TNM Path, N, RNP, Site Spec, Edy IDO3 COC

[Denise Jozwik]

Please see attached scenario regarding this Edit.

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[Jim Hofferkamp]

This is a tricky one.The edit in question is TNM Path N, Reg Nodes Pos – Ed 7 (COC). But before we get into the edit logic I need to confirm that the coding logic is correct.
Scenario:
2/5/16 Patient diagnosed C508, 8520/32.
2/15/16 Right mastectomy with SLN excision, 3/3 lymph nodes positive.
3/16 to 6/16 Chemotherapy
7/20/16 Completion of right axillary node dissection, 2/12 lymph nodes positive.

My question is whether the right axillary node dissection completed after chemotherapy should be counted in regional nodes positive/Examined. I pulled the rule below from the CS rules for regional nodes positive.

4. Cumulative nodes positive. Record the total number of regional lymph nodes removed and found to be positive by pathologic examination.
a. The number of regional lymph nodes positive is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment.

I’d really like to hear back from some of the forum members on how they interpret the coding rule and if they have a suggestion for the edit.

[Ruth Li]

For regional nodes positive: per CS for breast http://web2.facs.org/cstage0205/breast/Breast_fab.html , Note 1 states “Record this field even if there has been preoperative treatment.” So that would indicate the regional nodes positive would, in this case, include the ALND that happened POST-chemotherapy.

Donna Gress at the CAForum confirmed that the pathologic N category for this case is pN1a: http://cancerbulletin.facs.org/forums/node/73735 She points out this is because staging rules are different from 1st crs of tx rules.

Suggestion for the edit logic: in this case scenario, I believe the systemic/surgery sequence is coded 7 [surgery both before and after systemic therapy – systemic therapy was administered between 2 separate surgical procedures to the primary site; regional LN; surgery to other regional site(s), distant site(s), or distant LN(s)] and scope of regional lymph node surgery would also be a 7 [sentinel node bx & code 3,4,6 at different times]? Could one or both of these fields be included in consideration in the edit logic so an exception can be made when LN surgery happens before and after systemic tx such that staging of LN and examination of LN may not correspond directly?

[Jim Hofferkamp]

I’m going to add this to the agenda for the next Stage Edits WG call. Let me know if you can think of a work around.

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