COLLECTING CANCER DATA: HEMATOPOIETIC AND LYMPHOID .COLLECTING CANCER DATA: HEMATOPOIETIC AND LYMPHOID

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  • Hematopoietic and Lymphoid Neoplasms

    11/6/14

    NAACCR 2014-2015 Webinar Series 1

    COLLECTING CANCER DATA: HEMATOPOIETIC AND LYMPHOID

    NEOPLASMSJimHofferkamp,CTR(jhofferkam@naaccr.org)ShannonVann,CTR(svann@naaccr.org)

    Q&A PleasesubmitallquestionsconcerningwebinarcontentthroughtheQ&Apanel.

    Reminder: Ifyouhaveparticipantswatchingthiswebinaratyoursite,pleasecollecttheirnamesandemails. WewillbedistributingaQ&Adocumentinaboutoneweek.Thisdocumentwillfullyanswerquestionsaskedduringthewebinarandwillcontainanycorrectionsthatwemaydiscoverafterthewebinar.

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    FABULOUSPRIZES

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  • Hematopoietic and Lymphoid Neoplasms

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    NAACCR 2014-2015 Webinar Series 2

    HEMATOPOIETICANDLYMPHOIDDATABASEANDMANUAL

    Determinereportability Determinemultipleprimaries Assignprimarysite Assignhistology Assigngrade

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    DIAGNOSTICCONFIRMATION Microscopicallyconfirmed 1:Positivehistology Tissuespecimen Bonemarrowspecimen CBC,WBC,peripheralbloodsmearforleukemiaonly

    2:Positivecytology 3:PositivehistologyPLUS: PositiveimmunophenotypingAND/OR Positivegeneticstudies

    4:Positivemicroscopicconfirmation,methodnotspecified

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    DIAGNOSTICCONFIRMATION Notmicroscopicallyconfirmed 5:Positivelaboratorytest/markerstudy 6:Directvisualizationwithoutmicroscopicconfirmation 7:Radiologyandotherimagingtechniqueswithoutmicroscopicconfirmation

    8:Clinicaldiagnosisonly(otherthan5,6,or7)

    9:Unknownwhetherornotmicroscopicallyconfirmed

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  • Hematopoietic and Lymphoid Neoplasms

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    NAACCR 2014-2015 Webinar Series 3

    POPQUIZ Patientpresentswithunexplainedweightloss,chronicfatigue,andbruising.Peripheralbloodsmearshowedchronicmyeloidleukemia.

    Whatisthecodefordiagnosticconfirmation? 1Positivehistology

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    POPQUIZ Bonemarrowbiopsy:Blymphoblasticleukemia FISH:Mostlikelyrepresentsahyperdiploidclone

    Whatisthecodefordiagnosticconfirmation? 1Positivehistology

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    POPQUIZ Tonsillectomyandadenoidectomypath:Follicularlymphomaofthetonsil

    FISH:BCL2generearrangements;follicularlymphomagrade2

    Whatisthecodefordiagnosticconfirmation? 3PositivehistologyPLUS: Positiveimmunophenotyping AND/OR Positivegeneticstudies

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  • Hematopoietic and Lymphoid Neoplasms

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    NAACCR 2014-2015 Webinar Series 4

    POPQUIZ PETscan:Malignantadenopathyofmediastinalandretroperitoneallymphnodesconsistentwithlymphoma.

    Patientrefusedanyfurtherworkuportreatmentbecauseofotherseriouscomorbidities.

    Whatisthecodefordiagnosticconfirmation? 7Radiologyandotherimagingtechniqueswithoutmicroscopicconfirmation

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    POPQUIZ Bonemarrowbiopsy:Negative Cytogenetics:Lossofchromosome7 Dischargediagnosis:Myeloproliferativeneoplasm,unclassifiable

    Whatisthecodefordiagnosticconfirmation? 8:Clinicaldiagnosisonly(otherthan5,6,or7)

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    AMBIGUOUSTERMINOLOGYREPORTABILITY Apparently

    Appears

    Comparablewith

    Seepage20ofyourmanualforafulllist

    Donotreportcasesdiagnosedonlybyambiguouscytology(cytologydiagnosisprecededbyambiguousterm)

    HISTOLOGY

    Donotuseambiguoustermstocodeaspecifichistology

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  • Hematopoietic and Lymphoid Neoplasms

    11/6/14

    NAACCR 2014-2015 Webinar Series 5

    AMBIGUOUSTERMINOLOGYHISTOLOGY Exception CBCdone,nohistologyorprovisionaldiagnosisontheCBCorsmearreports.CBCstatesabnormallymphocytosis.FlowcytometrycompatiblewithCLL.Nootherworkupdone.

