SEER EOD and Summary Stage

SEER EOD and Summary Stage
KCR 2018 Spring Training

Overview What is SEER EOD Ambiguous Terminology General Guidelines
EOD Primary Tumor EOD Regional Nodes EOD Mets SEER Summary Stage 2018 Site Specific Data Items (SSDI)

What is SEER EOD? Effective for cases diagnosed 1/1/2018 and forward (Don’t use for cases before 1/1/2018) Applies to every site/histology combination, including leukemias and lymphomas Consists of: EOD Primary Tumor EOD Regional Nodes EOD Mets EOD uses all information available in the medical record EOD uses all information available in the medical record; in other words, it is a combination of the most precise clinical and pathological documentation of the extent of disease.

Ambiguous terminology
If you can’t find definitive statement of involvement use the SEER EOD Ambiguous Terminology List to interpret and determine the appropriate assignment of EOD Primary Tumor, EOD Regional Nodes or EOD Mets *IMPORTANT NOTES* Terminology in the schema takes priority over this list Use this list only for EOD 2018 or Summary Stage 2018 This is not the same list used for determining reportability as published in the SEER Manual, Hematopoietic Manual, or in Section 1 of the Standards for Oncology Registry Entry (STORE) Note 1: Terminology in the schema takes priority over this list. Some schemas interpret certain words as involvement; such as ‘encasing’ the carotid artery for a head and neck site or “abutment,” “encases,” or “encasement” for pancreas primaries. Note 3: This is not the same list used for determining reportability as published in the SEER manual, Hematopoietic Manual or in Section 1 of the Standards for Oncology Registry Entry (STORE). This is not the same list of ambiguous terminology provided in the Solid Tumors Rules published and maintained by the SEER Program.

EOD General guidelines
Be sure to check site-specific EOD 2018 schemas for exceptions and/or additional information EOD schemas apply to ALL primary sites and specified histologies. Most schemas are based on primary site, while some are based on histology alone For ALL sites, EOD is based on a combined clinical and operative/pathological assessment. Gross observations at surgery are particularly important when all malignant tissue cannot be, or was not removed In the event of a discrepancy between pathology and operative reports concerning excised tissue, priority is given to the pathology report

EOD General Guidelines Continued
EOD should include all information available within four months of diagnosis in the absence of disease progression or upon completion of surgery(ies) in first course of treatment, whichever is longer Clinical information, such as description of skin involvement for breast cancer and distant lymph nodes for any site, can change the EOD stage. Be sure to review the clinical information carefully to accurately determine the extent of disease If the operative/pathology information disproves the clinical information, use the operative/pathology information Information for EOD from a surgical resection after neoadjuvant treatment may be used, but ONLY if the extent of disease is greater than the pre-treatment clinical findings

Disease progression, including metastatic involvement, known to have developed after the initial stage workup, should be excluded when coding the EOD fields Autopsy reports are used in coding EOD just as are pathology reports, applying the same rules for inclusion and exclusion Death Certificate only (DCO) cases Code the following for DCO’s, unless more specific codes can be assigned. EOD Primary Tumor: 999 EOD Regional Nodes: 999 EOD Mets: 99

T, N, M information may be used to code EOD 2018 when it is the only information available Use the medical record documentation to assign EOD when there is a discrepancy between the T, N, M information and the documentation in the medical record. If you have access to the physician, please query to resolve the discrepancy When there is doubt that documentation in the medical record is complete, code the EOD corresponding to the physician staging EOD Schema-specific guidelines take precedence over general guidelines. Always read the information pertaining to a specific primary site or histology schema 10. Use the medical record documentation to assign EOD when there is a discrepancy between the T, N, M information and the documentation in the medical record. If you have access to the physician, please query to resolve the discrepancy. a. When there is doubt that documentation in the medical record is complete, code the EOD corresponding to the physician staging. Example: Patient diagnosed at community hospital with limited workup. Staging note from medical oncologist suggesting missing results from further outside test.

