1. 2017 Multi-state Regional Fall Conference
ICD-O Update Lois Dickie, Public Health Analyst, NCI Chair, NAACCR ICD-O-3 Implementation Work Group
2017 Multi-state Regional Fall Conference
Lakewood, Colorado
September 15, 2017

2. agenda Introduction ICD-O-3 Implementation Work Group Challenges
What’s new
Next steps

3. Disclaimer
The tables provided for this presentation have not yet been finalized by the standard setters. The final ICD-O-3 update documents will be released with the 2018 NAACCR Implementation Guidelines. The codes and associated terminology listed in the tables have not been implemented, incorporated into edits, added to the site/histology validation list or made available to vendors for inclusion in abstracting software
Please do not share or disseminate

4. ICD-O Introduction

5. ICD-O-3 Codes: where do they come from?
World Health Organization (WHO)
International Histological Classification of Tumors (blue books)
International Agency for Research on Cancer (IARC)
IARC/ICD-O Committee

6. Relationship between WHO & ICD-O-3
In developing the current edition of ICD-O, a particular effort was made to use the nomenclature appearing in the World Health Organization’s International Histological Classification of Tumors (WHO “blue books”) series. This series covers all the principal sites of cancer and includes morphology codes of ICD-O for each neoplasm
Benign (/0)
Borderline (/1)
In situ (/2)
Invasive (/3)
Syndromes

7. WHO & ICD-O-3
Since the 2011 update to ICD-O-3 codes, WHO has continued publishing updates to the WHO Blue Book series
As part of each new edition, subject matter experts (SME’s) review current literature pertaining to the organ or body system covered in the WHO Classification and make recommendations regarding revised histologic terminology and diagnostic testing
Revisions reviewed by WHO/IARC ICD-O committee to make sure recommended code changes and additions are appropriate
Blue book chapter authors worked with the International Agency for Research on Cancer ICD-O committee to review recently identified neoplasm entities and assign morphology codes
IARC ICD-O committee reviews new terms, synonyms, related terms, morphology and behavior code changes proposed by WHO blue book chapter authors

8. NEXT
When a new Blue Book edition is published, the terminology and codes are introduced into contemporary pathology terminology to be used in pathology reports. Malignant diagnoses from these books that find their way into cancer registries may not be listed in ICD-O-3, the standard reference for reportable conditions. This becomes an issue if there are no histology code available to register a case.
In some cases, a new code can be cross-walked to an existing code until the new code is implemented
Otherwise, the case remains unreportable until the new code is implemented

9. NAACCR ICD-O-3 Implementation Work Group

10. Background

11. Background 2011: NAACCR formed the ICD-O-3 Implementation Work Group
Work group members from NCI SEER, CDC, CoC, AJCC, NAACCR, Central and State registries, and Canada
Review and make recommendations to adopt changes from the 4th Ed Classifications of Tumors for CNS, Digestive System, and Hematopoietic & Lymphoid Tumors
Recommendations approved by Cancer Registration Steering Committee 2012
Implementation of new codes delayed and cross-walk created
Expected implementation was 2016
Delay due to software updates to databases, CS
Prior to 2012, ICD-O published new books which standard setters would adopt for cancer reporting. The ICD-O committee would prepare all documentation of changes and disseminate

12. Important Note
ICD-O-3 First Revision (ICD-O-3.1) includes all updates from WHO 4th Ed CNS, Digestive System, and Hematopoietic & Lymphoid Neoplasms

13. Current Activities July 2016: ICD-O-3 Work Group resumed
Between 2012 and 2017, WHO published seven 4th Ed Classifications of Tumors
Breast
Female Reproductive Organs
CNS
Head & Neck
Lung
Soft Tissue & Bone
Urinary

14. Activities cont’d Confirmation of work group members
Reaffirmed work group responsibilities
Weekly WebEx meetings
Timeline
Each new 4th Ed underwent comprehensive review in order to identify new proposed histologies and codes, changed behavior codes and associated terminology, new preferred terms, alternate terms, and synonyms
Comprehensive comparison of ICD-O-3 First Revision to 4th Ed Blue Books
Review of CAP Protocols

15. Activities cont’d
Deliberated ramifications of adopting behavior code and term changes
Deliberated ramifications of adopting new terminology
Deliberated ramifications of collecting severe dysplasia in GI sites (currently on hold)
Work group recommendations presented to NAACCR Change Management Board for approval
Rationale
Related Issues

16. Activities cont’d 2018 NAACCR Implementation Guidelines
Choose format for users
Updates for software vendors
Disseminate documentation to registrar and research communities
Share with AJCC
Share with Solid Tumor project
Update SEER site/histology validation list
Documentation for statistical reporting tools

17. Challenges

18. Challenges No WHO/IARC ICD-O committee overview of changes
No change summary provided by Who 4th Ed editors
ICD-O-3.2 or ICD-O-4 not expected before 2025
New codes and terms site specific
How to reinforce correct coding

19. Challenges cont’d No guidance from WHO on preferred names
No guidance from WHO on obsolete terms
Different histologies assigned the same ICD-O code
Specific terminology

