The 2018 Solid Tumor Manual (previously referred to as the Multiple Primary & Histology Rules) is now available in draft format at https://seer.cancer.gov/tools/solidtumor. When the manual has been approved in final format, it will be marked as final on the Seer website.
A few things to highlight regarding changes in the Solid Tumor Manual (Multiple Primary & Histology Rules):
- Do not use a physician’s statement when deciding whether a patient has a recurrence of a previous cancer or a new primary. Use the multiple primary rules as written unless a pathologist compares the present tumor to the original tumor and states that this is a recurrence of cancer from previous primary.
- Code the subtypes/variants when definitely described (no modifiers).
- Do Not code a histology (including subtype/variant) when described as:
- Differentiation
- Features
- Apparently
- Appears
- Comparable with
- Compatible with
- Consistent with
- Favor(s)
- Malignant appearing
- Most likely
- Presumed
- Probable
- Suspect(ed)
- Suspicious (for)
- Typical (of
- Terms modified by ambiguous terminology
IMPORTANT INFORMATION FOR CODING HISTOLOGIC TYPE FOR CASES DIAGNOSED 01/01/2018 FORWARD:
The North American Association of Central Registries (NAACCR) has released Guidelines for ICD-O-3 Histology Code & Behavior update effective for cases diagnosed 01/01/2018 forward. The update includes new ICD-O-3 codes, changes in behaviors for existing ICD-O-3 codes as well as new preferred terminology. The updated histology tables can be found at: https://seer.cancer.gov/icd-o-3
A summary of the Guidelines for ICD-O-3 Histology & Behavior Codes can be found in the: 2018 1st Quarter Newsletter released 03/11/18
- Recurrence (the term has two meanings)
- The reappearance of disease that was thought to be cured or inactive (in remission). Recurrent cancer starts from cancer cells that were not removed or destroyed by the original therapy.
- A new occurrence of cancer in the same primary site such as a previous adenocarcinoma of the right lung and a subsequent squamous cell carcinoma of the left lung called a “recurrence” of lung cancer. This type of recurrence arises from cells that have nothing to do with the earlier (first cancer). A new or another occurrence, incidence, episode, or report of the same disease (cancer) in a general sense – a new occurrence of cancer
BREAST MAJOR CHANGES:
- NST (No Special type), mammary carcinoma NST, and carcinoma NST are the new terms for duct or ductal carcinoma. Previously it was thought that carcinoma originated in the ducts or lobules of the breast hence the names duct carcinoma and lobular carcinoma. Current thinking is that carcinoma originates in the “terminal duct lobular unit” therefore the preferred term is NST or carcinoma NST.
- DCIS/Carcinoma NST in situ has a major classification change
- It is very important to code the grade of all DCIS
- Code histology that is majority of tumor
- Some words describing majority are:
- Majority
- Predominantly\
- See Histology coding rules for definition of/criteria for majority of tumors
- Terms which were previously used to determine histology but are no longer used include:
- Differentiation
- Components of
- Features (of)
BREAST HISTOLOGY RULES:
- Major Changes from 2007 Rules:
- Effective 01/01/2018 mammary carcinoma is a synonym for carcinoma no special type (NST) duct carcinoma not otherwise specified (NOS) 8500. It will no longer be coded as carcinoma NOS 8010.
-
- Do code histology when documented as:
- Majority
- Type
- Predominantly
- Variant
- Subtype
- Do Not code histology when documented as:
- Architecture
- Features (of)
- Component
- Foci, focus, focal
- Differentiation
- Pattern(s)
- Do code histology when documented as:
-
- Note 1: Only code differentiation or features when there is a specific code for the NOS with differentiation, features or type in Table 3 or the ICD-O
- Example: Diagnosis invasive breast carcinoma with neuroendocrine differentiation which has a specific ICD-O histology/morphology code 8574. Code the histology 8574.