EOD Primary Tumor Used to classify contiguous growth of the primary tumor with the organ of origin or direct extension into neighboring organs Used to derive EOD 2018 T and Derived Summary Stage 2018 at the central registry Code Description 000 In situ, intraepithelial, noninvasive, non-infiltrating SCHEMA-SPECIFIC CODES WHERE NEEDED 800 No evidence of primary tumor 999 Unknown; extension not stated Primary tumor cannot be assessed Not documented in patient record Death Certificate Only

EOD Primary Tumor Coding Instructions Hints
Assign the farthest documented contiguous extension of the primary tumor Localized is only used when you can’t find any other information Use the highest applicable code, but you also have to use the priority order: Pathology report Imaging Physical Exam Code the farthest documented contiguous direct extension of tumor away from the primary site. If an involved organ or tissue is not specifically mentioned in the code descriptions, approximate the location from listed structures in the same anatomic area and assign the appropriate code based on that information. EOD Primary Tumor codes are hierarchical with the exception of code 800. “NOS” codes should be used only after an exhaustive search for more specific information. 3. Use highest applicable code: Assign the highest applicable code for direct extension of primary tumor at diagnosis, whether the determination was clinical or pathological. Use the following priority order: a. Pathology report b. Imaging - If extension is determined positive based on imaging and then confirmed to be negative on pathological exam, code EOD Primary Tumor based on the pathological findings Physical exam - If extension is determined positive based on physical exam and then confirmed to be negative on pathological exam, code EOD Primary Tumor based on the pathological findings 4.

EOD Primary Tumor Coding Instructions Hints
If the patient receives neoadjuvant (preoperative) systemic therapy (chemotherapy, immunotherapy) or radiation therapy, code the clinical information if that is the farthest extension documented. If the post-neoadjuvant surgery shows more extensive disease, code the extension based on the post-neoadjuvant information In situ tumors with nodal or metastatic involvement Multiple tumors – code the furthest extension Occult Primary – Code 800 Some sites have additional information needed to be coded for EOD – For example prostate gets EOD Primary Tumor and Prostate Path Extension 5. In situ tumors: An in situ diagnosis can only be made microscopically, because a pathologist must identify the basement membrane and determine that it has not been penetrated. If the basement membrane has been disrupted (in other words, the pathologist describes the tumor as microinvasive, microinvasion), the case is no longer in situ. Assign code 000 for in situ tumors. Exception: For some schemas, e.g., Breast, there may be multiple categories of in situ codes. Use schema-specific instructions and codes 6. In situ tumors with nodal or metastatic involvement: In the event of an in situ tumor with nodal or metastatic involvement, assign EOD Primary Tumor as in situ and code the EOD Regional Nodes and/or EOD Mets appropriately. This is a change from previous versions of EOD and Summary Stage. 7. When multiple tumors are reported as a single primary, code the furthest direct extension from any tumor. 8. Discontinuous or distant metastases: Discontinuous/discontiguous metastases are usually coded in the EOD Mets field. Some exceptions include: mucinous carcinoma of the appendix, corpus uteri, ovary, fallopian tube and female peritoneum, where discontinuous metastases in the pelvis or abdomen are coded in EOD Primary Tumor. For some schemas, e.g., Breast, Lung, and Kidney, direct (contiguous) extension to certain specific sites is listed under EOD Mets. If the structure involved by direct extension is not listed in EOD Primary Tumor categories, look for it in EOD Mets. If the specific structure involved by direct extension is not listed in either data item, assign the highest known contiguous extension code in EOD Primary Tumor. 9. Code 800 when there is no evidence of the primary tumor (occult primary). This field and Prostate Pathological Extension, must both be coded, whether or not a prostatectomy was performed. Information from prostatectomy and autopsy is excluded from this field and coded only in Prostate Pathological Extension

EOD Regional Nodes Used to classify regional lymph nodes involved with cancer at the time of diagnosis Used to derive EOD 2018 N and Derived Summary Stage 2018 at the central registry Code Description 000 No regional lymph node involvement SCHEMA-SPECIFIC CODES WHERE NEEDED 800 Regional lymph node(s), NOS Lymph node(s), NOS 888 Use for these sites only: Brain; CNS Other; HemeRetic; Ill-Defined Other (includes unknown primary site); Intracranial Gland; Lymphoma; Lymphoma-CLL/SLL, Plasma Cell Myeloma 999 Unknown; regional lymph node(s) not stated Regional lymph node(s) cannot be assessed Not documented in patient record Death Certificate Only

