITH or WITHOUT dermal lymphatic infiltration

    73 Diagnosis of inflammatory carcinoma T4d RE RE

    WITH a clinical description of inflammation, erythema, edema,

    peau d'orange, etc., of more than 50% of the breast,

    WITH or WITHOUT dermal lymphatic infiltration

    95 No evidence of primary tumor T0 U U Appendix C Site-Specific Coding Modules C-477

    SEER Program Coding and Staging Manual 2004

99 Unknown extension TX U U

    Primary tumor cannot be assessed

    Not documented in patient record

    * For Extension codes 10, 20, and 30 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this site.

    ** For codes 05 and 07 ONLY, summary stage is assigned based on the value of Behavior Code ICD-0-3 as shown in the Extension Behavior Table for this site.

Breast

    CS TS/Ext-Eval

    SEE STANDARD TABLE

Breast

    CS Lymph Nodes

    Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in the field Mets at DX. Note 2: If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2 mm and code the lymph nodes as positive in this field. Use code 60 in the absence of other information about regional nodes.

    Note 3: If no lymph nodes were removed surgically, then use only the following codes for clinical evaluation of axillary nodes: 00 - Clinically negative 50 - Fixed/matted nodes, 60 - Clinically positive axillary nodes 99 - Unknown/not stated.

    Note 4: If pre-surgical therapy was given and there is a clinical evaluation (positive or negative) of lymph nodes, then use only the following codes for clinical evaluation of axillary nodes: 00 - Clinically negative 50 - Fixed/matted nodes 60 - Clinically positive axillary nodes AND Code a '5' in the nodes evaluation field. If there is no clinical evaluation of nodes, use the information from the pathologic evaluation and code a '6' in the nodes evaluation field. Note 5: Isolated tumor cells (ITC) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected only by immunohistochemical (IHC) or molecular methods but which may be verified on H and E stains. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). Lymph nodes with ITCs only are not considered positive lymph nodes.

    Note 6: Codes 13-50 are used for positive axillary nodes without internal mammary nodes.

    Code Description TNM SS77 SS2000

    00 None; no regional lymph node involvement, including ITCs * NONE NONE

    detected by immunohistochemistry or molecular methods ONLY.

    (See Note 5 and Site-specific Factors 4 and 5.)

    05 Regional lymph node(s) with (ITCs) detected on routine H and E N0(i+) NONE NONE

    stains. (See Note 5)

    13 Axillary lymph node(s), ipsilateral, micrometastasis ONLY N1mi RN RN

    detected by immunohistochemical (IHC) means ONLY (at least one

    micrometastasis greater than 0.2 mm and all micrometastases less

    than or equal to 2 mm)

    15 Axillary lymph node(s), ipsilateral, micrometastasis ONLY N1mi RN RN

    detected or verified on H&E (at least one micrometastasis greater

    than 0.2 mm and all micrometastases less than or equal to 2 mm)

    Micrometastasis, NOS

    25 Movable axillary lymph node(s), ipsilateral, positive with more than ** RN RN

    micrometastasis (i.e., at least one metastasis greater than 2 mm)

    26 Stated as N1, NOS ** RN RN

    28 Stated as N2, NOS ** RN RN

    C-478 Site-Specific Coding Modules Appendix C

Report this document

For any questions or suggestions please email
cust-service@docsford.com