In Situ not histologically confirmed

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    Jim Hofferkamp

    Has anyone else been seeing this?

    Hi Jim,

    We are seeing increase in new cases of non-invasive/in-situ neoplasm of pancreas and lung and occasional breast where the diagnosis is made on imaging or by direct visualization and not confirmed histologically as non-invasive/in–situ cancer. They may or may not treat the patient – some end up being watch and wait such as the broncho-alveolar carcinoma of lung histologies.

    This combination of in-situ/non-invasive without histologic confirmation of behavior is not valid for SEER IF31 – the Diagnostic Confirmation, Behavior Edit.

    We can set the Histology Override Field – but, then we actually lose the ability to find them later. So, we might want to focus this with more attention to these exceptions in near-term edit updates.

    For pancreas these are diagnosed on EUS or direct visualization and include histology such as IPMN (8453/2 – intraductal papillary mucinous neoplasm) and ITPN (8503/2 – intraductal tubule-papillary neoplasm) and MCN (8470/2 – mucinous cystadenocarcinoma, non-invasive). We mostly see IPMN dx from EUS in Florida.

    For lung these are diagnosed on CT imaging and include what were previously termed “broncho-alveolar carcinoma” or BAC and subtypes such as lepidic and acinar adenocarcinoma of lung, etc.

    For breast – most MRI studies that are trying to establish DCIS dx or LCIS dx are still in trial – but, headed in same direction.

    Thx, Steve

    Steven Peace, CTR
    FCDS Senior Manager Research Support
    Florida Cancer Data System
    University of Miami Miller School of Medicine
    P.O. Box 016960 (D4-11)
    Miami, FL 33101
    Phone: (305)-243-4601
    Fax: (305)-243-4871
    FCDS Web Site:


    We have not yet seen it in MO, but I did ask on CA Forum how to stage it and got this answer. :

    07-11-17, 02:12 PM
    Technology is advancing to the point that EUS and CT may diagnose in situ cancers of the pancreas and lung for which treatment may be watchful waiting. Thus histologic confirmation is never done. How are these to be staged??

    07-24-17, 03:03 PM
    I understand your point, but at this time the physician experts stated that in situ cannot be diagnosed on imaging. Until that opinion changes, Tis may not be assigned.
    Donna M Gress, RHIT, CTR

    Will that cause a problem with current TNM edits?

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