2010 Hematopoietic and Lymphoid Neoplasm Project Maneuvering the Hemato DB and Rules

2010 Hematopoietic and Lymphoid Neoplasm Project

Maneuvering the Hemato DB and

Rules

Maneuvering the Hemato DB & Rules

New Version of Hemato Manual

Posted to SEER website

http://seer.cancer.gov/tools/heme/ in

dex.html

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Multiple primaries calculator replaces the 2001 Single versus Subsequent Primaries pull-out table Two references do not match

Replaces the 2002 Abstracting and Coding Guide (“the Red Book”)

Does not replicate ICD-O-3 Obsolete terms and codes deleted


Primary Site Code Display One correct primary site code - WHO

and ICD-O-3 Abstractor notes list common and rare

primary sites• Notes do not display on default view

Used by data collectors, QI staff and data matching/consolidation staff


Five Steps of Navigation: Provisional histology; primary site/hist Reportability Instructions MP Rules PH Rules Grade Rules

• Phenotype/lineage for hematopoietic and lymphoid neoplasms


1: Provisional histology; site/hist “Smart” searches Ex: Use “histiocytic, diffuse” to locate

histiocytic, diffuse lymphoma• Use quotation marks

Matched term and sort feature Warnings display for unlikely terms of

site/hist combinations


Example: Search “marginal zone” Select marginal zone lymphoma Display disease information Display abstractor notes Review common and rare primary sites


2: Reportability Instructions: Not rules nor hierarchical Informational

• Abiguous terms; usual treatment(s) Clinical diagnoses Smoldering, early, evolving, indolent

and pre-diagnoses


2: Reportability Instructions Newly reportable neoplasms Documentation of definitive Dx ICD-O /1 an MD calls malignant New terms and codes (Appendix D) When to query the Hemato DB


3: MP Rules M1: Minimal info; single primary M2: Single histology; single primary M3-M12: Multiple histologies M13: Last resort

• Use MP calculator


4: PH Rules PH1-PH3 Path report is not an auto-default PH 1: Code primary site from scans,

documentation, path, Hemato DBPath not automatic default

PH 2: Dx of inclusion/exclusion• Equivocal tests + clincal presentation = Dx

PH 3: Minimal information: use documentation, clinical impression, death certificate, office or out-pt report


PH Modules 1-9: Module 1: Generl instructions Modules 2-6: Histology-specific; based on

provisional Dx established in Step 1 Modules 7-8: Speciality modules

• 7: Primary site for lymphoma (PH25 - 37)• 8: Histology (PH 38 - 39)

Module 9: Last resort• Hemato DB• Numerically higher code


5: Assigning grade: phenotype/lineage Notes 1 & 2: Assign grade; do not use

ICD-O-3 table 13 Use rules; need not be specified on

path report Phenotype/lineage inherent in histologic

type


5: Grade and lineage/phenotype Grade 9: not applicable

• Myeloproliferative, myeloproliferative / myelodysplastic, myelodysplastic, histiocytic, dendritic, ambiguous lineage

Use path or H&P, consult, final Dx, face sheet


5: Grade and lineage/phenotype Valid codes are 5-9 Do not use low, intermediate and high grade

to code lineage/phenotype Numeric lists of neoplasm lineages

• T-cell• B-cell• Null-cell• NK cell

“Clean up” rule for inadequate documentation, mixed phenotypes


Diagnostic confirmation Read diagnostic confirmation, genetic data,

disease immunophenotyping Are genetics or immunophenotyping part of dx

criteria?• Need immunohistochemistry (tests tissue, BM, or

blood for antigens by staining• Was it ordered?• Are results available?

Dx conf. Code 3: histology and immunohistology (HP/L cases only)


Treatment: Read abstractor notes

• High-level information only Use MP calculator Check rules M1 - M12 Follow-back on suspected treatment(s)


Case Walk-Through Dx: Duodenum: Multiple polyps with

intestinal follicular lymphoma Look up “intestinal follicular” Display abstractor notes Read variant information


Case Walk-Through Read reportability instructions included

in histology code range Review MP rules

• Stop at rule M2: single histology = single primary


Determine primary histology Open PH modules Find follicular lymphoma code 9690/3 Check module 6, PH 16 and 17


Determine grade/phenotype/lineage Codes are numerically arranged Look up 9690/3 Stop at rule G6: T-cell neoplasm


Questions?

This work was supported by Contract HHSN26120000024C between the National Cancer Institute and the Connecticut Department of Public Health.

Documents

2010 Hematopoietic and Lymphoid Neoplasm Project Maneuvering the Hemato DB and Rules