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UKACR GYNAE CANCER
STUDY DAY
ANALYSIS OF CASE STUDIES
Tuesday, 8th April 2008Julian Hodge Building, Cardiff
Joy McRae - ACC
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GENERAL POINTS
CASE STUDIES
Few registries had cases to be submitted for
consideration at this study day.
So, it was decided to re-visit the cases used
at the 1999 Gynae Cancers Study Day.
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General Points (2)
Reason for no problem cases?
Is the documentation better now??e.g.
The Royal College of Pathologists have
introduced a pro forma reporting which is
a benefit to data recording in some English
registries.
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Instructions
Case Studies:Please bring this sheet with you on 8th April
Please consider the information below as all you can find in yourdata sources and record (as you wouldnormally) -
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Instructions (Cont…)
1. The morphology of the tumour(s).
2. The anatomical site(s) of the tumour(s).
3. The ICD (indicating clearly which classn
used) .
4. The anniversary date(s) or “date(s) of diagnosis” for the tumours(s)
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Classifications UsedICD10 ECRIC, NI, NYCRIS, OXFORD, SCOTLAND
SWCIS, TRENT, WCISU, WMCIU
ICD02NWCIS – Liverpool Office (LO)
Manchester Office (MO)
ICD03SI, Thames
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INTERNATIONAL STANDARDS
Cancer Registration
Use of these classifications and adherence
to the rules therein ensure the recording of
quality data for cancer incidence.
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THE CASESTUDIES!
Good News!
Consensus on Cases 6, 8, 9, 12
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Case 9
Coding & Classification Group
No. of Primaries = NONE
Comments:
“BENIGN – Not registerable”
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Case 12Coding & Classification Group
No. of Primaries = ONE
Morphology Code = M9100/1
ICD Code (Placenta) = D39.2/C58.9
Diagnosis Date = 14.10.06
“Invasive Mole coded as an Uncertain Tumour”
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Case 12 – REGISTRIES’ ANSWERS
No. of Primaries = ONE
Morphology Code = M9100/1
ICD Code (Placenta) = D39.2/C58.9
Basis of Dx = Histology
Diagnosis Date = 14.10.06
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Case 6Coding & Classification Group
No. of Primaries = ONE
Morphology Code = M8010/3
ICD Code (Cervix) = C53.9
Diagnosis Date = 03.05.04
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Case 6 (Cont..)
Coding & Classification Group
Comments:
“Poorly differentiated epithelial tumour = carcinoma NOS”
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Case 6 – REGISTRIES’ ANSWERSNo. of Primaries = ONE
Morphology Code = M8010/3
ICD Code (Cervix) = C53.9
Basis of Dx = Histology
Diagnosis Date = 03.05.04(ONE - 02.05.04 : ONE – 04.05.04)
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Case 8Coding & Classification Group
No. of Primaries = ONE
Morphology Code = M8380/3
ICD Code (Ovary ) = C56/C56.9
Diagnosis Date = 19.06.04“Taken from Cytology”
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Case 8 – REGISTRIES’ ANSWERS
No. of Primaries = ONE
Morphology Code = M8380/3
ICD Code (Ovary ) = C56/C56.9
Diagnosis Date = 19.06.04 x 6 16.06.04 x 3
22.06.04 x 215.06.04 x 120.06.04 x 1
Basis of Dx: 2 Cytology : 11 Histology
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Case 1- Coding & ClassificationNo. of Primaries = 1
Morphology code = M8070/5
or M8076/5
ICD Code (Cervix) = C53.9
Diagnosis Date = 02.08.05
C&CG confirm that it is impossible to state the site the tumour has arisen from by histology alone. Therefore unless patholgist states site tumour arises – Cervix NOS
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Case 1 – REGISTRIES’ ANSWERS
No. of Primaries = 1
Morphology code = M8070/5 x 5
M8076/5 x 3
M8076/3 x 5
ICD Code (Cervix) = (next sheet)
Diagnosis Date = 02.08.05 x 12
03.08.05 x 1
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Case 1 – Site code
ECRIC -ICD10 Exocervix C53.1 M8070/5
Northern Ireland -ICD10 In NI microinvasive coded as invasive
C53.9 M8076/3
NWCIS (LO) - ICD02 Cervix M8076/5
NWCIS (MO) - ICD02 Cervix C53 M8076/3
NYCRIS - ICD10 Cervix M8076/5
Oxford - ICD10 Cervix C53.9 M8070/5
Scotland - ICD10 Cervix C53.9 M8076/3
Southern Ireland- ICD03 Cervix - Endocervical canal C53.0 M8076/3
SWCIS - ICD10 Cervix M8070/5
Thames – ICD03 impossible to state the site tumour has arisen from by histology alone. Therefore unless the pathologist states site tumour arises, code site
as cervix NOS.
