[Jim Hofferkamp]

You are correct. The current version of the edit forces a stage group other than 99 if the peripheral blood involvement is unknown.

For example cT1 cN0 cM0 must be a stage 1A even if peripheral blood involvement is unknown.

The edit is being updated to force a stage group of 99 if peripheral blood involvement is unknown. The exception would be if the patient had an N3 and or M1.

You may want to recommend to the registrar that they hold the case until the next metafile is released.

[Jim Hofferkamp]

I’m going to add this to the agenda for the next Stage Edits WG call. Let me know if you can think of a work around.

[Jim Hofferkamp]

I just checked and there is a more current of CRS than 3.15.0 that was released in February. The most current version of CRS is necessary to run v16E. I think that is why you are not seeing the cNO listed as a value for the pN data item for GIST.

[Jim Hofferkamp]

A few reasons i can think of that may explain some of the differences.

1. Reporting from surgery centers. If a patient has a colonoscopy with polypectomy and is found to have a low grade in situ tumor, they may not receive any additional treatment. A more invasive tumor would probably be treated with resection. If the central registry doesn’t have good reporting from surgery centers, their in situ cases may be down.
2. High grade dysplasia is a big issue among pathologist. Some pathologist consider high grade dysplasia to be carcinoma in situ and others do not. Each facility is responsible for determining when or if a high grade dysplasia should be abstracted as carcinoma in situ. If some of the larger facilities are reporting some or all of their high grade dysplasia cases as carcinoma in situ, it could impact rates.
3. A less likely explanation might be the AJCC definition of Tis for colon. A Tis for colon includes tumors that invade the lamina propria. They do this because these patients should be treated like in situ cases (not like T1 patients). Even though the T value is Tis, these cases should have a behavior of /3 and summary stage of 1-localized. However, some registrars see that AJCC calls these Tis and assume the behavior should match.

[Jim Hofferkamp]

Hi Ardis,
This is situation where SEER and NPCR/CoC are asking for different things. I think you probably want the NPCR version of this edit in your state edit set Primary Site, Stage Group 2016 – Ed 7 (NPCR).

The NPCR and COC stage edits only allow 88 for stage group for ocular adnexal lymphoma. SEER requires that this be staged as a lymphoma, allows 1, 1A,1B,2,2A,2B,3,3A,3B,4,4A,4B,99 for stage group.

[Jim Hofferkamp]

This is a tricky one.The edit in question is TNM Path N, Reg Nodes Pos – Ed 7 (COC). But before we get into the edit logic I need to confirm that the coding logic is correct.
Scenario:
2/5/16 Patient diagnosed C508, 8520/32.
2/15/16 Right mastectomy with SLN excision, 3/3 lymph nodes positive.
3/16 to 6/16 Chemotherapy
7/20/16 Completion of right axillary node dissection, 2/12 lymph nodes positive.

My question is whether the right axillary node dissection completed after chemotherapy should be counted in regional nodes positive/Examined. I pulled the rule below from the CS rules for regional nodes positive.

4. Cumulative nodes positive. Record the total number of regional lymph nodes removed and found to be positive by pathologic examination.
a. The number of regional lymph nodes positive is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment.

I’d really like to hear back from some of the forum members on how they interpret the coding rule and if they have a suggestion for the edit.

[Jim Hofferkamp]

NPCR has posted the TNM.dll at https://www.cdc.gov/cancer/npcr/tools/tnmstaging/

Below is a summary of the changes.

CDC has created software in the form of a dynamic link library (DLL) and application programming interface (API) to help cancer registries collect data on stage of disease for cancers according to the TNM system of the American Joint Committee on Cancer (AJCC). A revised API was released on June 2, 2017. The changes from the February 2017 release are—
• Additional clinical N values added to TNM Path N [NAACCR item 890] for the following schemas—
o All GISTschemas
o Corpus Uteri Carcinomas
o Bone
o Melanoma of Skin
o Soft Tissue Sarcoma
• Prostate—Derivation algorithm for NPCR Derived Path Stg Grp [NAACCR item number 3655] was revised to use the higher of the Gleason scores coded in SSF8 and SSF10.
• Derivation algorithm for NPCR Derived Clin Stg Grp [NAACCR Item Number 3650] modified to derive stage in situ for Tis N0 M0 regardless of grade code for the following schemas—
o Esophagus Squamous Cell Carcinoma
o Esophagus Adenocarcinoma
o Esophagogastric Junction Squamous Cell Carcinoma
o Esophagogastric Junction Adenocarcinoma

Content from AJCC’s Cancer Staging Manual, 7th edition, has been licensed for use in the application programming interface (API) by NPCR registries. A version without the licensed content can be downloaded from https://www.cdc.gov/cancer/npcr/tools/tnmstaging/ .

For access to the licensed version, or for more information, contact Joseph Rogers, [email protected].
.

