2021 Tumor Registry Updates & Changes in Grade Manuals
Dive into the latest updates in tumor registry protocols for 2021, highlighting changes in Grade Manuals, SSDI requirements, and STORE Manual implementations. Explore new data fields, guidelines, and resources to stay current in cancer registry management.
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Presentation Transcript
2021 Tumor Registry Updates Leslie Woodard, ICRA Education Chair April 22, 2021
Objectives Highlight the changes in the updated Grade Manual 2.01 and provide examples on appropriate use of the different grade tables Identify the new SSDI data fields and requirements Present the 2021 STORE Manual changes and show how to implement them
Please note this is done to the best of my ability and interpretation of the rules based off the information available to me at the time the presentation was made (March 2021). Please also make note the NCDB has been changing many of their answers on the forum when being asked for further clarification, so I did the best I could with what I had.
Grade Manual Version 2.01 effective for cases diagnosed 1/1/2018 forward Grade post therapy clin (yc) new for cases diagnosed 1/1/2021+ SSDI Manual Updated Manuals! Version 2.0 effective for cases diagnosed 1/1/2018 forward Many updates/clarifications added Includes new data items for cases diagnosed 1/1/2021+ STORE Manual STORE 2021 effective for cases diagnosed 1/1/2021+ Clarifications, fields added, fields removed SARSCOV2 data fields required for diagnosis years 2020 and 2021 CTR Guide to Coding Radiation Therapy Treatment in the STORE Version 3.0
Where? SSDI and Grade Manuals: https://apps.naaccr.org/ssdi/list/2.0
Where? STORE and Radiation Coding Guide: https://www.facs.org/Quality- Programs/Cancer/NCDB/call-for- data/cocmanuals https://www.facs.org/- /media/files/quality- programs/cancer/ncdb/store_m anual_2021.ashx https://www.facs.org/- /media/files/quality- programs/cancer/ncdb/case_st udies_coding_radiation_treatm ent.ashx
Whats Changed? New clarifications / updated notes New post-therapy clin grade For specifics see the change log: Microsoft Word - Version 2.0 Changes for SSDI and Grade Manuals.5.18.20 (naaccr.org)
Grade Tables Based off Schema ID 29 different grade tables Schemas do use the same grade tables Example: Grade Table 1
Grade Tables Recommended/preferred grade systems Listed first in each schema grade table Sometimes the only grade option If that s the case, and you don t have the preferred grade given you must report as unknown
Example Example Pancreas bx: Well differentiated adenocarcinoma Look up which grade table to use for pancreas Look up Read Read the grade clinical instruction notes Assign the grade from the options available in the pancreas specific table Assign
Example Example Colon bx = high grade carcinoma Look up Look up the correct grade table for colon Read Read the grade clinical instruction notes Assign grade from the options given in the colon grade specific table Assign
Example Example Endometrial bx = serous carcinoma Look up the correct grade table for endometrium (corpus carcinoma) Look up Read Read the grade clinical instruction notes Assign grade from the options given in the corpus carcinoma grade specific table Assign
Example Example MRI Brain: Incidental meningioma Look up the correct grade table for a meningioma (Brain, CNS Other, Intracranial Gland) Look up Read Read the grade clinical instruction notes Assign grade from the options given in the grade specific table Assign
Generic Grade Table Generic Grade Table For use when you don t have the preferred grade given to you Can only use if your schema table has grade options A-D Page 33-34 of grade manual
Example Example Appendectomy = Low grade neuroendocrine tumor Look up Look up the correct grade table for NET appendix Read the grade pathological instruction notes. Because low grade does not match the preferred grading system, we are to use the generic grade table per note 2. Read Assign Assign grade from the options given in the NET grade specific table by using the generic grade table crosswalk.
