Part IV. Diagnostic Procedures

IV.2 Diagnostic Confirmation

A gauge of the reliability of histologic and other data is the method of confirming that the patient has cancer. Coding for the confirmation field is in the order of the conclusiveness of the method, the lowest number taking precedence over other codes. The most conclusive method, microscopic analysis of tissue, is therefore coded as 1, while microscopic analysis of cells, the next most conclusive method, is coded as 2. Medical records should be studied to determine what methods were used to confirm the diagnosis of cancer, and the most conclusive method should be coded in the confirmation field. Since the confirmation field covers the patient's entire medical history in regard to the primary tumor, follow up data (see Section VII.1) might change the coding. The codes, in the order of their conclusiveness, are:

	Microscopic Confirmation
1	POSITIVE HISTOLOGY Use for microscopic confirmation based on biopsy, including punch biopsy, needle biopsy, bone marrow aspiration, curettage, and conization. Code 1 also includes microscopic examination of frozen section specimens and surgically removed tumor tissue, whether taken from the primary or a metastatic site. In addition, positive hematologic findings regarding leukemia and NRHD are coded 1. Cancers first diagnosed as a result of an autopsy or previously suspected and confirmed in an autopsy are coded 1 if microscopic examination is performed on the autopsy specimens.
2	POSITIVE CYTOLOGY, NO POSITIVE HISTOLOGY Cytologic diagnoses based on microscopic examination of cells, rather than tissue. (Do not use code 2 if cancer is ruled out by a histologic examination.) Included are sputum, cervical, and vaginal smears; fine needle aspiration from breast or other organs; bronchial brushings and washings; tracheal washings; prostatic secretions; gastric, spinal, or peritoneal fluid; and urinary sediment. Also include diagnoses based on paraffin block specimens from concentrated spinal, pleural, or peritoneal fluid.
4	POSITIVE MICROSCOPIC CONFIRMATION, METHOD NOT SPECIFIED Cases with a history of microscopic confirmation, but with no information about whether based on examination of tissue or cells.
	No Microscopic Confirmation
5	POSITIVE LABORATORY TEST OR MARKER STUDY Clinical diagnosis of cancer based on certain laboratory tests or marker studies that are clinically diagnostic for cancer. Examples are the presence of alpha fetoprotein (AFP) for liver cancer and an abnormal electrophoretic spike for multiple myeloma or Waldenstrom's macroglobulinemia. Although an elevated PSA is nondiagnostic of cancer, if the physician uses the PSA as a basis for diagnosing prostate cancer with no other workup, record as code 5.
6	DIRECT VISUALIZATION WITHOUT MICROSCOPIC CONFIRMATION Includes diagnoses by visualization and/or palpation during surgical or endoscopic exploration, or by gross autopsy. But do not use code 6 if visualization or palpation during surgery or endoscopy is confirmed by a positive histology or cytology report.
7	RADIOGRAPHY WITHOUT MICROSCOPIC CONFIRMATION Includes all diagnostic radiology, scans, ultrasound, and other imaging technologies not confirmed by a positive histologic or cytologic report or by direct visualization.
8	CLINICAL DIAGNOSIS ONLY (Other than 5, 6, or 7) Cases diagnosed by clinical methods other than direct visualization and/or palpation during surgery, endoscopy, or gross autopsy, if not confirmed microscopically.
9	UNKNOWN WHETHER OR NOT MICROSCOPICALLY CONFIRMED (Death Certificate Only cases are included in code 9.)

The SEER Program Manual entry available

COC Facility Oncology Registry Data Standards (FORDS manual) entry available

NAACCR Data Standards and Data Dictionary entry available