Problem with blank pN edit for some primary sites

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    AnonymousHelen Gosnell
    Spectator

    We are having an issue with the new v16d edit that will not allow us to leave pathologic N blank if pathologic T has a valid value. This is a problem for primary sites that allow cN for pathologic stage for cases where there are clinically positive lymph nodes. The decision was made to only add cN0 to the pathologic N choices until the AJCC 8th ed starts in 2018. Since we don’t have a choice for cN1 for pathologic N, in order to code these cases we leave the pathologic N blank and code the clinical N as cN1. The new edit will not allow us to validate the case this way. If we code pNx and a valid stage group, we get another edit. The only way to get these cases to pass the v16d edits is to code pathologic N pNx and the stage group as 99. For Corpus Uteri C54._ in particular, these cases are not usually staged clinically (unless they are stage 4) so both the clinical and pathologic stages would be coded unknown. Our only other choice is to leave these cases incomplete.

    Blank pM when you have a valid pT & pN (not blank)

    The primary site we are seeing this the most with is Corpus Uteri C54._

    An example of an actual case-

    Endometrial cancer
    Path stage: pT1b cN1 cM0, stage 3C1 per surgeon. Diagnosed 6/15/16.

    Verified by Donna Gress that clinical N can be used for path stage for primary site C54:

    http://cancerbulletin.facs.org/forums/forum/ajcc-tnm-staging/gynecologic-sites-chapters-33-39/70334-uterine-carcinosarcoma-pathologic-stage-group

    Here’s the edit report when the case is coded with pathologic N blank, clinical N cN1:
    _____________________________________________________________________________________
    Metafile Name: NAACCR_v16D_20170216.rmf
    EditSets Used: Hosp: Vs16 COC Required – All

    Error Number: 1 (6070)
    Edit Name: TNM Path T, Path N (COC)
    Edit Set Name: Hosp: Vs16 COC Required – All
    Edit Error Message: If TNM Path T is coded, TNM Path N must not be blank
    Field(Pos): TNM Path T (940)=> p1B
    Field(Pos): TNM Path N (944)=> <BLANK>
    Field(Pos): Date of Diagnosis (530)=> Y:2016 M:06 D:15
    Field(Pos): Behavior Code ICD-O-3 (554)=> 3
    Field(Pos): Type of Reporting Source (563)=> 1
    Field(Pos): TNM Path Stage Group (952)=> 3C1

    ________________________________________________________________________________________
    Here’s the edit report if the pathologic N is coded to pNx:

    Metafile Name: NAACCR_v16D_20170216.rmf
    EditSets Used: Hosp: Vs16 COC Required – All

    Error Number: 1 (6009)
    Edit Name: Primary Site, TNM Path Stage Valid B- Ed 7 (COC)
    Edit Set Name: Hosp: Vs16 COC Required – All
    Edit Error Message: Inconsistency between TNM categories Tp1B NpX Mc0 and assigned TNM stage 3C1
    Field(Pos): TNM Path T (940)=> p1B
    Field(Pos): TNM Path N (944)=> pX
    Field(Pos): TNM Path M (948)=> c0
    Field(Pos): TNM Path Stage Group (952)=> 3C1
    Field(Pos): Primary Site (540)=> C543
    Field(Pos): Histologic Type ICD-O-3 (550)=> 8980
    Field(Pos): Behavior Code ICD-O-3 (554)=> 3
    Field(Pos): Date of Diagnosis (530)=> Y:2016 M:06 D:15
    Field(Pos): TNM Edition Number (938)=> 07
    Field(Pos): TNM Path Descriptor (956)=> 0
    Field(Pos): Age at Diagnosis (193)=> 068
    Field(Pos): Grade (555)=> 3
    Field(Pos): CS Site-Specific Factor 1 (1003)=> 120
    Field(Pos): CS Site-Specific Factor 8 (1024)=> 000
    Field(Pos): CS Site-Specific Factor10 (1030)=> 988
    Field(Pos): CS Site-Specific Factor13 (1039)=> 988
    Field(Pos): CS Site-Specific Factor15 (1045)=> 988
    Field(Pos): CS Site-Specific Factor16 (1048)=> 988
    Field(Pos): CS Site-Specific Factor25 (1075)=> 988
    Field(Pos): Sex (192)=> 2
    Field(Pos): Type of Reporting Source (563)=> 1

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