Example Example Lung bx = Low grade neuroendocrine tumor Look up the correct grade table for NET Lung Look up You ll notice there is not a specific NET table for NET of lung; simply use the lung grade tables Read Read the grade clinical instruction notes. Assign grade from the options given in the lung grade specific table. The grade table does not include generic grade codes, so there is no crosswalk you can use. Assign
New Note New Note Grade tables 1-25 having the following note Note 2: There is a preferred grading system for this schema. If the clinical grade given uses the preferred grading system and the pathological grade does not use the preferred grading system, do not record the Grade Clinical in the Grade Pathological field. Assign Grade Pathological (followed by grade table specific rules)
Example Example Breast bx = IDC, Nottingham grade 3 Breast lumpectomy = IDC, nuclear grade 2 Look up Look up the correct grade table for breast Read the grade clinical and pathological instruction notes Read The clinical grade uses the preferred grade system Per the notes, nuclear grade is not to be used for invasive breast carcinoma and the generic grade category should be assigned CLIN Assign grade from the options given in the breast grade specific table Assign PATH
Generic Grade Table Generic Grade Table Breast lumpectomy = IDC, nuclear grade 2
Example Example Rectum bx = undifferentiated adenocarcinoma APR = High grade adenocarcinoma Look up the correct grade table for rectum. Look up Read the grade clinical and pathological instruction notes. Read Assign grade from the options given in the grade table and following the notes. Assign CLIN PATH
New General New General Instruction Instruction If a report is sent out for consult and the results are different than the original report, record the results from the consult
Example Prostate bx at outside facility = Gleason 7 (3+4) adenocarcinoma Consult of bx slides at your facility = Gleason 7 (4+3) adenocarcinoma SSDI: Gleason Patterns Clinical Code 43 (Primary pattern 4, secondary pattern 3) Consult takes priority
3938: ALK Arrangement (Lung) 3939: EGFR Mutational Analysis (Lung) 3940: BRAF Mutational Analysis (Colon and Rectum) 3941: NRAS Mutational Analysis (Colon and Rectum) 3942: CA 19 9 Pre Tx Lab Value (Pancreas) New SSDIs
3/5/21 Lung biopsy: Adenocarcinoma EGFR documented as wild type in med/onc note Example SSDI: EGFR Mutational Analysis Code 0: Normal
2/1/21: Pancreas bx = adenocarcinoma 2/15/21: Started gemcitabine 2/16/21: CA19-9 = 7 U/ml Example SSDI: CA 19-9 PreTx Lab Value Code XXXX.9
Change in SSDI Requirements CoC and SEER no longer requiring the following; no word from the state yet: 3850: HER2 IHC Summary (Breast) 3851: HER2 ISH Dual Probe Copy Number (Breast) 3852: HER2 ISH Dual Probe Ratio (Breast) 3853: HER2 ISH Single Probe Copy Number (Breast) 3854: HER ISH Summary (Breast) 3859: HIV Status (Lymphoma)
New Data Items Effective With Diagnosis Date 1/1/2021+ AJCC TNM Post Therapy Clin (yc) T [1062] AJCC TNM Post Therapy Clin (yc) T Suffix [1063] AJCC TNM Post Therapy Clin (yc) N [1064] AJCC TNM Post Therapy Clin (yc) N Suffix [1065] AJCC TNM Post Therapy Clin (yc) M [1066] Grade Post Therapy Clin (yc) [1068]
Training provided by Donna Gress Located on the ACS Education and Training site https://learning.facs.org/ Post Therapy Clin (yc) Staging/Grade Updated grade manual addresses yc grade
Post Therapy Clin (yc) Staging/Grade Required Initial plan was neoadjuvant therapy with surgery; patient ended up not having surgery Reason for no surgery can be due to either good or poor response to neoadjuvant therapy Optional Patient completes neoadjuvant therapy and is restaged, continues to surgery Post Therapy Path (yp) Staging is REQUIRED for this scenario (yc is optional)
2/1/2021: Rectal bx = adenocarcinoma. Treating physician stages as cT3 cN0 cM0 2/15/2021: Patient starts neoadjuvant chemoradiation with plans for resection after 5/15/2021: Post-therapy staging scans show no residual tumor. Patient decides he does not want to proceed with surgery Example Post Therapy (yc) staging criteria has been met ycT0 ycN0 cM0 No post therapy stage group defined
AJCC rules differ from STORE rules Change in chemotherapy agent subcategory (drug class) equates subsequent treatment per STORE Per AJCC the drug class change does NOT change staging rules; still assign posttherapy staging (yc or yp) The neoadjuvant treatment plan is still in place Reminder!