[Jim Hofferkamp]

NPCR has posted the TNM.dll at https://www.cdc.gov/cancer/npcr/tools/tnmstaging/

Below is a summary of the changes.

CDC has created software in the form of a dynamic link library (DLL) and application programming interface (API) to help cancer registries collect data on stage of disease for cancers according to the TNM system of the American Joint Committee on Cancer (AJCC). A revised API was released on June 2, 2017. The changes from the February 2017 release are—
• Additional clinical N values added to TNM Path N [NAACCR item 890] for the following schemas—
o All GISTschemas
o Corpus Uteri Carcinomas
o Bone
o Melanoma of Skin
o Soft Tissue Sarcoma
• Prostate—Derivation algorithm for NPCR Derived Path Stg Grp [NAACCR item number 3655] was revised to use the higher of the Gleason scores coded in SSF8 and SSF10.
• Derivation algorithm for NPCR Derived Clin Stg Grp [NAACCR Item Number 3650] modified to derive stage in situ for Tis N0 M0 regardless of grade code for the following schemas—
o Esophagus Squamous Cell Carcinoma
o Esophagus Adenocarcinoma
o Esophagogastric Junction Squamous Cell Carcinoma
o Esophagogastric Junction Adenocarcinoma

Content from AJCC’s Cancer Staging Manual, 7th edition, has been licensed for use in the application programming interface (API) by NPCR registries. A version without the licensed content can be downloaded from https://www.cdc.gov/cancer/npcr/tools/tnmstaging/ .

For access to the licensed version, or for more information, contact Joseph Rogers, [email protected].
.

[Jim Hofferkamp]

The v16E metafile is posted to the NAACCR Website. I will be sending out listserv announcement later today.

I know i said this last time, but I really think this will be the last update prior to the release of v18.

NPCR will be releasing an update to the TNM.dll to go along with the updated metafile. The TNM.dll update should be posted later this week. You can find a link to the TNM.dll on the edit webpage.

https://www.naaccr.org/standard-data-edits/

[Jim Hofferkamp]

We are making a few last minute tweeks to the v16e metafile. I’m hoping to have those complete today or tomorrow. We are also trying to coordinate the release of v16e metafile with an update of the TNM.dll that will be released by NPCR. I was hoping we could get them posted this week, but it may be Tuesday or Wednesday of next week.

[Jim Hofferkamp]

Ardis,
This is an issue that will be correct in the v16E metafile that will probably be posted next week. I’ll be sending out additional information about the new metafile later in the week.

The problem is we only collect the highest grade so if the clinical pre treatment grade is lower than the post surgery grade and grade is part of TNM stage, the edit was failing. Below is a description of the changes we made to the edit to accommodate this situation. It’s not ideal, but seems to be the best option at this time. Essentially, the edit now allows any grade for clinical stage.

Description, edit logic modified to validate stage for sites using grade as staging parameter when grade is higher than allowed for assigned stage. This change was made to allow correct staging when a grade for pathologic staging would be higher than the grade for clinical staging. There is only one grade field collected, the higher grade by registry coding guidelines, and the edit was enforcing the recorded grade in clinical stage evaluation. The sites using grade as a staging component include Appendix-Carcinoma, Esophagus/Esophagus GE Junction, Bone, Soft Tissue Sarcoma, and GIST (mitotic rate). Soft Tissue Sarcoma is not edited because of other grade concerns.

[Jim Hofferkamp]

Hi Tiffany,
I think the edit is correct. Per the CAnswer forum post below, lymph nodes still need to be removed to meet the rules for classification for pN2c.

http://cancerbulletin.facs.org/forums/forum/ajcc-tnm-staging/skin-chapters-29-31/68244-staging-for-intransit-mets-when-no-lns-were-removed

[Jim Hofferkamp]

Thank you for sending this in. Someone else sent a similiar question just before we released v16d. We confirmed with AJCC that for a primary peritoneum such as the example above, the lowest T value is T3.

See http://cancerbulletin.facs.org/forums/forum/ajcc-tnm-staging/education-developed-by-partner-organizations/naaccr-webinars/68147-primary-peritoneum-t1a-t2c

[Jim Hofferkamp]

You are correct. p2c should be an allowable value if SSF 3 is 005.

This will be corrected in the next metafile.

[Jim Hofferkamp]

Hi Sandra,
We checked with AJCC and there was a typo on the spreadsheet that you used for your pull down menus. The spreadsheet indicated that N0 was valid for Gestational Trophoblastic Tumors. That is incorrect. As you know, the chapter for this site (pg 439) does not define any N values. The edits expect an 88 to be used in both the cN and pN data items. The edit will also allow a blank as well.

We will not be changing the edits at this time. I would recommend that registrars either enter an 88 or just leave the field N fields blank for primaries of this site.

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