EOD Regional Nodes Coding Instruction Hints
Record the specific involved regional lymph node chain(s) farthest from the primary site If not possible to determine if a lymph node is regional or distant, check the scheme for a site that is nearby Use the highest applicable code, but you also have to use the priority order: Pathology report Imaging Physical Exam 1. Record the specific involved regional lymph node chain(s) farthest from the primary site. Regional lymph nodes are listed for each schema. EOD Regional Nodes are hierarchical, with the exception of code 800. a. Generally, the regional lymph nodes in the chain(s) closest to the primary site have lower codes, while nodes farther away from the primary or in farther lymph node chains have higher codes, although there are exceptions due to lymph drainage patterns. b. If a lymph node chain is not listed, check the abstractor notes in SEER*RSA, Appendix C of the Hematopoietic Manual, an anatomy textbook, ICD-O-3, or a medical dictionary for a synonym. If the lymph node chain or its synonym are not listed in regional lymph nodes, code the involved node(s) in EOD Mets. i. Tip for coding lymph nodes: If not possible to determine if a lymph node is regional or distant, check the scheme for a site that is nearby. Example: If unable to determine if a listed regional node for esophagus is regional or distant, check the stomach EOD regional nodes. If the lymph node chain is listed as regional for stomach, assume the named lymph node is not an obscure name for a lymph node chain and that it is probably distant for the esophagus. 2. Use highest applicable code: Assign the highest applicable code for involvement of lymph nodes at diagnosis, whether the determination was clinical or pathological. Use the following priority order when determining lymph node involvement. If there is a discrepancy between clinical information and pathologic information about the same lymph nodes, pathologic information takes precedence if no preoperative treatment was administered. It is not necessary to biopsy every lymph node in the suspicious area to disprove involvement. Use the following priority order: a. Pathology report b. Imaging - If nodes are determined positive based on imaging and then confirmed to be negative on pathological exam, code EOD Regional Nodes 000 based on the negative pathological findings. c. Physical exam - If nodes are determined positive based on physical exam and then confirmed to be negative on pathological exam, code EOD Regional Nodes 000 based on the negative pathological findings. Exception: Assign code 800, “Regional lymph node(s), NOS or Lymph node(s), NOS” only when there is lymph node involvement, but no available information regarding the specific node(s) involved.

If the patient receives neoadjuvant (preoperative) systemic therapy (chemotherapy, immunotherapy) or radiation therapy, code the clinical information if that is the most extensive lymph node involvement documented. If the post-neoadjuvant surgery shows more extensive lymph node involvement, code the regional nodes based on the post-neoadjuvant information. Terms, such as “palpable,” “enlarged,” “visible swelling,” “shotty,” or “lymphadenopathy” should be ignored for solid tumors, unless there is a statement of involvement by the clinician or the patient was treated as though regional nodes were involved For solid tumors, the terms “fixed” or “matted” and “mass in the hilum, mediastinum, retroperitoneum, and/or mesentery” (with no specific information as to tissue involved) are recorded as involvement of lymph nodes Example: Palpable axillary lymph nodes found, consistent with mets. Record as involvement of lymph nodes Example: Enlarged renal hilar nodes found on CT, positive for cancer. Record as involvement of lymph nodes

Accessible and Inaccessible lymph nodes Code EOD Regional Nodes 000 (negative) instead of 999 (unknown) when ALL three of the following conditions are met: There is no mention of regional lymph node involvement in the physical examination, pre-treatment diagnostic testing, or surgical exploration. The patient has localized disease The patient receives what would be the standard treatment to the primary site (treatment appropriate to the stage of disease as determined by the physician), or patient is offered usual treatment but refuses it Assign code 999 when there is reasonable doubt that the tumor is localized Accessible lymph nodes: For “accessible” lymph nodes that can be observed, palpated, or examined without instruments, such as the regional nodes for the breast, oral cavity, salivary gland, skin, thyroid, and other organs, look for some description of the regional lymph nodes. A statement such as “remainder of examination negative” is sufficient to code 000 negative regional lymph nodes. Note: If there is mention of a clinical evaluation but no mention of positive lymph nodes, assign code 000. Inaccessible lymph nodes: For certain primary sites, regional lymph nodes are not easily examined by palpation, observation, physical examination, or other clinical methods. These are lymph nodes within body cavities that in most situations cannot be palpated, making them inaccessible. Bladder, colon, corpus uteri, esophagus, kidney, liver, lung, ovary, prostate, and stomach are examples of inaccessible sites (this is not an all-inclusive list). When EOD Primary Tumor is low stage/Localized and standard treatment is done, it is sufficient to code 000 for negative regional lymph nodes. Example: When there is evidence that a prostate cancer has penetrated through the capsule into the surrounding tissues (regional disease) and regional lymph node involvement is not mentioned, it would be correct to code 999 for unknown lymph node involvement in the absence of any specific information regarding regional nodes.

