03-24-2023 Sarcoma Grade-To Calculate or Not to Calculate
Scenario #1: 2023
- Core biopsy right thigh mass: dedifferentiated liposarcoma [no further information about grade mentioned in path report]
Question: How would you assign Grade Clinical?
- 3 G3: Sum of differentiation score, mitotic count score and necrosis score of 6, 7, or 8. Stated as FNCLCC Grade 3
- C Poorly differentiated
- D Undifferentiated, anaplastic
- 9 Grade cannot be assessed (GX) Unknown
Answer & Rationale: 9 Grade cannot be assessed (GX) Unknown
- Grade Coding Instructions & Tables
- Grade ID 09-Grade Clinical Instructions
- NOTE 5: Codes 1-3 [FNCLCC] take priority over A-D, H.
- Note 6: Code 9 (unknown) when
- Grade from primary site is not documented
- Grade ID 09-Grade Clinical Instructions
- Dedifferentiated Liposarcoma is assigned histology of 8858/3 – Just a reminder “dedifferentiated” is part of the histology name, and not an indicator of grade.
- There was no FNCLCC grade listed in the path report, nor any of the generic terms of Well differentiated, Moderately differentiated, Poorly differentiated, Undifferentiated, anaplastic, or High grade only therefore assign grade as a 9-grade from primary site not documented.
Scenario #2: 2023
- Resection right soft tissue right thigh:
- Histologic Type: Dedifferentiated liposarcoma
- Histologic Grade: High Grade
- Mitotic Rate:
- 15 mitoses per 10 high-power fields (HPF)
- Necrosis present
- Extent of Necrosis: 30%
Question: How would you assign grade pathologic?
- 3 G3: Sum of differentiation score, mitotic count score and necrosis score of 6, 7, or 8, Stated as FNCLCC Grade 3
- H Stated as “high grade” only
Answer & Rationale: 3 G3: Sum of differentiation score, mitotic count score and necrosis score of 6, 7, or 8, Stated as FNCLCC Grade 3
- Grade Coding Instructions & Tables
- Grade ID 09-Grade Clinical Instructions
- NOTE 5: Codes 1-3 [FNCLCC] take priority over A-D, H.
- Grade ID 09-Grade Clinical Instructions
- Dedifferentiated Liposarcoma is assigned histology of 8858/3 -Just a reminder “dedifferentiated” is part of the histology name, and not an indicator of grade.
- There was no FNCLCC listed in the path report, but the components to calculate the FNCLCC grade were in the path report. FNCLCC grading is composed of three components: 1) Tumor differentiation Score 2) Mitotic Count Score 3) Necrosis Score. Refer to AJCC Chapter 39 Introduction to Soft Tissue Sarcoma page 494.
- Table 39.1 Dedifferentiated liposarcoma is has a tumor differentiation score of 3
- Mitotic count of 15 has a mitotic count score of 2
- Necrosis Present 30% has a Necrosis Score of 1
- Thus 3+2+1=6 Which equates to a FNCLCC Histologic Grade of G3
- There was no FNCLCC listed in the path report, but the components to calculate the FNCLCC grade were in the path report. FNCLCC grading is composed of three components: 1) Tumor differentiation Score 2) Mitotic Count Score 3) Necrosis Score. Refer to AJCC Chapter 39 Introduction to Soft Tissue Sarcoma page 494.
TIP: If your pathologists are documenting the scores for each of the individual data items and not assigning the final (French Federation of Cancer Centers Sarcoma Group [FNCLCC]) grade, you should talk to them and request they assign it. Refer to College of American Pathologists Protocol for the Examination of Resection Specimens from Patients with Soft Tissue Tumors for more information. https://documents.cap.org/protocols/Soft.Tissue_4.1.0.0.REL_CAPCP.pdf
CAnswer Forum Posts
https://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/bone-and-soft-tissue-schemas/93697-clarification-on-sarcoma-grade/page2#post130922https://cancerbulletin.facs.org/forums/forum/site-specific-data-items-grade-2018/bone-and-soft-tissue-schemas/126836-calculating-fnclcc-grade-soft-tissue-sarcomas