- Negative example: The diagnosis is carcinoma NST/duct carcinoma with apocrine features. There is no ICD-O histology/morphology code for carcinoma NST/duct carcinoma with apocrine features. Code carcinoma NST/duct carcinoma 8500
- Note 1: Only code differentiation or features when there is a specific code for the NOS with differentiation, features or type in Table 3 or the ICD-O
PRIORITY ORDER FOR USING DOCUMENTATION TO CODE HISTOLOGY:
- The most specific diagnosis in tissue reports from the primary tumor. The most specific histology may be found in either the biopsy or resection pathology
- Tissue reports are pathology from core needle biopsy, local resection/lumpectomy or mastectomy.
- This is a change from 2007 rules which said to code histology from the “most representative specimen/greatest amount of tumor tissue” which is most cases was the local tumor excision or mastectomy
- The definition of the most specific histology is subtype/variant such as carcinoma NST 8500 (least specific) and a subtype/variant pleomorphic carcinoma 8022 (more specific). It may also be a generic term such as carcinoma NOS 8010 (least specific) and a variant/subtype carcinoma NOS, glycogen-rich carcinoma 8315 (most specific)
- Example: patient had an excisional biopsy with a pathologic diagnosis of pleomorphic carcinoma 8022. There was microscopic involvement of one margin. The patient chose to have a total mastectomy. Pathology from the total mastectomy showed minimal residual carcinoma NST 8500. Code the most specific histology, pleomorphic carcinoma 8022
- Use the tissue reports in the following priority order with #1 having the highest priority:
- #1. Addendum on the pathology report
Note: Addendums may contain formation from outside consults, special stains, genetic testing, or other tests for which results were not available when the final diagnosis was dictated - #2. Comments on the pathology report
Note: comments may contain information from outside consults, special stains, genetic testing, or other tests for which results were not available when the final diagnosis was dictated - #3. Final diagnosis on the pathology report
- #4. The synoptic CAP reports
- Note: CAP reports are usually done at the same time as the final diagnosis so may not contain special testing. They are also limited to the diagnostic terms available in the CAP protocol.
- #1. Addendum on the pathology report
2. Cytology report
3. Tissue or cytology from metastatic site when there is no pathology/cytology specimen from primary site
4. Physician’s documentation when there is no pathology/cytology specimen or pathology/cytology report is not available
5. Radiology reports when none of the options 2-4 are available
COLORECTAL MAJOR CHANGES:
Colon Chapter includes Colon, Rectosigmoid & Rectum (C180-C189, C199, C209)
- Neuroendocrine tumors (formerly carcinoid) arising in the appendix are reportable
- Pseudomyxoma peritonei now has a two-tired system that classifies as either high-grade or low-grade
- High-grade pseudomyoma peritonei is malignant /3
- Low-grade pseudomyxoma peritonei is not malignant /0
- There are dysplasias which have an in situ behavior code /2 in WHO and in the ICD-O-3 Addendum. They are not reportable in the US.
- Dysplasia was not collected in the past. If dysplasia is added to the database with the same code as in situ tumors there will be a huge upsurge in the incidence of in situ neoplasms
- There would be no way to separate the dysplasia from the in-situ neoplasms in the database which would cause problems with surveillance since the prognosis and probabilities of disease progression are different between an in-situ tumors and a dysplasia
- Pathologists frequently use the term severe dysplasia or high grade dysplasia in place of carcinoma in situ. Code CIS only if the pathologist expressly states CIS
- Polyps are disregarded when coding histology. For example, adenocarcinoma in an adenomatous polyp is coded as adenocarcinoma 8140.
- Terms that can be used to identify subtypes/variants:
- Majority
- Type
- Predominantly
- Variant
- Subtype
- Terms that cannot be used to identify subtypes/variants:
- Architecture
- Features (of)
- Component
- Foci, focus, focal
- Differentiation
- Pattern(s)
PRIORITY ORDER FOR USING DOCUMENTATION TO CODE HISTOLOGY
- The histology from tissue/pathology report with the most specific histologic diagnosis. Use the following priority order:
- Addendum and/or comments
- Final on the pathology report
- CAP synoptic report
- Cytology report
- Code the histology from metastatic site when no other pathology is available
- Physician’s documentation when there is no pathology/cytology specimen or pathology/cytology report is not available