In situ tumors with metastatic nodal involvement If direct extension of the primary tumor into a regional lymph node is shown, code the involved node(s) in EOD Regional Nodes For some schemas, ITCs are counted as positive regional nodes, while other schemas count them as negative Discontinuous (satellite) tumor deposits (peritumoral nodules) for colon, appendix, rectosigmoid and rectum - If there are Tumor Deposits and node involvement, code only the information on node involvement in this field In the event of an in situ tumor with metastatic nodal involvement, assign EOD Primary Tumor as in situ (code 000) and code EOD Regional Nodes appropriately (positive). This is a change from prior versions of EOD a. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a primary tumor. b. If it contains metastatic tumor, this indicates that other lymph nodes may contain tumor. If it does not contain metastatic tumor, other lymph nodes are not likely to contain tumor. Occasionally there is more than one sentinel lymph node 13. Discontinuous (satellite) tumor deposits (peritumoral nodules) for colon, appendix, rectosigmoid and rectum: These can occur WITH or WITHOUT regional lymph node involvement. Assign the appropriate code according to guidelines in individual schemas. Tumor nodules in pericolic or perirectal fat without evidence of residual lymph node structures can be one of several aspects of the primary cancer: discontinuous spread, venous invasion with extravascular spread, or a totally replaced lymph node. If there are Tumor Deposits and node involvement, code only the information on node involvement in this field.

Use code 800 for the following situations: Lymph node assignment for the EOD schema is based on location (specifically listed lymph nodes) and the only documentation available is that lymph nodes are involved. Lymph node assignment for the EOD is based on number and/or size and the only documentation available is that lymph nodes are involved. Unidentified nodes included with the resected primary site. Nodes may be identified in the operative or pathology report (including the final diagnosis), microscopic or gross description. Lymph nodes which are not specified as regional or distant should be assumed to be regional nodes.

EOD Mets Used to classify the distant site(s) of metastatic involvement at time of diagnosis Used to derive EOD 2018 M and Derived Summary Stage 2018 at the central registry Code Description 00 No distant metastasis Unknown if distant metastasis None SCHEMA-SPECIFIC CODES WHERE NEEDED 70 Distant metastasis, NOS 88 Use for these sites only: HemeRetic; Ill-Defined Other (includes unknown primary site); Kaposi Sarcoma; Lymphoma; Lymphoma-CLL/SLL; Plasma Cell Myeloma, Plasmacytomas 99 Death certificate only (DCO)

EOD Mets Coding Instruction Hints
Determination of EOD Mets requires only history and physical examination A few schemas may include direct extension of the primary tumor into distant organs or tissues If the patient receives neoadjuvant (preoperative) systemic therapy (chemotherapy, immunotherapy) or radiation therapy, code the clinical information description that identifies the most extensive metastasis If the post-neoadjuvant surgery shows additional or more extensive metastasis, code EOD Mets based on the post-neoadjuvant information Use the highest applicable code, but you also have to use the priority order: Pathology report Imaging Physical Exam Imaging of distant organs is not required. In other words, when a case lacks any extensive workup, the registrar can infer that there are no distant metastases based solely on physical exam documentation. a. Assign 00 for cases in which there are no distant metastases as determined by clinical, radiographic and/or pathologic methods. b. A case is classified as clinically free of metastases (code 00) unless there is documented evidence of metastasis by clinical means or by cytological/pathological examination of a metastatic site. For the following scenarios, code 00 can be used: i. No information is available (no PE, imaging or pathology) ii. There is reasonable doubt that the tumor is no longer localized and there is no documentation of distant metastasis c. Assign the appropriate EOD Mets codes for cases in which one or more distant metastases is identified by clinical, radiographic and/or pathologic methods. EOD Mets codes are hierarchical with the exception of code 70. For a few schemas, such as Breast, Lung, Kidney, and Ovary, the EOD Mets category may include direct extension of the primary tumor into distant organs or tissues. If the structure involved by direct extension is not listed in EOD Primary Tumor, look for the structure in EOD Mets. If the specific structure involved by contiguous extension is not listed in either EOD Primary Tumor or EOD Mets, assign the highest available code in EOD Primary Tumor.

