2010 Hematopoietic and Lymphoid Neoplasm Project

1. 2010 Hematopoietic and Lymphoid Neoplasm Project Maneuvering the Hemato DB and Rules

2. Maneuvering the Hemato DB & Rules • New Version of Hemato Manual • Posted to SEER website • http://seer.cancer.gov/tools/heme/ index.html • Sign up for e-mail notifications

3. Maneuvering the Hemato DB & Rules • 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

4. Maneuvering the Hemato DB & Rules • 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

5. Maneuvering the Hemato DB & Rules • Five Steps of Navigation: • Provisional histology; primary site/hist • Reportability Instructions • MP Rules • PH Rules • Grade Rules • Phenotype/lineage for hematopoietic and lymphoid neoplasms

6. Maneuvering the Hemato DB & Rules • 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

7. Maneuvering the Hemato DB & Rules • Example: • Search “marginal zone” • Select marginal zone lymphoma • Display disease information • Display abstractor notes • Review common and rare primary sites

8. Maneuvering the Hemato DB & Rules • 2: Reportability Instructions: • Not rules nor hierarchical • Informational • Abiguous terms; usual treatment(s) • Clinical diagnoses • Smoldering, early, evolving, indolent and pre-diagnoses

9. Maneuvering the Hemato DB & Rules • 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

10. Maneuvering the Hemato DB & Rules • 3: MP Rules • M1: Minimal info; single primary • M2: Single histology; single primary • M3-M12: Multiple histologies • M13: Last resort • Use MP calculator

11. Maneuvering the Hemato DB & Rules • 4: PH Rules PH1-PH3 • Path report is not an auto-default • PH 1: Code primary site from scans, documentation, path, Hemato DB Path 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

12. Maneuvering the Hemato DB & Rules • 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

13. Maneuvering the Hemato DB & Rules • 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

14. Maneuvering the Hemato DB & Rules • 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

15. Maneuvering the Hemato DB & Rules • 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

16. Maneuvering the Hemato DB & Rules • 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)

17. Maneuvering the Hemato DB & Rules • Treatment: • Read abstractor notes • High-level information only • Use MP calculator • Check rules M1 - M12 • Follow-back on suspected treatment(s)

18. Maneuvering the Hemato DB & Rules • Case Walk-Through • Dx: Duodenum: Multiple polyps with intestinal follicular lymphoma • Look up “intestinal follicular” • Display abstractor notes • Read variant information

19. Maneuvering the Hemato DB & Rules • Case Walk-Through • Read reportability instructions included in histology code range • Review MP rules • Stop at rule M2: single histology = single primary

20. Maneuvering the Hemato DB & Rules • Determine primary histology • Open PH modules • Find follicular lymphoma code 9690/3 • Check module 6, PH 16 and 17

21. Maneuvering the Hemato DB & Rules • Determine grade/phenotype/lineage • Codes are numerically arranged • Look up 9690/3 • Stop at rule G6: T-cell neoplasm

22. Maneuvering the Hemato DB & Rules • Questions? This work was supported by Contract HHSN26120000024C between the National Cancer Institute and the Connecticut Department of Public Health.