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California Cancer Registry Volume I: Data Standards and Data Dictionary Source: Cancer Reporting in California: Abstracting and Coding Procedures for Hospitals (California Cancer Reporting System Standards, Vol. I), updated May 2007 |
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California Cancer Registry Volume I: Data Standards and Data Dictionary Source: Cancer Reporting in California: Abstracting and Coding Procedures for Hospitals (California Cancer Reporting System Standards, Vol. I), updated May 2007 |
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Histology is the study of the minute structure of cells, tissues, and organs in relation to their functions. It is primarily through histological analysis that neoplasms are identified. Determination of the correct histology code can be one of the most difficult aspects of abstracting. Training and experience are essential for development of the ability to assign the correct code. The rules are taken from the SEER Program. They provide guidance, but no set of rules can cover all situations. Ask the regional registry for advice when the rules do not seem to apply to a case or when their application results in a code that seems incorrect. It is always appropriate to ask for advice about coding from a pathologist or clinician familiar with the case. (Be sure to document the physician's answer to your query in a text field.)
For cases diagnosed January 1, 2005 through December 31, 2006, apply the SEER Multiple Primary and Histology Rules as written in the SEER Program Coding and Staging Manual, 2004, pages 7-19 and 84-87. http://www.seer.cancer.gov/manuals/2004Revision 1/SPM_2004_maindoc.r1.pdf
Beginning with cases diagnosed January 1, 2007 forward, the 2007 Multiple Primary and Histology Rules must be used to determine histologic type. Do not apply these rules to cases diagnosed prior to January 1, 2007. Refer to the Multiple Primary and Histology Coding Rules Manual for details and instructions. http://www.seer.cancer.gov/tools/mphrules/mphrules_manual_01012007.pdf
In coding histology, use all pathology reports regarding the tumor. The specimen taken from a resection is usually the most representative, unless all the cancerous material was removed during a biopsy. An AJCC staging form may also be used if it is signed by a physician. Other diagnostic procedures or the final clinical diagnosis may be used as the basis for coding histology only if no pathology report is available. Document on the abstract every source of information used.
Before attempting to code histology, determine whether the case involves a single primary or multiple primaries (see Section II.1.3). Base the code on the best information in the report(s), whatever section it appears in. If the final diagnosis states a specific histologic type, enter the code for that type. However, if the microscopic description or a comment contains a definitive statement of a more specific type (i.e., one with a higher code number), enter the more specific code.
For the hematopoietic diseases, code to the more specific morphology, if that can be determined, which may not be the numerically higher code number. When in doubt which code to use, consult a medical advisor or pathologist.
Difficulties in selecting the correct code often occur because different histological terms are used to describe the same tumor in different pathology reports or in different parts of the same report. They might describe the same histology, subtypes of the same histology, the histologies of different parts of the same tumor, or a mixed histology. (See Section II.1.3 for rules about whether tumors with mixed histologies are to be considered single or separate primaries.) Various mixed histologies are assigned their own code numbers in ICD O 3. Many of these are found in the index under "Mixed" and "Mixed Tumor," but others are listed under one or the other histologic type. For example, mixed adenocarcinoma and squamous cell carcinoma of the cervix is coded as adenosquamous carcinoma (8560/3) and indexed under "Mixed." However, not all mixed histologies have their own numbers in ICD-O-3. When coding mixed histologies or tumors described with more than one term, behavior is a key factor (for explanation of behavior codes, see Section V.3.4). Use the following rules.
Single Lesion, Same Behavior.
If two histologic types or subtypes existing in the same primary tumor have the same behavior code, select the appropriate morphology code using the following rules in order:
(1) Use a combination code if one exists.
Examples
(1) Predominantly lobular with a ductal component. Use the combination code for lobular and ductal carcinoma.
(2) Invasive breast carcinoma—predominantly lobular with foci of ductal carcinoma. Use the combination code for lobular and ductal carcinoma.
(2) If one term appears in ICD-O-3 as an NOS (e.g., "carcinoma" appears as "carcinoma, NOS") and the other is more specific, use the more specific term.
Examples
(1) Adenocarcinoma (8140/3) of the sigmoid colon with mucin-producing features. Code as mucin-producing adenocarcinoma (8481/3).
(2) Invasive carcinoma, probably squamous cell type. Code as squamous cell carcinoma (8070/3), because it is more specific than carcinoma, NOS (8010/3).
(3) Adenocarcinoma of prostate, focally cribriform. Code cribriform carcinoma (8201/3) since it is more specific than adenocarcinoma.
(3) Code the histology of the majority of the tumor if there is no combination code (Rule #1) and neither term is equivalent to an NOS term (Rule #2) in ICD-O-3. Such phrases as "predominantly...", "with features of...", and "...type" indicate that the description applies to the majority of the tumor. Phrases that do not describe the majority of the tumor (e.g., "with foci of...," "areas of...,", "elements of...", "component of...", "pattern...", and "...focus of/focal") are to be ignored when both terms are specific and no combination code exists.
Example
Predominantly leiomyosarcoma associated with foci of well developed chondrosarcoma. Code as leiomyosarcoma.
(4) If no combination code is available (Rule #1) and one term is not more specific than another (Rule #2) and the majority of the tumor is not indicated (Rule #3), use the term that has the higher histology code in ICD-O-3.
Example
Tubular carcinoma (8211/3) and medullary carcinoma (8510/3). Code as medullary carcinoma (8510/3).
Single Lesion, Different Behavior.
If the behavior codes are different, select the morphology code with the higher behavior number.
Example
Squamous cell carcinoma in situ (8070/2) and papillary squamous cell carcinoma (8052/3). Code as papillary squamous cell carcinoma (8052/3).