Eod mets coding instruction hints
Isolated Tumor Cells (ITCs), Circulating Tumor Cells (CTCs), and Disseminated Tumor Cells (DTCs) In situ tumors with metastatic involvement Small clusters of tumor cells not greater than 0.2 mm in largest dimension found in distant sites such as bone, circulating blood, or bone marrow and having uncertain prognostic significance. a. For breast, code 05 when a biopsy of a distant site shows ITCs, CTCs or DTCs detected by IHC or molecular techniques. b. For other sites, CTCs, DTCs, and ITCs are coded 00 In the event of an in situ tumor with metastatic involvement, assign EOD Primary Tumor as in situ (code 000) and code EOD Mets appropriately (positive). This is a change from prior versions of EOD

Summary Stage 2018

Summary Stage 2018 Uses all the information in the medical record
*Applicable for the following SS2018 chapters: Brain, CNS Other, Intracranial Gland Code Definition In situ 1 Localized only 2 Regional by direct extension only 3 Regional lymph nodes only 4 Regional by BOTH direct extension AND lymph node involvement 7 Distant site(s)/node(s) involved 8 Benign/borderline* 9 Unknown if extension or metastasis (unstaged, unknown, or unspecified) Death certificate only case It is a combination of the most precise clinical and pathological documentation of the extent of disease. In addition, the main category of Regional stage is subcategorized by the method of spread. *Applicable for the following SS2018 chapters: Brain, CNS Other, Intracranial Gland

Summary Stage 2018 Coding Instruction Hints
In situ diagnosis can only be made microscopically Beginning with Summary Stage 2018 there is no Code 5 for Regional, NOS Regional lymph nodes are listed for each chapter/site If a lymph node chain is not listed in code 3, then the following resources can be used to help identify regional lymph nodes Appendix C of the Hematopoietic Manual Anatomy textbook ICD-O-3 manual Medical dictionary (synonym) Note: If the pathology report indicates an in situ tumor but there is evidence of positive lymph nodes or distant metastases, code to the regional nodes/distant metastases. Make sure to check the instructions for chapters in which code isn’t applicable for those chapters If any of these reports provides evidence that the cancer has spread beyond the boundaries of the organ of origin, the case is not localized. If the pathology report, operative report and other investigations show no evidence of spread, the tumor may be assumed to be localized.

Summary Stage 2018 Coding Instruction Hints
Read the pathology and operative report(s) for comments on gross evidence of spread, microscopic extension and metastases, as well as physical exam and diagnostic imaging reports for mention of regional or distant disease Pathologic information takes precedence It is not necessary to biopsy every lymph node in the suspicious area to disprove involvement Use the highest applicable code, but you also have to use the priority order: Pathology report Imaging Physical Exam If no preoperative treatment was administered and there is a discrepancy between clinical information and pathological information about the same lymph nodes, pathological information takes precedence. It is not necessary to biopsy every lymph node in the suspicious area to disprove involvement. Use the following priority order: Pathology report Imaging If nodes are determined positive based on imaging and then confirmed to be negative on pathological exam, treat the regional nodes as negative when assigning Summary Stage Physical exam If nodes are determined positive based on physical exam and then confirmed to be negative on pathological exam, treat the regional nodes as negative when assigning Summary Stage

