Scenario: 2019 biopsy proven Sarcoma
Physical Exam: Large, raised, oval-shaped mass at left trapezius, mild firm to touch, approximately 9 x 7 cm size, well circumscribed.
CT neck: 5.5 x 3.2 complex mass in region of left trapezius muscle.
PET: 5.7 x 8.1 heterogeneously enhancing, hypermetabolic left upper shoulder mass
Patient received Neo-adjuvant treatment
Path resection after neoadjuvant 8.2cm tumor
Question: How would the Tumor Size Summary be coded?
- 090 (the largest size of tumor noted on physical exam)
- 081 (the largest size of tumor noted on PET)
- 082 (the largest size of tumor noted on path report after neo-adjuvant therapy)
Answer: 081 (the largest size of tumor noted on PET)
Rationale: Can’t use the size on the path report because there was neo-adjuvant therapy. The size on the scans hold priority over the physical exam, so you refer to the size on the scans. There is no priority order of scans, so you take the largest size noted on any scan and in this example the size on the PET was larger than the size on the CT.
STORE, Tumor Size Summary
- If neoadjuvant therapy followed by surgery, do not record the size from the pathologic specimen. Code the largest size of tumor prior to neoadjuvant treatment.
- If no surgical resection, then largest measurement of the tumor from physical exam, imaging, or other diagnostic procedures prior to any other form of treatment.
- Priority of imaging/radiographic techniques: Information on size from imaging/radiographic techniques can be used to code size when there is no more specific size information from a pathology or operative report, but it should be taken as low priority, over a physical exam.
CAnswer Forum Post
09-04-19, 02:00 PM
To clarify, the order of priority (1 being the priority):
1. Pathology or operative report
2. Imaging/radiographic technique
3. Physical exam
The next version of the STORE will be updated with the following information for Tumor Size Summary , Coding Rules #4 – Information on size from imaging/radiographic techniques can be used to code the tumor size when there is no more specific size information from pathology or operative report. It should be taken as a lower priority, but over a physical exam.