2010 Hematopoietic and Lymphoid Neoplasm Project

Issues, Timing and Transformations

Issues, Timing and Transformations

Changes in classification

Reportability

MP Rules

PH Rules

Progression vs Transformation

Issues, Timing and Transformations

Changes in classification: What the NHL???

• Previously 2 classifications: NHL and HL• Based on presence or absence of

• Philadelphia chromosome• Reed-Sternberg cells

• NHL three categories:• Precursor B-cell• Mature B-cell• Mature T-cell and NK cell

Issues, Timing and Transformations

Classification now based on cell lineage Defined by immunophenotype and/or

genetic abnormalities Precursor lymphoid neoplasms

• B lymphoblastic leukemia/lymphoma• Term “non-Hodgkin” obsolete

Issues, Timing and Transformations

Reportability Update case-finding lists Update reportability algorithms

• Add Langerhans histiocytosis - all• Add other newly reportable• Add new WHO terms

Use ICD-9-CM casefinding list• http://seer.cancer.gov/tools/ casefinding/ind

ex.html

Issues, Timing and Transformations

MP Rules Rules M1 and M2

• Minimal information; single histology Rules M3 - M12

• Multiple histologies• Single report, multiple histologies• Multiple reports, different histologies

Issues, Timing and Transformations

Rule M3 Multiple “non-Hodgkin” histologies in a

single lymph node or organ considered a single primary

“Composite lymphoma” Does not require biopsy of multiple

lymph nodes for confirmation Do not query Hemto DB

• Refer to MP Rules

Issues, Timing and Transformations

Rule M4 Hodgkin and non-Hodkin lymphoma in a

single lymph node or organ is a single primary

Does not require biopsy of multiple lymph nodes for confirmation

Do not query Hemto DB• Refer to MP Rules

Issues, Timing and Transformations

Rule M5 Hodgkin lymphoma and non-Hodgkin

lymphoma in two different lymph nodes or organs abstracted as two primaries

Lymph nodes may be in same lymph node chain

Example: • Cervcal LN: Hodgkin lmphoma• Inguinal LN: Follicular lymphoma

Issues, Timing and Transformations

Rule M6 NOS histology followed by a specific

histology; MP calculator states same: single primary

Change histology code to specific histology

Notify CTR• NAACCR M or NAACCR U

Issues, Timing and Transformations

Example of M6 9650 Classical HL (CHL)

9651 Lymphocyte-rich CHL 9652 Mixed cellularity CHL 9653 Lymphocyte-depleted CHL 9659 Nodular lymphocyte predominant

CHL 9663 Nodular sclerosis CHL

Issues, Timing and Transformations

Rules M7 - M12: Rare Instances Rule M7

Chronic followed by acute histology within 21 days AND one (+) BM is a single primary

Probable provisional Dx followed by final Dx

Use BM for diagnosis

Issues, Timing and Transformations

Rule M8 Both chronic and acute histology within

21 days AND two (+) BM is two primaries• One BM = chronic• One BM = acute

Issues, Timing and Transformations

Rule M9 Both chronic and acute histology

within 21 days and BM = single primary Likely ongoing work-up Use most recent (later) diagnosis

Issues, Timing and Transformations

Rule M10 Original Dx chronic and subsequent Dx

acute (blast) > 21 days is multiple primaries

Issues, Timing and Transformations

Rule M11 First Dx is acute; reverts to chronic is

one primary Code as acute Follow-back to rule out treatment Follow back for BM

Issues, Timing and Transformations

Rule M12 Original Dx is acute; after Rx verts to

chronic is two primaries Change from previous rules Use Hemato DB to confirm separate

primaries

Issues, Timing and Transformations

Primary Site and Histology (PH) Rules Nine Modules Ambiguous terms used to determine

reportability, not histology Use PH rules for histology

Issues, Timing and Transformations

Module 7: Lymphoma primary site Code primary as BM (C42.1) if BM only

is involved Lymphoma in organ and its regional

LNs coded to organ site No evidence of lymphoma in LNs and

physician suspects organ origin, code to Unknown (C80.9)

Issues, Timing and Transformations

Module 8: Histology (multiple) If non-specific and specific, single

primary Code to specific Use Hemato DB to confirm same

histology (multiplicity calculator)

Issues, Timing and Transformations

Module 9: Default Rules Impossible to apply modules 1-8 Inadequate or missing documentation Conflicting reports Conflicting cell phenotypes PH 4-PH 40 do not determine histology

use numerically higher code

Issues, Timing and Transformations

Progression vs Transformation Understanding progression vs

transformation Defining progression and

transformation Using the Hemato DB to determine

progression vs transformation

Issues, Timing and Transformations

Progression: worsening of disease over time Generally chronic Same cell type, function, genetics Change in symptoms, treatment and/or

prognosis Ex: smoldering myeloma to frank or

“full blown” myeloma

Issues, Timing and Transformations

Transformation: change in nature, function or condition Genetic transformation Change in potential or type Ex: PV to AML New primary Need incidence count for both chronic

and acute Verify with Hemato DB

Issues, Timing and Transformations

Questions?

This work was supported by Contract HHSN26120000024C between the National Cancer Institute and the Connecticut Department of Public Health.