1 / 43

Putting the Puzzle Together: Breast Collaborative Staging

Putting the Puzzle Together: Breast Collaborative Staging . Melissa Riddle, RHIT, CTR October 6, 2012. Objectives. Understand why collaborative staging was created Learn the concepts of collaborative staging for breast cases. Collaborative Staging.

ciqala
Download Presentation

Putting the Puzzle Together: Breast Collaborative Staging

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Putting the Puzzle Together:Breast Collaborative Staging Melissa Riddle, RHIT, CTR October 6, 2012

  2. Objectives • Understand why collaborative staging was created • Learn the concepts of collaborative staging for breast cases

  3. Collaborative Staging • 5yr group effort among all standard setters in North America • Designed by and for cancer registrars to code the facts about a cancer case • General rules apply to all sites/histologies unless superseded by site-specific rule

  4. Collaborative Staging • Used for cases diagnosed 1/1/2004 and forward • CSv2 for cases diagnosed 1/1/2010 and forward • Derives: • AJCC TNM • SEER Summary • Understand SEER Summary and TNM is necessary in order to analyze cases

  5. Collaborative Staging • Allows both clinical and pathologic information to be used to determine stage • Pathologic information takes precedence

  6. Collaborative Staging • CS Solution: Mixed or “Best Staged” • Result: more relevant to actual practice • Fewer unstageable cases Registrar records: T elements + c/p N elements + c/p M elements + c/p Site Specific Factors (tumor markers) Computer Derives: c/pT c/p N c/p M And Stage Group SS77, SS2000

  7. Data Elements: • CS Tumor Size • CS Extension • CS TS/Exten Eval • CS Lymph Nodes • CS LN Eval • Regional LN Positive • Regional LN Exam • CS Mets @ DX • CS Mets Eval • SSF 1-25

  8. Breast CS

  9. Collaborative Staging • Evaluation Fields: • Code based on the procedure performed • Scans • Biopsies • Surgery • Derives the TNM as clinical or pathologic

  10. Breast Evaluation Codes

  11. Breast CS Data Items • Tumor Size • Extension • Lymph Nodes • Lymph Node Positive/Exam • Distant Mets at Diagnosis • Site Specific Factors 1-24

  12. Tumor Size/Extension

  13. Tumor Size • Code the specific size of the tumor in mm • Convert any size in cm to mm • Pathologic size: • Take pathologic size over clinical • Record the invasive size Example: Invasive Ductal Carcinoma, 0.5cm; DCIS, 2cm Code Tumor Size: 005

  14. Tumor Size • Special Codes: • 990 Microinvasion; Microscopic focus • 991-995 No specific size: “less than ___cm” • 996 seen on mammogram only but no size given • 997 Paget’s of nipple, no underlying tumor • 998 Diffuse

  15. Extension • In Situ only: 000 • No invasive disease • Invasive cancer without skin involvement: 100 • Skin involvement: 200 • Adherence, Attachment, Fixation, Induration & Thickening • Without diagnosis Inflammatory Breast CA

  16. Example: L breast partial mastectomy Path report partial mastectomy: 2cm invasive ductal carcinoma invading into skin CS Extension: 200 (invade skin) Cs breast: extension

  17. Extension • Inflammatory Breast CA: • Based on clinical information • Codes based on percentage of breast involved: • Code 600: 33% or less • Code 725: more than 33% but less than 50% • Code 730: more than 50% • Code 750*: percentage unknown *Most common code for IBC

  18. Regional Lymph Nodes

  19. Lymph Nodes • Regional Lymph Nodes Only: • Do NOT code cervical or contralateral axillary LN • Includes Levels 1-3 Ipsilateral Axillary LN, internal mammary LN and Supraclavicular LN • Clinical vs. Pathologic • If the only information about involved regional LN is from physical exam or imaging- clinical • If there are positive LN found on sampling/dissection- pathologic

  20. Level 1 & 2 Axilla LN • Code 250: • Pathologic involvement LN • Code 255: • Clinical involvement moveable LN • Code 510: • Clinical involvement fixed/matted LN • Code 520: • Pathologic involvement fixed/matted LN • Code 600: • Axillary, NOS

  21. Example: R breast modified radical mastectomy (MRM) Path from R MRM: 3cm invasive ductal carcinoma; 2/4 R axillary LN involved with metastatic disease CS LN: 250 (pathologic positive movable axillary LN) Cs breast: Lymph nodes

  22. Reg LN Positive • Record all positive pathologic examined regional lymph nodes Example: 3/5 R axillary LN involved with invasive duct carcinoma CODE: 03 • Code 95: • Positive LN only on core biopsy or FNA • Code 98: • No regional LN were examined pathologically

