Grade Pathological
Notes
Note 1: Grade Pathological must not be blank.
Note 2: Assign the highest grade from the primary tumor.
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
https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates
- 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 clinical work up from the primary tumor in different scenarios based on behavior or surgical resection
- Behavior
- Tumor behavior for the clinical and the pathological diagnoses are the same AND the clinical grade is the highest grade
- Tumor behavior for clinical diagnosis is invasive, and the tumor behavior for the pathological diagnosis is in situ
- Surgical Resection
- Surgical resection is done of the primary tumor and there is no grade documented from the surgical resection
- Surgical resection is done of the primary tumor and there is no residual cancer
- No surgical resection
- Surgical resection of the primary tumor has not been done, but there is positive microscopic confirmation of distant metastases during the clinical time frame
Note 7: Code 9 (unknown) when
- Grade from primary site is not documented
- Surgical resection is done after neoadjuvant therapy and grade from the primary site is not documented and there is no grade from the post therapy clinical work up
- Surgical resection is done after neoadjuvant therapy and there is no residual cancer and there is no grade from the post therapy clinical work up
- No resection of the primary site (see exception in Note 6, Surgical resection, last bullet)
- Neo-adjuvant therapy is followed by a resection (see Grade Post Therapy Path (yp))
- Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available
- Clinical case only (see Grade Clinical)
- There is only one grade available and it cannot be determined if it is clinical, pathological, post therapy clinical or post therapy pathological
Default
9NAACCR Item
NAACCR #3844Metadata
SSDICode | 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 |