20. Challenges cont’d User-friendly format (both numeric and alpha)
User’s guide
Documentation for vendors
Determine if edits should or can be created to insure correct coding
Develop North American version of ICD-O-3.2

21. New ICD-O codes, changes to behavior codes and new terms
2018 ICD-O-3 Changes
New ICD-O codes, changes to behavior codes and new terms

22. New ICD-O codes/terms 11 previously approved ICD-O-3 codes
Total of 32 new ICD-O-3 codes

23. 2018 Changes Previously approved codes/terms
Action
8163/3
Pancreatobiliary-type carcinoma (C24.1)
Adenocarcinoma, pancreatobiliary-type (C24.1)
Cases diagnosed prior to 1/1/2018 use code 8255/3
8265/3
Micropapillary carcinoma, NOS (C18. _, C19.9, C20.9)
Cases diagnosed prior to 1/1/2018 use code 8507/3*
8552/3
Mixed acinar ductal carcinoma
Cases diagnosed prior to 1/1/2018 use code 8523/3
9395/3
Papillary tumor of pineal region
Cases diagnosed prior to 1/1/2018 use code 9361/3*
9425/3
Pilomyxoid astrocytoma
Cases diagnosed prior to 1/1/2018 use code 9421/3
9431/3
Angiocentric glioma
Cases diagnosed prior to 1/1/2018 use code 9380/*1
Table shows only reportable new codes/terms
Asterisk means to apply matrix rule

24. 2018 Changes Previously approved codes/terms
Action
9432/1
Pituicytoma
Cases diagnosed prior to 1/1/2018 use code 9380/1*
9509/1
Papillary glioneuronal tumor
Rosette-forming glioneuronal tumor
Diffuse leptomeningeal glioneuronal tumor
Cases diagnosed prior to 1/1/2018 use code 9505/1

25. 2018 New ICD-O-3 Codes/Terms with Special Instructions
Action
8054/3
Warty carcinoma (C60.0-C60.2, C60.8, C60.9)
Condylomatous carcinoma (C60.0 – C60.2, C60.8, C60.9)
Cases diagnosed prior to 1/1/2018 use code 8051/3
8085/3
Squamous cell carcinoma, HPV-positive (C01.9, C31.0 – C31.3, C31.9, C10.2, C10.3, C10.8, C10.9)
8086/3
Squamous cell carcinoma, HPV-negative (C01.9, C31.0 – C31.3, C31.9, C10.2, C10.3, C10.8, C10.9)
8519/2
Pleomorphic lobular carcinoma in situ
ICD-O-3 rule F DOES NOT APPLY to code Invasive pleomorphic lobular carcinoma is coded 8520/3

26. 8054/3 Warty Carcinoma Condylomatous Carcinoma
Previously listed under code 8051/3 as synonyms for verrucous carcinoma
WHO 4th Ed Tumors of Male Genital Organs has defined these histologies as an exophytic and papillomatous HPV-related tumor
This histology differs from verrucous carcinoma is not HPV-related

27. 8085/3 SCC, HPV-positive Specific to oropharynx sites ONLY
Oropharyngeal SCC (OPSCC) associated with high-risk HPV is an epidemiologically, pathologically, and clinically distinct form of head and neck squamous cell carcinoma

28. 8086/3 SCC, HPV-negative Specific to oropharynx sites ONLY
HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) is a subset of OPSCC that lacks association with high-risk HPV

29. 8519/2 Pleomorphic lobular carcinoma in situ
Pleomorphic lobular carcinoma in situ is difficult to differentiate from DCIS and requires special immunostaining for diagnosis
Diagnostic criteria and definition for invasive lobular carcinoma differs
Per WHO 4th Ed Tumors of the Breast, pleomorphic is a variant of invasive lobular carcinoma, however WHO has not proposed a specific ICD-O code for this variant
Invasive pleomorphic lobular carcinoma is to be coded lobular, NOS (8520/3) as confirmed with CAP breast pathologist
Matrix rule (ICD-O-3 rule F) does not apply to 8519

30. Behavior code changes & associated terms
13 existing ICD-O-3 codes with behavior changes and associated terms
3 reportability to be determined by standard setters
1 behavior change resulting in reportable to non-reportable

31. Behavior code changes: Reportability TBD
Code/behavior
Term
Action
8071/2
Differentiated penile intraepithelial neoplasia (C60. _)
TBD
Differentiated-type vulvar intraepithelial neoplasia (C51. _)
8460/2
Serous borderline tumor-micropapillary variant (C56.9)
8811/1
Myxoinflammatory fibroblastic sarcoma (MIFS) (C49. _)

32. Behavior code/term changes: Issues
8253/2 Adenocarcinoma in situ, mucinous (C34. _)
Important note: Lung primaries ONLY: For cases diagnosed 1/1/2018 forward do not use cod (mucinous adenocarcinoma) for in situ adenocarcinoma, mucinous or invasive mucinous adenocarcinoma