  23. Reg LN Examined • Record the total number of pathologically examined regional LN Example: 3/5 R axillary LN involved with invasive duct carcinoma CODE: 05 • Code 95: • Regional LN examined by core biopsy or FNA only • Code 00: • No regional LN examined pathologically

  24. Distant Mets at Diagnosis

  25. Distant Mets • Code 00: • No evidence of metastatic disease • Code 10: • Involvement distant LN: • Cervical • Contralateral/Bilateral Axillary and/or internal mammary LN • Code 40: • Distant met site except distant LN

  26. Distant Mets • Code 42: • Further contiguous extension: • Skin over axilla, contralateral breast, sternum, upper abdomen • Code 44: • Involve any of the following: • Adrenal gland • Bone • Contralateral breast- if stated metastatic • Lung • Ovary • Sat nodules skin other than primary breast

  27. Distant Mets • Code 50: • Distant LN • Distant Sites (listed in codes 40-44) • Code 60: • Distant mets, NOS

  28. ExampleR breast with palpable mass 4cm with fixed R axillary LN mass. CT AB/Pelvis: Innumerable liver mets CS Mets @ DX: 40 (Distant mets other than distant LN) CS breast: mets at DX

  29. Site Specific Factors

  30. Collaborative Staging • Site-Specific Factors • Not all 25 SSF are used for every case • Breast has the most with 24 to complete • Additional information needed to derive TNM • Prognostic Tumor Markers/Labs • Special Interest/Future Research • Other clinically significant information

  31. SSF 1: ER & SSF 2: PR • If there is any sample positive, record as positive • Do NOT record ER results from Oncotype DX or other multigene test • 010- Positive • 020- Negative • 997- Test ordered results not in chart • 999- Unknown

  32. SSF 3: Pos Level 1 & 2 LN • Based on pathologic information ONLY • Code 098: • No pathologically examined LN • Code 000: • Negative LN • Code 001-089: • Code the exact number of positive LN • Code 095: • Positive LN by biopsy or FNA

  33. SSF 7: BR Score • Priority Order: • BR Score • BR Grade • Codes 030-090: • BR Score range of 3-9 • Codes 110-130: • BR Grade: Low, Intermediate, High • Code 998: • No histologic exam of primary tumor

  34. HER 2 • SSF 8: IHC test value • Scores 0, 1+, 2+, 3+ • SSF 9: IHC interpretation • Record the pathologists interpretation of the test value: positive, negative, equivocal • SSF 10: FISH value • Record ratio as given • Code 991: ratio less than 1.00 • SSF 11: FISH interpretation • Record the interpretation of the test value

  35. HER 2 • SSF 14: Other/Unknown test • Statement in medical record on HER2, unknown type of testing performed • Other type of test performed • SSF 15: Summary of results • Based on codes in SSF 9, 11, 13 and 14 • Both IHC and FISH/CISH record results of FISH/CISH • Except when IHC is performed to clarify equivocal test of FISH/CISH

  36. SSF 16: ER, PR & HER2 • Identifies Triple negative patients • Code Pattern: • First digit: ER • Second digit: PR • Third digit: HER2 • Digits: • 0= negative • 1= positive • Information unknown on one or more test code 999

  37. SSF 16 • Example: ER: positive (SSF1: 010) PR: positive (SSF2: 010) HER2: negative (SSF 15: 020) SSF 16 Code: 110 • Triple Negative patients code 000

  38. SSF 22: Multigene Method • Assess: • likelihood of response to chemotherapy • evaluate prognosis or distant recurrence • Code 010: Oncotype DX • Code 020: MammaPrint • Code 030: Other test

  39. SSF 23: Multigene Result • Record the results of the multigene method: • Oncotype DX: Scores range 0-100 • MammaPrint: Low Risk or High Risk • Codes 000-100 • Record actual Oncotype DX score • Code 200: Low Risk • Code 300: Intermediate Risk • Code 400: High Risk

  40. SSF 24: Paget’s Disease • Record any mention of Paget’s disease • Pathologic takes precedence over clinical info • Negative exam of nipple • Interpret as no Paget’s disease • Pathology report mentions pagetoid involvement of nipple, Code 020 • Does NOT include pagetoid involvement of ducts or lobules

  41. Current Version CSv02.04 http://www.cancerstaging.org/cstage/manuals/coding0204.html Additional Help: http://cancerbulletin.facs.org/forums/

  42. The Whole Picture • Now you can put these pieces together while using the CS Manual to create a beautiful picture! • Always read your notes for CS, they are the little pieces that create the whole!

  43. Thank You! Melissa Riddle, RHIT, CTR melissariddlespeaks@ymail.com

More Related