New Data Items Effective For Diagnosis Year 2020-2121 NCDB--SARSCoV2--Test [3943] NCDB--SARSCoV2--Pos [3944] NCDB--SARSCoV2--Pos Date [3945] NCDB--COVID19--Tx Impact [3946] You are required to go back through any 2020 cases already abstracted to complete these data fields *if you are CoC accredited*. These are NOT required by the state of IN.
SARSCoV2 Timing of test doesn t matter (before or after diagnosis/during 1st course treatment) Only diagnostic tests can be used Antibody tests are not diagnostic tests, so can t be used
Example Example Case: 3/12/20: COVID-19 Pre-Procedure Risk Assessment PCR Negative 3/15/20: Breast bx Positive for cancer 3/20/20: Virtual visit with treatment team Decision for HT for 2 months during pandemic shut-down. Surgery to follow. 6/1/20: Lumpectomy Abstract: NCDB--SARSCoV2--Test [3943] Code 1: Patient tested for Active SARS-CoV-2 NCDB--SARSCoV2--Pos [3944] Code 0: Patient did not test positive for active SARS- CoV-2; No positive test NCDB--SARSCoV2--Pos Date [3945] Blank (no positive test) NCDB--COVID19--Tx Impact [3946] Code 3: First Course of Treatment plan altered
Example Example Case: 3/12/20: COVID-19 Pre-Procedure Risk Assessment PCR Negative 3/12/20: COVID-19 Antibody IGG Positive 3/15/20: Breast bx Positive for cancer 3/20/20: Virtual visit with treatment team Decision for HT for 2 months during pandemic shut-down. Surgery to follow. 6/1/20: Lumpectomy Abstract: NCDB--SARSCoV2--Test [3943] Code 1: Patient tested for Active SARS-CoV-2 NCDB--SARSCoV2--Pos [3944] Code 0: Patient did not test positive for active SARS-CoV-2; No positive test NCDB--SARSCoV2--Pos Date [3945] Blank (no positive test) NCDB--COVID19--Tx Impact [3946] Code 3: First Course of Treatment plan altered
Example Example Case: 1/1/21: Lung bx Positive for cancer 1/15/21: COVID-19 High Sensitivity PCR Negative 1/18/21: RLL Lobectomy 2/1/21: Started adjuvant chemo x4 cycles 2/20/21: COVID-19 Rapid Molecular Positive Med/onc documents delay in cycle 2 due to positive COVID test 3/7/21: Proceed with cycle 2 Abstract: NCDB--SARSCoV2--Test [3943] Code 1: Patient tested for Active SARS-CoV-2 NCDB--SARSCoV2--Pos [3944] Code 1: Patient tested positive for active SARS-CoV-2; test positive on at least one test NCDB--SARSCoV2--Pos Date [3945] 02/20/2021 NCDB--COVID19--Tx Impact [3946] Code 1: Treatment not affected, no change http://cancerbulletin.facs.org/forums/forum/fords-national-cancer-data- base/fords/treatment-outcomes/sarscov2-covid/115373-covid19-tx-impact
Example Example Case: 3/20/20: Patient s screening colonoscopy gets cancelled due to COVID-19 shutdown 5/1/20: Scope gets rescheduled and finds rectal cancer Patient tested negative for COVID prior to colonoscopy 5/15/20: Neoadjuvant treatment started 12/1/20: All treatment complete, patient on surveillance Abstract: NCDB--SARSCoV2--Test [3943] Code 1: Patient tested for Active SARS-CoV-2 NCDB--SARSCoV2--Pos [3944] Code 0: Patient did not test positive for active SARS- CoV-2; No positive test NCDB--SARSCoV2--Pos Date [3945] Blank no positive test NCDB--COVID19--Tx Impact [3946] Code 2: First Course of Treatment timeline delayed