    Pertheabstractornotesinthedatabase,abnormallymphocytosisispresentinCLL.

    AssignhistologyforCLL(9823/3)sincethereisnoothercodethatcanbeused.

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    TRANSFORMATION Achronicneoplasmisaneoplasmthatcantransformtoanacute/moresevereneoplasm FollicularLymphoma(9695/3)diagnosedin2012 DiffuselargeBcelllymphoma(9680/3)diagnosedin2014

    Anacuteneoplasmisaneoplasmthatmayhavetransformedfromachronicneoplasm Acutemyeloidleukemia(9861/3) Refractoryanemiawithringsideroblasts(9982/3)

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    USINGTHEHEMEDBANDHEMATOPOIETICMANUAL

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  • Hematopoietic and Lymphoid Neoplasms

    11/6/14

    NAACCR 2014-2015 Webinar Series 6

    REVIEWOFHEMATOPOIETICWORKSHEET

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    STEPSINPRIORITYORDERFORUSINGTHEHEMEDBANDHEMATOPOIETICCODINGMANUAL1. Assignaworkinghistologycode2. Determinethenumberofprimaries3. Verifyorrevisetheworkinghistology4. Determinetheprimarysite5. Determinegrade6. UsetheHematopoieticMultiplePrimariesCalculator

    wheninstructedbytheHematopoieticManual

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    STEPSINPRIORITYORDER1. Assignaworkinghistologycode2. Determinethenumberofprimaries3. Verifyorrevisetheworkinghistology4. Determinetheprimarysite5. Determinegrade6. UsetheHematopoieticMultiplePrimariesCalculator

    wheninstructedbytheHematopoieticManual

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  • Hematopoietic and Lymphoid Neoplasms

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    NAACCR 2014-2015 Webinar Series 7

    EXAMPLE1 Apatientwasdiagnosedwithfollicularlymphomain2008thatwasnevertreated.Hereturnsin2014withdiffuselargeBcelllymphoma(DLBL).The2014pathstatesthatthisisatransformationoftheuntreatedfollicularlymphomafrom2008.

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    STEP1ASSIGNAWORKINGHISTOLOGY FollicularLymphoma,NOS 9690

    DLBL 9680

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    STEP2APPLYTHEMULTIPLEPRIMARYRULES M10 AbstractasmultipleprimarieswhenaneoplasmisoriginallydiagnosedasachronicneoplasmANDthereisaseconddiagnosisofanacuteneoplasmmorethan21daysafterthechronicdiagnosis.

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  • Hematopoietic and Lymphoid Neoplasms

    11/6/14

    NAACCR 2014-2015 Webinar Series 8

    EXAMPLE1 Apatientwasdiagnosedwithfollicularlymphomain2008thatwasnevertreated.Hereturnsin2014withdiffuselargeBcelllymphoma(DLBL).The2014pathstatesthatthisisatransformationoftheuntreatedfollicularlymphomafrom2008.

    TwoprimariesperruleM10Whatifin2014thepatientwasfoundtohavelargecellrichBcellnonHodgkinlymphomaofgerminalcenterinsteadofDLBL?

    http://seer.cancer.gov/seerinquiry/index.php?page=view&id=20110062&type=q

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    EXAMPLE2 Apatientpresentswithahistoryofacutemyeloidleukemiadiagnosed2/20/10.Thepatientwastreatedwithchemotherapy.Thepatienthasbeendiseasefreeuntilhewasrecentlyfoundtohaverefractoryanemiawithringsideroblasts.