Site Specific Data Items

SSDIs Go into effect for cases diagnosed 01/01/2018 and forward
SSF/SSDIs are based on the year of diagnosis, not when the case is abstracted Example: 2017 case abstracted in 2018 Code the applicable/required SSFs, not the SSDIs Schemas are based on primary site, histology and schema discriminator (when applicable) Each Schema tells: Which SSDIs to use What Grade ID to utilize What AJCC 8th Edition chapter to utilize What EOD Schema to utilize What Summary Stage Chapter to utilize Can’t code SSDIs for cases before 2018 Each Site-Specific Data Item (SSDI) applies only to selected schemas. SSDI fields should be blank for schemas where they do not apply. “Site” in this instance is based on the primary site, the AJCC chapter, the EOD schema, or the Summary Stage schema a schema ID with “No AJCC chapter.” For this schema ID, the primary site is not covered in AJCC. There are several schemas like this, most of which you should recognize from CS. You will also notice that there are no SSDIs for this schema.

Changes with SSDIs Data Items can include decimal points if applicable
Data Items have different lengths Data Items can include decimal points if applicable Different coding conventions used to document Recording of actual values, percentages, ranges Recording different definitions of unknown “Test not done” and “Unknown if test done” combined Code reads “X not assessed or unknown if assessed” The general changes include: data items are different lengths. There will no longer be a standard 3 digit data item. For some data items, mostly lab values, decimals will be part of the code. Also, depending on the data item, different coding conventions may be used to record actual values, percentages and ranges. And there will be some changes to coding unknown. Examples of these will be provided further in the presentation. One major change was combining the codes for test not done and unknown if done. The introduction of these two separate codes in CSv2 caused a lot of confusion amongst registrars and SSDI felt that the distinction between the two was not enough to continue with the separate codes.

SSDI Manual Includes: Basic information about data item: Item Length
Based primarily on CS Part I, Section II Includes: Basic information about data item: Item Length NAACCR Item # NAACCR Alternate Name (when applicable) AJCC 8th edition chapter(s) Description Rationale The draft was based on CS Part I, Section II, which had information about all the SSFs in addition to the coding instructions, codes and code descriptions found for each of the SSFs.

So here is a screenshot from the SSDI manual of these features listed on the previous slide.
The beginning of each SSDI has this same information. The description and rationale were developed for NAACCR Volume II and were included here as well. The description provides information about the data item, while the rationale provides the reason it is being collected. For a majority of the SSDIs, the rationale for collecting the data item is based on the relevant AJCC chapter

Schema Discriminators
Used when primary site and/or histology are not enough to get to the appropriate schema Schema discriminators for 2018 Schema discriminator 1 Schema discriminator 2 Schema discriminator 3 (none for 2018) Due to the complexity of some of the 8th edition chapters, additional schema discriminators have also been added. There are now three data items for schema discriminators since some chapters require more than 1 schema discriminator. Most of the chapters that require a schema discriminator only need one. I would use the EGJ/stomach discriminator and compare it to SSF 25. At the beginning of the SSDI manual, you’ll find the 3 Schema discriminators listed, along with the description and rationale.

New Schema Discriminators for 2018
AJCC 8th Edition Chapter Purpose Occult Head and Neck Lymph Nodes 6 (New) Used to distinguish an unknown head and neck tumor that has positive regional nodes Oropharyngeal p16 10, 11 Used to distinguish between oropharyngeal p16+ tumors and p16- tumors Histology Discriminator for 8020/3 16 Histology code 8020/3 (undifferentiated carcinoma): Squamous vs glandular (adenocarcinoma) (see AJCC 8th edition, page 186) Discriminator not used for any other histology Here are the new Schema discriminators. The Occult Head and Neck Lymph nodes discriminator is used when there is a unknown primary with positive cervical lymph nodes and the suspected primary is in the head and neck. The oropharyngeal p16 discriminator distinguishes between p16+ and p16- Oropharyngeal tumors. Histology discriminator for Esophagus determines the appropriate staging table to use. This discriminator does not apply to any other histology, so if you enter 8140 as the histology, this schema discriminator will not appear.