Exception: If the histology of the invasive component is an NOS term (e.g., carcinoma, adenocarcinoma, melanoma, sarcoma), use the specific term associated with the in situ component, but enter an invasive behavior code.
Example
Squamous cell carcinoma in situ (8070/2) with areas of invasive carcinoma (8010/3). Code as squamous cell carcinoma (8070/3).
Multiple Lesions Considered a Single Primary.
When multiple lesions are considered a single primary (see Section II.1.3 for criteria), apply the following rules:
If one lesion is described with an NOS term (e.g., carcinoma, adenocarcinoma, melanoma, sarcoma) and the other with an associated term that is more specific (e.g., large cell carcinoma, mucinous adenocarcinoma, spindle cell sarcoma, respectively), code the more specific term.
If the histologies of multiple lesions can be represented by a combination code, use that code.
When both an adenocarcinoma (8140/3) and an adenocarcinoma (in situ or invasive) in a polyp or adenomatous polyp (8210) arise in the same segment of either the colon or rectum, code as adenocarcinoma (8140/3). The same applies to an adenocarcinoma and an adenocarcinoma (in situ or invasive) in a tubulovillous or villous adenoma (8261 or 8263). When both a carcinoma (8010/3) and a carcinoma (in situ or invasive) in a polyp or adenomatous polyp (8210) arise in the same segment of either the colon or rectum, code as carcinoma (8010/3).
For such unspecific terms as "malignant tumor," "malignant neoplasm," and "cancer," enter the code for neoplasm (8000). Do not use the code for a clinically malignant tumor that has not been microscopically confirmed (9990). (For diagnostic confirmation, see Section IV.2.) If a diagnosis is based only on a cytology report stating "malignant cells," use code 8001 (malignant cells, NOS).
If a histologic or cytologic diagnosis is based only on tissue or fluid from a metastatic site, assume that the primary tumor had the same histology, and code the behavior as 3 (malignant, primary site). (For explanation of behavior, see Section V.3.4.)
Lymphomas present some unique coding difficulties because of the complexity of the classification and the variety of terminologies in use. The following rules will be helpful in choosing the correct ICD-O-3 code for the histologic type:
Terminology from the WHO Classification of Hematopoietic Neoplasms (Table 13, pp. 16-18 in ICD-O-3) is preferred over older terminology.
In the new classification, the following terms have equivalent meanings:
Follicular lymphoma = follicle center cell lymphoma
Mantle cell lymphoma = mantle zone lymphoma
Anaplastic large B-cell lymphoma = diffuse large cell lymphoma
Do not code grade 1, 2 or 3 for follicular lymphoma or Hodgkin’s lymphoma in the 6th digit grade field. The grade refers to the type of cell, not the differentiation.
If two diagnoses are given, code the more specific term, which may not be the one with the higher code number.
The terms lymphoma, malignant lymphoma, and non Hodgkin's lymphoma are used interchangeably.
Avoid using non specific or unclassified lymphoma terms if there are specific diagnoses that can be coded.
In older classifications, some terms have equivalent meanings, for example,
Centroblastic = non-cleaved
Centrocytic = cleaved
Follicular = nodular
Histiocytic = large (cell)
Lymphocytic = small (cell)
Mixed lymphocytic and histiocytic = mixed small and large (cell).
When the term "mixed cellularity" is used with non-Hodgkin's lymphoma, it means mixed lymphocytic histiocytic lymphoma.
Note the rules for coding certain special cases.
Renal Adenocarcinoma. Code as renal cell carcinoma (8312/3). The word "cell," as used in ICD-O-3, is generally optional and often not found in hospital reports.
Lymphocytic Lymphoma (small cell type) And Chronic Lymphocytic Leukemia. When a case is diagnosed in a lymph node(s) or extranodal site or organ, prepare one abstract with the site and histologic type coded as lymphoma. When a case is diagnosed in the blood or bone marrow, and there is no lymph node or organ involvement, prepare one abstract with the site and histologic type coded as leukemia. (See also Section II.1.3.6 for rules about reporting lymphoma and leukemia.)
Malignant Lymphoreticular Process. Code as malignant neoplasm, NOS (8000/3). However, for lymphoreticular process further classifiable as myeloproliferative arising in the bone marrow, code as malignant myeloproliferative disease (9960/3). For lymphoreticular process classified as lymphoproliferative arising in the lymph tissue, code as malignant lymphoproliferative disease (9970/3).
(Adeno)carcinoma in a Polyp. Adenocarcinoma in a polyp should be coded 8210 even if it is stated only in the microscopic description and not in the final diagnosis.
Adenocarcinoma with Mucin. The tumor must be at least 50% mucinous, mucin-producing, or signet ring to be coded to the specific histology.
Code mucinous adenocarcinoma arising in a villous adenoma and mucinous adenocarcinoma arising in a villous glandular polyp to 8480/3, mucinous adenocarcinoma.
T-Cell Large Granular Lymphocytic Leukemia. Pathologic confirmation is required for a diagnosis of T-cell large granular lymphocytic leukemia and these cases should be reported with a behavior code of /3. Do not report cases with a behavior of /1.
Although T-cell large granular lymphocytic leukemia (code 9831) is a very indolent form of leukemia and therefore assigned a behavior code of /1 in ICD–O–3, the World Health Organization Table 13 of the ICD-O-3 lists this entity with a behavior code of /3. Infrequently this entity is symptomatic enough to be confirmed pathologically, thus the CCR is requiring pathologic confirmation for this diagnosis and that these cases be reported with a behavior code of /3.
http://www.seer.cancer.gov/tools/mphrules/mphrules_manual_01012007.pdf
SEER Program Manual entry available
COC Facility Oncology Registry Data Standards (FORDS manual) entry available
NAACCR Data Standards and Data Dictionary entry available