Gastro-intestinal stromal tumors (GIST) and Thymoma s Diagnosis Date of 1/1/2021+ If they have a behavior code of 3 Regardless of foci, metastasis or nodes New Reportability Rule
Example Example Gastrectomy = 2 cm GIST, NOS Single foci, no nodes removed GIST, NOS = 8936/3 per ICD-O 3.2 ICD O 3 Coding Updates (naaccr.org)
Regional lymph node biopsies no longer come into play with: Date of First Course of Treatment [1270] Date of First Surgical Procedure [1200] Radiation/Surgery Sequence [1380] Systemic/Surgery Sequence [1639] RX Summ Treatment Status [1285] Major Change! *Diagnosis date 1/1/2021+
Example 1/5/2021: Left breast bx and axillary node bx 1/25/2021: Lumpectomy with ALND 2/15/2021: Starts adjuvant chemo 4/15/2021: Starts radiation Date of First Course of Treatment 01/25/2021 Date of First Surgical Procedure 01/25/2021 Radiation/Surgery Sequence 3 (XRT after surgery) Systemic/Surgery Sequence 3 (systemic after surgery)
2/1/2021: Lung bx 2/21/2021: EBUS with 4L FNA 3/1/20201: Starts SBRT Example Date of First Course of Treatment 03/01/2021 Date of First Surgical Procedure Date flag 11 (no first course surgical procedure) Radiation/Surgery Sequence 0 (no XRT and/or surgery) Systemic/Surgery Sequence 0 (no systemic therapy and/or surgery)
Example 2/15/2021: Left breast bx and axillary node bx 2/20/2021: Patient refuses further workup/treatment Date of First Course of Treatment 02/20/2021 Date of First Surgical Procedure Date flag 11 (no surgical procedure) Radiation/Surgery Sequence 0 (no radiation and/or surgery) Systemic/Surgery Sequence 0 (no systemic therapy and/or surgery) RX Summ Treatment Status 0 (no treatment given)
Resources Grade Coding Instructions and Tables Version 2.01 Ruhl J, Ward E, Hofferkamp J, et al. (November 2020). Grade Manual. NAACCR, Springfield, IL 62704-4194 https://www.naaccr.org/wp-content/uploads/2021/03/Grade-Manual_v- 2.01.pdf?v=1617197127 Site-Specific Data Item (SSDI) Manual Version 2.0 Ruhl J, Ward E, Hofferkamp J, et al. (September 2020). Site-Specific Data Item (SSDI) Manual. NAACCR, Springfield, IL 62704-4194 https://www.naaccr.org/wp-content/uploads/2021/03/SSDI-Manual_v- 2.0.pdf?v=1617197127 Version 2.0 Changes for SSDI and Grade Manual Change Log https://www.naaccr.org/wp-content/uploads/2020/09/Version-2.0- Changes-for-SSDI-and-Grade-Manuals.5.18-1.pdf?v=1617197127 Standards for Oncology Registry Entry STORE 2021 Commission on Cancer. (January 20201). Standards for Oncology Registry Entry STORE 2021. American College of Surgeons, Chicago, IL 60611-3295 https://www.facs.org/quality-programs/cancer/ncdb/call-for-data/cocmanuals CAnswer Forum http://cancerbulletin.facs.org/forums/auth/login-form
Thank You! Contact: Leslie.Woodard@franciscanalliance.org
