Grade Post Therapy Path (yp)
**Note 1:** Leave Grade Post Therapy Path (yp) blank when
* No neoadjuvant therapy
* Clinical or pathological case only
* Neoadjuvant therapy completed; surgical resection not done
* There is only one grade available and it cannot be determined if it is clinical, pathological, post therapy clinical or post therapy pathological
**Note 2:** There is a preferred grading system for this schema. If the post therapy clinical grade given uses the preferred grading system and the post therapy pathological grade does not use the preferred grading system, do not record the Grade Post Therapy Clin (yc) in the Grade Post Therapy Path (yp) field.
* *Example:* Neoadjuvant therapy completed. Bone biopsy reports states moderately differentiated sarcoma. The surgical resection states a high grade sarcoma. Assign Grade Post Therapy Path (yp) using the H code
* Code Grade Post Therapy Clin (yc) as 2 since Moderately differentiated (G2) is the preferred grading system
* Code Grade Post Therapy Path (yp) as H since the preferred grading system was not used and there is a code available for “high grade” only
**Note 3:** Assign the highest grade from the resected primary tumor assessed after the completion of neoadjuvant therapy.
**Note 4:** If there are multiple tumors with different grades abstracted as one primary, code the highest grade.
**Note 5:** Code the appropriate grade from a resection done after neoadjuvant therapy.
**Note 6:** Codes 1-3 take priority over H.
* If “high grade” is documented and G2 (Moderately differentiated, high grade) or G3 (Poorly differentiated, high grade) are not documented, code H (high grade, NOS)
**Note 7:** Code 1 for stated as “low grade” only.
**Note 8:** G3 includes undifferentiated and anaplastic.
**Note 9:** Use the grade from the post therapy **clinical work up** from the primary tumor in different scenarios based on behavior or surgical resection
* Tumor behavior for the post therapy clinical and the post therapy pathological diagnoses are the same AND the post therapy clinical grade is the highest grade
* Tumor behavior for post therapy clinical diagnosis is invasive, and the tumor behavior for the post therapy pathological diagnosis is in situ
* **Surgical Resection**
* Surgical resection is done of the primary tumor after neoadjuvant therapy is completed and there is no grade documented from the surgical resection
* Surgical resection is done of the primary tumor after neoadjuvant therapy is completed and there is no residual cancer
**Note 10:** Code 9 (unknown) when
* Surgical resection is done after neoadjuvant therapy and grade from the primary site is not documented
* Surgical resection is done after neoadjuvant therapy and there is no residual cancer
* Grade checked "not applicable" on CAP Protocol (if available) and no other grade information is available
**Note 11:** If you are assigning an AJCC 8th edition stage group
* Grade is required to assign stage group
* Code H is treated as a G3 when assigning AJCC stage group
* An unknown grade may result in an unknown stage group