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
  • 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

9

NAACCR Item

NAACCR #3844

Metadata

SSDI
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