Kentucky Cancer Registry Spring training, 2010 H EMATOPOIETIC AND L YMPHOID N EOPLASM P ROJECT.

HEMATOPOIETIC AND LYMPHOID NEOPLASM PROJECT

WHY NEW RULES?

Medical advances

Immunophenotyping, molecular and genetic testing

New, more specific histology terms

Revised WHO Classification of Hematopoietic and Lymphoid Neoplasms

New reportability conditions

9751/3, 9975/3, 9831/3, and transformations

NEW REFERENCE – THE HEMATOPOIETIC

DATABASEManual (Rules)

Reportability

Multiple primary rules

Site and histology codes

Grade

Glossary

Tables

MP Calculator

Database

Disease definition

Synonyms

Definitive diagnostic method

Genetic tests and Immunophenotyping

Treatments

Transformations

Abstractor notes

HEMATOPOIETIC DATABASE

BRIEF DEMO OF DATABASE FEATURES

Casefinding lists

Hematopoietic Manual

Search feature

By diagnosis or by code

Displayed information

Abstractor notes

Multiple Primary Calculator

WHO CLASSIFICATION

CELL LINEAGES

“acute” “chronic”

“immature” “mature”

“undifferentiated” “differentiated”

Reference: Hoffbrand, Pettit, Vyas: Color Atlas of Clinical hematology (4 th ed.), 2010

MYELOID LINE –6 TABLES

Myeloproliferative Neoplasms

Myelodysplastic/Myeloproliferative Neoplasms

Myelodysplastic Syndromes

Myeloid and Lymphoid Neoplasms with Eosinophilia and Abnormalities of PDGFRA, PDGFRB or FGFR1

FROM PRESENTATION BY GRACA M. DORES, MD, MPH, CLASSIFICATION, CHARACTERISTICS, AND BEHAVIOR OF MYELOID NEOPLASMS, GIVEN AT THE SEER ADVANCED TOPICS WORKSHOP ON APRIL 19, 2010.

MYELOID TABLES 5 AND 6

Acute Myeloid Leukemia and Related Precursor Neoplasms

Acute Leukemias of Ambiguous Lineage

Show no clear differentiation along a single lineage

Includes those with mixed phenotypes

LYMPHOID LINE –6 TABLES

Precursor Lymphoid Neoplasms

Mature B-Cell Neoplasms

Mature T-Cell and NK-Cell Neoplasms

Hodgkin Lymphoma

Histiocytic and Dendritic Cell Neoplasms

Post-Transplant Lymphoproliferative Disorders

AT: WWW.LYMPHOMATION.ORG/ABOUT-DETAILS.HTM

WHO CLASSIFICATION 2008: PRINCIPLES

Term ‘NHL’ becoming obsolete

Neoplasms of precursor cells classified separately from those of more mature cells

Leukemia/Lymphoma are different manifestations of the same disease

Mature lymphoid neoplasms are subclassified on the basis of differentiation, morphology, immunophenotype, genetic tests, and clinical presentation

CLASSIFICATION BASED ON:

Morphology and biologic features

Lymphoma, Myeloid sarcoma, and plasma cell tumors are diagnosed by tissue biopsy

Leukemias by blood counts and BM biopsy

Genetic tests – DNA analysis

FISH for follicular lymphoma

Karyotyping of CML for Philadelphia chromosome

CLASSIFICATION BASED ON:

Immunophenotype

Identifies molecules associated with some lymphomas and leukemias which are expressed on the outer surface of the cell

Includes IHC and flow cytometry

Examples are Burkitt lymphoma and Adult T cell leukemia/lymphoma

Clinical features

Myeloproliferative neoplasm, unclassifiable

SPECIAL TYPES OF DIAGNOSES

Provisional diagnoses

NOS histology – could be awaiting further test results or could be only information available. Update if more info comes in

NOS with possible/probable specific histology – DO NOT USE these ambiguous terms – code the NOS term until more definitively diagnosed

Ex. MPN (9960/3), probably PV (9950/3). Code 9960 until you have a definitive diagnosis

Diagnosis of exclusion – based on equivocal tests and clinical presentation

Examples: MDS, refractory thrombocytopenia

DIAGNOSTIC CONFIRMATION

Code Label Definition

1 Positive histology Tissue microscopically examined and positive

2 Positive cytology Fluid cells microscopically examined and positive

3 Positive histology PLUS• Positive immunophenotypingAND/OR• Positive genetic studies

Histology is positive for cancer, and there are also positiveimmunophenotyping and/or genetic test results.

…

REVIEW MANUAL SECTIONS

What’s New

Reportability rules

Multiple Primary rules

Primary site and histology rules

Grade rules

Glossary and Appendices

HEMATOPOIETIC DATABASE

REVIEW DATABASE FEATURES

Display codes

Search terms and codes

Definitions, synonyms

Display special studies, treatment, transformations

Abstractor’s notes

MP Calculator