Primary Site, TNM Clin Stage Valid A-Ed (COC)

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    Edit error: “Tc1 Nc0 Mc0, staging parameter for C414, inconsistent with TNM stage 1A”. Site is pelvic bone, M9220/3 chondrosarcoma. Biopsy was noted as Grade 1 and case was clinically staged as Tc1, Nc0, Mc0, Stage Group 1A. At time of resection pathology noted Grade 3. The facility is questioning the edit forcing them to clinically stage the case as Stage Group 2A using Grade 3 when clinical staging information documented Grade 1. What guideline supports using highest grade for clinical stage group instead of grade at time the case is clinically staged?

    Thanks for your help!

    Jim Hofferkamp

    This is an issue that will be correct in the v16E metafile that will probably be posted next week. I’ll be sending out additional information about the new metafile later in the week.

    The problem is we only collect the highest grade so if the clinical pre treatment grade is lower than the post surgery grade and grade is part of TNM stage, the edit was failing. Below is a description of the changes we made to the edit to accommodate this situation. It’s not ideal, but seems to be the best option at this time. Essentially, the edit now allows any grade for clinical stage.

    Description, edit logic modified to validate stage for sites using grade as staging parameter when grade is higher than allowed for assigned stage. This change was made to allow correct staging when a grade for pathologic staging would be higher than the grade for clinical staging. There is only one grade field collected, the higher grade by registry coding guidelines, and the edit was enforcing the recorded grade in clinical stage evaluation. The sites using grade as a staging component include Appendix-Carcinoma, Esophagus/Esophagus GE Junction, Bone, Soft Tissue Sarcoma, and GIST (mitotic rate). Soft Tissue Sarcoma is not edited because of other grade concerns.

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