33. Behavior code/term changes: Issues
8311/3
Code and behavior have been proposed for two different histologies:
Hereditary leiomyomatosis & RCC-associated renal cell carcinoma (C64.9) Adult
MiT family translocation renal cell carcinoma (C64.9) Pediatric
Hereditary are rare cancers
MiT exposure to chemotherapy is a risk factor

34. New terms for existing ICD-O-3 codes
90 new associated terms for existing ICD-O codes (and probably more)
Some ICD-O-3 codes have more than one new term
8500/2 has three new alternate terms
8500/3 has four new alternate terms
New associated terms are site specific
No old terms made obsolete at this time
Some terms included in table have been recommended by CAP and are not included in WHO blue books

35. New Terms: Examples
8500/2
Low grade cribriform cystadenocarcinoma (LGCCC) (0.69, C0.89)
Non-invasive mammary carcinoma*
Mammary carcinoma, in situ*
* Prior to 2018, mammary carcinoma, in situ or invasive, has been coded to 8010/3. Mammary was used when the pathologist was unable to determine if the morphology was ductal or lobular. These tumors are now considered ductal
Oral cavity and salivary gland

36. New Terms: Examples 8520/3 Invasive lobular carcinoma (C50. _)
Invasive lobular carcinoma, solid type (C50. _)
Pleomorphic lobular carcinoma (C50. _)

37. New Terms: Examples 8250/3 8253/3 8254/3
Lepidic adenocarcinoma (C34. _)
Lepidic predominant adenocarcinoma (C34. _)
8253/3
Invasive mucinous adenocarcinoma (C34. _) (DX prior to 1/1/2018 use code 8480)
8254/3
Mixed invasive mucinous and non-mucinous adenocarcinoma (C34. _)
WHO 4th Ed Lung: A new IASLC/ATS/ERS classifications of lung adenocarcinoma proposed significant changes for resected tumors including discontinuing the terms bronchioloalveolar carcinoma (BAC)

38. New Terms: Examples 8551/3 Acinar adenocarcinoma (LUNG PRIMARIES ONLY)
WHO 4th Ed Tumors of Lung has proposed code 8551/3 for acinar adenocarcinomas of lung rather than use the existing code 8550/3 which is also acinar adenocarcinoma
Specific criteria are needed for diagnosis of acinar in lung primaries
Cases diagnosed prior to 1/1/2018 use code 8550/3

39. New Terms: Examples
8461/3 High-grade serous carcinoma (C56.9, C48. _, C57.0, C57.1-C57.3)
Pathology diagnosis must state “high-grade serous carcinoma”
8830/3 Undifferentiated HIGH-GRADE pleomorphic sarcoma
Difference between 8802/3 (pleomorphic cell sarcoma) and 8830/3 is terminology. Diagnosis must state high-grade to code 8830/3

40. New Terms: Examples 8933/3 Mullerian adenosarcoma (C54. _)
Mullerian adenosarcoma is not the same histology as Mixed Mullerian Tumor (8950/3)
8933/3 applies to adenosarcoma and Mullerian adenosarcoma
Issue: carcinosarcoma (8980/3) and malignant mixed Mullerian tumor (MMMT)(8950/3)
WHO 4th Ed GYN now includes MMMT as synonym for carcinosarcoma
8950/3 no longer included in WHO 4th Ed
Path diagnosis often stated as carcinosarcoma (malignant mixed Mullerian Tumor).
Per SME, when stated this way code carcinosarcoma (8980/3). If diagnosis is MMMT, code 8950/3

41. What’s Next

42. Documentation Addendum format Vendor format
Combine new codes, behavior changes, and new terms into one table
Word pdf in both numeric and alpha
Vendor format
Excel file
Statistical reporting tools

43. Documentation Develop user’s guide to accompany table
Develop accompanying document with ICD-O-3 Work Group, project background and rationale

44. Quality Assurance & Edits
Update SEER Site/Histology validation list
Determine if new edits should be created to assure correct site and histology coding
Determine if existing edits can be updated to assure correct site and histology coding

45. Dissemination Notify and disseminate ICD-O-3.1 update/addendum
NAACCR list serve
NCRA
NPCR
State Tumor Registrar Associations
Education

46. Important Reminders You should be using ICD-O-3 First Revision!!!!
Sign-up for notifications and updates on at least on of the standard setter’s list serves
Check the ICD-O addendum BEFORE using the Solid Tumor rules (MP/H)

47. NAACCR ICD-O-3 Implementation Work Group
Lois Dickie, NCI/SEER Chair
Lorette Bowers, Canada
Lynda Douglas, CDC
April Fritz
Ann Griffin, UCSF
Donna Gress, AJCC
Jim Hofferkamp, NAACCR
Annette Hurlbut, Elekta
Tiffany Janes, Seattle SEER
Mary Lewis, CDC
Gail Noonan, Canada
Susana Perez, Texas
Steven Peace, Florida
Lynn Ries
Winny Roshala, Greater California
Melissa Scott, Canada
Kathleen Thoburn, CoC

48. Questions Comments

49. Thank you!