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:** Assign the highest grade from the resected primary tumor assessed after the completion of neoadjuvant therapy. **Note 3:** If there are multiple tumors with different grades abstracted as one primary, code the highest grade. **Note 4:** Codes 1-4 take priority over A-D, L and H. **Note 5:** CNS WHO classifications use a grading scheme that is a "malignancy scale" ranging across a wide variety of neoplasms rather than a strict histologic grading system that can be applied equally to all tumor types. * Code the WHO grading system for selected tumors of the CNS as noted in the AJCC 8th edition Table 72.2 when WHO grade is not documented in the record + A list of the histologies that have a default grade can also be found in the *Brain/Spinal Cord* CAP Protocol in Table 1: *WHO Grading System for Some of the More Common Tumors of the CNS*, Table 2: *WHO Grading System for Diffuse Infiltrating Astrocytomas and Table* 3: *WHO Grading Meningiomas* * For **benign tumors ONLY (behavior 0),** code 1 can be automatically assigned for all histologies + This was confirmed by the CAP Cancer Committee **Note 6:** Use the grade from the post therapy **clinical work up** from the primary tumor in different scenarios based on behavior or surgical resection * **Behavior** * 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 7:** 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


NAACCR #3845


Code Description
1 WHO Grade I : Circumscribed tumors of low proliferative potential associated with the possibility of cure following resection
2 WHO Grade II: Infiltrative tumors with low proliferative potential with increased risk of recurrence
3 WHO Grade III: Tumors with histologic evidence of malignancy, including nuclear atypia and mitotic activity, associated with an aggressive clinical course
4 WHO Grade IV: Tumors that are cytologically malignant, mitotically active, and associated with rapid clinical progression and potential for dissemination
L Stated as "low grade" NOS
H Stated as "high grade" NOS
A Well differentiated
B Moderately differentiated
C Poorly differentiated
D Undifferentiated, anaplastic
9 Grade cannot be assessed (GX); Unknown
<BLANK> See Note 1