New Schema Discriminators for 2018
AJCC 8th Edition Chapter Purpose Urethra/Prostatic Urethra 63 (New) Used to distinguish between urethra (male and female) and prostatic urethra, both coded to primary site C680 Thyroid Gland/Thyroglossal Duct 73, 74 Used to distinguish between thyroid and thyroglossal duct, both coded to primary site C739 Note: Thyroglossal duct tumors are not eligible for AJCC 8th edition stage Histology discriminator for 9591/3 79, 80, 83 Used to distinguish between different alternate terms for 9591/3. (Alternate names also included in the Hematopoietic database) Urethra now has a schema discriminator because there are different T tables for Urethra (male and female) and prostatic urethra, both of which are coded to primary site C68.0. For Thyroid, the thyroglossal duct is not staged. Thyroglossal duct tumors are rare

SSDIs required for Staging
Some schemas have SSDIs that are required for staging List can be found in the SSDI Manual under SSDIs required for Stage Other schemas have additional SSDIs that are needed for derivation of EOD Stage Group at the Central Registry List can be found in the SSDI Manual under SSDIs used for EOD Derived Stage Group list of SSDIs that are required in addition to T, N, or M to derive a Stage group. the additional SSDIs will also be required to derive components of EOD

PSA Length of data item dependent on highest value recommended by AJCC 8th edition Examples: PSA of 3.5 Enter 3.5 PSA of 12.2 Enter 12.2 PSA 125 Enter 125.0 PSA Unknown Enter XXX.9 Code Description 0.1 0.1 or less nanograms/milliliter (ng/ml) (Exact value to nearest tenth of ng/ml) 0.2 – ng/ml (Exact value to nearest tenth of ng/ml) XXX.1 1,000 ng/ml or greater XXX.7 Test ordered, results not in chart XXX.9 Not documented in medical record PSA lab value not assessed or unknown if assessed Here is the new PSA lab value data item. For PSA, the highest recorded value can go up to 999.9, with 1,000 or greater being coded as XXX.1 Pay close attention to the values that have the X’s. The number of X’s required will depend on the length of the data item. Although leading zeroes are not required for the actual values, the leading X’s are.

Melanoma Breslow Tumor Thickness
Code Description 0.0 No mass/tumor found 0.1 Greater than 0.0 and less than or equal to 0.1 0.2 – 99.9 millimeters XX.1 100 millimeters or larger A0.1-A9.9 Stated as “at least” some measured value of 0.1 to 9.9 AX.0 Stated as greater than 9.9 mm XX.8 Not applicable: Information not collected for this schema (If this item is required by your standard setter, use of code XX.8 will result in an edit error) XX.9 Not documented in medical record Microinvasion; microscopic focus or foci only and no depth given Cannot be determined by pathologist In situ melanoma Breslow Tumor Thickness not assessed or unknown if assessed Examples: 0.4 mm Enter 0.4 2.56 mm Enter 2.6 11 mm Enter 11.0 At least 2.0 mm Enter A2.0 Greater than 4 mm Enter XX.9 If the pathologist states “greater than” instead of “at least”, code to XX.9, unless it is greater than 9.9 mm (Code AX.0)

Perineural Invasion Code Description
Perineural invasion not identified/not present 1 Perineural invasion identified/present 8 Not applicable: Information not collected for this case (If this information is required by your standard setter, use of code 8 may result in an edit error.) 9 Not documented in medical record Pathology report does not mention perineural invasion Cannot be determined by the pathologist Perineural invasion not assessed or unknown if assessed The biggest change to this data item is going to 1 digit long, instead of the standard 3 digits from CS. In this data item, you will see in code 9, “Cannot be determined.” This is based on the CAP protocol. Sometimes a physician will indicate cannot be determined because the specimen is not adequate to determine the level of perineural invasion. It should only be used when this selection is noted on the CAP protocol/pathology report. Another big change is when perineural invasion is not mentioned. In CS, if there was no mention of perineural invasion, you could code not present. There are several data items that are like this. Another example of this is Tumor Deposits for Colon and Rectum. Prior to 2018 if pathology report was available and there was no mention of tumor deposits, the registrar could assume there were no tumor deposits and code none. For the SSDI, this assumption cannot be made. There must be a statement that there are no tumor deposits to code 00. Note: If there is no mention of perineural invasion, must code 9. In CS, if there was no mention of perineural invasion, none could be coded. This applies to several data items and is noted in the SSDI manual

SEER EOD and Summary Stage Case Examples

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