Esophagus grade clin vs path

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    AnonymousNancy Rold

    Reporting Hospital did a review of slides of the outside bx and the path said: Barrett’s esophagus with extensive low grade dysplasia and focal high grade dysplasia. (bx 2/2/2016)

    Clinical stage per AJCC : T pIS (HGD) Nc0 Mc0, Grade X or 9 because HGD grade not coded, Group 0 Correct?

    Then surg path says: Esophagus, distal, endoscopic mucosal resection:
    – Invasive, moderately differentiated, adenocarcinoma arising in the background of Barrett’s esophagus with
    high grade dysplasia
    – Carcinoma invades into the muscularis mucosae
    – Invasive carcinoma is present at the cauterized lateral margin
    – See comment and synoptic

    Microscopic Description and Comment:
    Microscopic examination of the tissue fragments from endoscopic mucosal resection of the distal esophagus show
    Barrett’s mucosa with extensive high grade dysplasia. Two of the five fragments show invasive adenocarcinoma,
    which invade into, but not through, the muscularis mucase. The invasive carcinoma is present at the cauterized
    lateral margin of mucosal resection (block A1). The deep margin is free of carcinoma. No lymphovascular invasion or
    perineural invasion is identified. Deeper levels from blocks A1 and A2 were examined which confirmed the above

    Pathologic stage Tp1A Nc0 Mc0, Grade 2, Group p1A Correct?

    But registry software does not allow space for separate clinical and a pathology grades. Rule is to record the invasive grade = 2
    So clinical stage then fails because edit Primary Site, TNM Clinical Stage Valid A does not allow a grade 2 with TisN0M0 Group 0. Per Editwriter tests, it only allows grade 1 or 9 with that stage.

    What to do in registry software? Does registrar need to change grade code or Clinical T and group? Or does edit need to be adapted to accept Clin group 0 with Grade other than 1 or 9?

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