Tumor Tip of the Week 5-24-204 Ambiguous Terms on Cytology-Later Confirmed=Date of Diagnosis

Scenario:

• 5-12-2024 Pleural fluid cytology-Staining pattern is consistent with metastatic carcinoma, most likely of breast origin.
• 5-15-2024 Oncologist stated the patient had pleural fluid cytology that was positive for carcinoma, most likely from breast primary. Will schedule imaging and breast biopsy.
• 5-20-2024 US guided left breast needle biopsy-Invasive ductal carcinoma consistent w/breast primary, grade 2.

Question: How would you code the date of diagnosis?

• 5/12/2024
• 5/15/2024
• 5/20/2024

Answer: 5-12-2024

Rationale: For 2022+ cases, cytology with ambiguous terminology is considered the date of diagnosis when there is positive histology that confirms the diagnosis at a later date.

SEER Program Coding & Staging Manual

• Date of Diagnosis
  • Use the date of suspicious cytology when the diagnosis is proven by subsequent biopsy, excision, or other means
    • Example: Cytology suspicious for malignancy 01/12/2023. Diagnosis of carcinoma per biopsy on 02/06/2023. Record 01/12/2023 as the date of diagnosis.
    • Note 1: “Suspicious” cytology means that the diagnosis is preceded by an ambiguous term such as apparently, appears, compatible with, etc.
    • Note 2: Do not use ambiguous cytology alone for case ascertainment.

STORE Manual confirms this with an example under the instructions for Date of Initial Diagnosis.