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    STEP1ASSIGNAWORKINGHISTOLOGY Acutemyeloidleukemia 9861/3

    Refractoryanemiawithringsideroblasts 9982/3

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  • Hematopoietic and Lymphoid Neoplasms

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    NAACCR 2014-2015 Webinar Series 9

    STEP2APPLYTHEMULTIPLEPRIMARYRULES RuleM13 AbstractmultipleprimarieswhenaneoplasmisoriginallydiagnosedasacuteANDrevertstoachronicneoplasmaftertreatment

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    EXAMPLE2 Apatientpresentswithahistoryofacutemyeloidleukemiadiagnosed2/20/10.Thepatientwastreatedwithchemotherapy.Thepatienthasbeendiseasefreeuntilhewasrecentlyfoundtorefractoryanemiawithringsideroblasts. TwoprimariesperruleM13

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    EXAMPLE3 Apatientpresentedtoyourfacilityon10/11/13foracolonoscopyandbiopsyofamassintheascendingcolon.Thepathologyreportshoweddiffuselargecelllymphoma.ThepatienthadabonemarrowbiopsythatcamebackpositiveforperipheralTcelllymphoma.Isthisoneprimaryortwo?

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  • Hematopoietic and Lymphoid Neoplasms

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    NAACCR 2014-2015 Webinar Series 10

    STEP1ASSIGNAWORKINGHISTOLOGY DiffuseLargeBCellLymphoma 9680

    PeripheralTcelllymphoma 9702

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    STEP2APPLYTHEMULTIPLEPRIMARYRULES RuleM15 UsetheHemeDBMultiplePrimariesCalculatortodeterminethenumberofprimariesforallcasesthatdonotmeetthecriteriaofM1M14

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    EXAMPLE3 Apatientpresentedtoyourfacilityon10/11/13foracolonoscopyandbiopsyofamassintheascendingcolon.Thepathologyreportshoweddiffuselargecelllymphoma.ThepatienthadabonemarrowbiopsythatcamebackpositiveforperipheralTcelllymphoma.Isthisoneprimaryortwo? TwoprimariesperRuleM15/multipleprimarycalculator

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  • Hematopoietic and Lymphoid Neoplasms

    11/6/14

    NAACCR 2014-2015 Webinar Series 11

    STEPSINPRIORITYORDER1. Assignaworkinghistologycode2. Determinethenumberofprimaries3. Verifyorrevisetheworkinghistology4. Determinetheprimarysite5. Determinegrade6. UsetheHematopoieticMultiplePrimariesCalculator

    wheninstructedbytheHematopoieticManual

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    STEPSINPRIORITYORDER Example Patienthashistoryoflivertransplant. Lymphadenopathyofaxillary,mediastinal,andhilarnodes Axillarylymphnodebiopsy:Posttransplantlymphoproliferativedisorder(PLTD)

    Cytogenetics:TranslocationsinvolvingcMYC,BCL6,andIgHgenes;PLTDanddiffuselargebcelllymphoma(DLBCL)

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  • Hematopoietic and Lymphoid Neoplasms

    11/6/14

    NAACCR 2014-2015 Webinar Series 12

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  • Hematopoietic and Lymphoid Neoplasms

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    NAACCR 2014-2015 Webinar Series 13

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    STEPSINPRIORITYORDER1. Assignaworkinghistologycode2. Determinethenumberofprimaries3. Verifyorrevisetheworkinghistology4. Determinetheprimarysite5. Determinegrade6. UsetheHematopoieticMultiplePrimariesCalculator

    wheninstructedbytheHematopoieticManual

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    PRIMARYSITEANDHISTOLOGYCODINGRULES Module1:PostTransplantLymphoproliferativeDisorderPH1

    Module2:PlasmacytomaPH2PH4 Module3:Chroniclymphocyticleukemia/smalllymphocyticlymphoma(CLL/SLL)PH5PH6

    Module4:Lymphoma/Leukemia(Specificneoplasmsthatcanmanifestaseitherleukemiaorlymphomaorbothleukemiaandlymphoma)PH7PH8

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  • Hematopoietic and Lymphoid Neoplasms

    11/6/14

    NAACCR 2014-2015 Webinar Series 14

    PRIMARYSITEANDHISTOLOGYCODINGRULES Module5:MyeloidNeoplasmsandMastCellNeoplasmsPH9PH10

    Module6:CodingPrimarySiteforSpecifiedLymphomasPH11PH17

    Module7:CodingPrimarySiteforLymphomasOnlyPH18PH27

    Module8:NOSandMoreSpecificHistologyPH28PH29

    Module9:CodingPrimarySiteandHistologyPH30PH31

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    EXAMPLE4 Finaldiagnosis:Chroniclymphocyticleukemia/smalllymphocyticlymphoma;multiplelymphnoderegionsandbonemarrowinvolved

    Ass