Scenario:
- 02-20-2023 MRI Brain: Approximately 0.7 cm T2 hyperintense, hypo enhancing lesion in the central pituitary gland is suspicious for a pituitary microadenoma.
- 04-21-2023 Office Visit: Hyperprolactinemia (prior hx of elevated prolactin), Micro prolactinoma 7 mm. No drugs on board to elevate prolactin. No FHx of pituitary tumors.+ galactorrhea, no headaches, regular cycles, no h/o infertility, not planning any more conception. Plan: Complete pituitary panel, including prolactin. If prolactin high, start dopa agonist treatment (cabergoline 025-0.5 mg weekly).
- 04-29-2023 Prolactin 40.90 ng/mL (High)
- 06-11-2023 Prolactin again mildly elevated, thus would start treatment with Dostinex 0.25 mg weekly
Question: How will you assign diagnostic confirmation?
- 5 Positive laboratory test/marker study
- 7 Radiography and other imaging techniques without microscopic confirmation
- 8 Clinical diagnosis only, other than 5, 6 or 7
Answer: 7 Radiography and other imaging techniques without microscopic confirmation
Discussion & Rationale An elevated prolactin level alone is not diagnostic of a prolactinoma, so we won’t use code 5. The MRI was suspicious for a pituitary microadenoma, and a Prolactinoma is the most common type of pituitary tumor (adenoma) that produces a hormone. It makes up about 30% of all pituitary adenomas. We would assign diagnostic confirmation as 7.
From: AskSEERCTR <askseerctr@imsweb.com>
Based on the information provided, the date of diagnosis is 02-20-2023. We do not see this as a case diagnostically confirmed by lab or marker study. While we agree that code 5 can be assigned for solid tumor cases, code 5 does not fit the scenario described. The lab test confirmed elevated prolactin which can be due to several causes. Per the SEER manual: Assign code 5 when the diagnosis of cancer is based on laboratory tests or tumor marker studies that are clinically diagnostic for that specific cancer and there is no other diagnostic work up (e.g., imaging). (#6, page 102, https://seer.cancer.gov/manuals/2023/SPCSM_2023_MainDoc.pdf )
For this case, assign code 7 – Radiology and other imaging techniques without microscopic confirmation.
Histology code 8271/0 is correct.
Other Fields to consider:
| Field | Answer | Rationale/Notes | |
| Primary Site: | C751 | Solid Tumor Rules Non-Malignant CNS Table 5 Most Common Intracranial Primary Site | |
| Histology/Behavior: | 8271/0 | Be sure to include in text physician office notes stating physician calling this a prolactinoma & prolactin lab levels | |
| Grade Clinical: | 1 | Grade Manual For benign tumors ONLY (behavior 0), code 1 can be automatically assigned for all histologies. This was confirmed by the CAP Cancer Committee | |
| Grade Pathological: | 9 | Grade Manual Code 9 (unknown) when No resection of the primary site (see exception in Note 5, Surgical resection, last bullet) | |
| Diagnostic Confirmation: | 7 | From: AskSEERCTR <askseerctr@imsweb.com> Based on the information provided, the date of diagnosis is 02-20-2023. We do not see this as a case diagnostically confirmed by lab or marker study. While we agree that code 5 can be assigned for solid tumor cases, code 5 does not fit the scenario described. The lab test confirmed elevated prolactin which can be due to several causes. Per the SEER manual: Assign code 5 when the diagnosis of cancer is based on laboratory tests or tumor marker studies that are clinically diagnostic for that specific cancer and there is no other diagnostic work up (e.g., imaging). (#6, page 102, https://seer.cancer.gov/manuals/2023/SPCSM_2023_MainDoc.pdf) For this case, assign code 7 – Radiology and other imaging techniques without microscopic confirmation. | |
| Hormone: | 01 | SEER*Rx Interactive Antineoplastic Drugs Database Cabergoline (Alternate Name Dostinex) Category: Hormones and hormonal mechanisms Primary Site: Pituitary (prolactinoma) Remarks: Pharmacia, Upjohn. Suppresses prolactin secretion by anterior pituitary. Coding: This drug should be coded | |