C53.9 M8076/5
Trent - ICD10 Cervix C53.9 M8070/5
Wales - ICD10 Cervix C53.9 M8076/3
WMCIU - ICD10 Exocervix C53.1 M8070/5
“We default to exocervix for all squamous cell carcinoma” WMCIU
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Case 2Coding & Classification Group
No. of Primaries = 1
Morphology code M8070/3
ICD Code = C51.9
Site in Text = Vulva (Bilateral)
Diagnosis Date = 18.01.04
Bilateral diagnosed at the same time therefore ONE registration – see Training Manual section 3 page 9
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Case 2 - REGISTRIES’ ANSWERS
Morphology Code = M8070/3 x 13No. of Primaries = 12 x ONE 1 x TWOThe TWO Primary Sites are :Overlapping lesion of Vulva and LabiaMajora
HOWEVER, there are discrepancies in recording the site. (Next Page)
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CASE 2
ECRIC Vulva ICD10 C51.1Comments: Right labia majora and bilateral labia minora so code to minora as dominant site.
Ireland Overlapping lesion of vulva + Labia major
ICD10 C51.8 C51.1
NWCIS (LO) Vulva NOS ICD02 M8070/3
NWCIS (MO) Vulva ICD02 C51.9
Comment: Possible C51.8 overlapping
NYCRIS Vulva ICD10 M80703
Oxford Vulva (Bilateral) ICD10 C51.9
Scotland Vulva ICD10 C51.8Comment: Registered once as directed in the E&W Training Manual Part 3 p9.
Southern Ireland Overlapping lesion of vulva
ICD03 C51.8
SWCIS Vulva ICD10 M8070/3
Thames Vulva (Bilateral) ICD03 C51.9
Trent Labia Majora ICD10 C51.0Comment: One primary using multiple primary rules in UKACR manual, taken and coded the
biggest tumour component.
Wales Vulva ICD10 C51.8/C51.1
Comment: ONE registration as Bilateral occurring at the same time
WMCIU Vulva ICD10 C51.8
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Case 3Coding & Classification Group
No. of Primaries = TWO
Morphology code = M8070/2 or M8077/2
& M8070/3
ICD10 Site Codes = D06.9 & C53.9 or
ICD0 = C53.9 & C53.9
Site in text = In situ cervix NOS &
invasive cervix NOS
Diagnosis Date = 02.01.04 & 04.07.04
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Case 3Coding & Classification Group
Comments:TWO registrations because first dx.of in situ was diagnosed and treatedFollowed by second diagnosis morethan 3 months later. These both constitute a different episode of care.
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Case 3 – REGISTRIES’ ANSWERS
No. of Primaries = TWO
Morphology code = M8070/2 or M8077/2
& M8070/3
ICD10 Site Codes = D06.9 & C53.9 or
ICD0 = C53.9 & C53.9
Site in text = In situ cervix NOS &
invasive cervix NOS
(2 registries defaulted to exocervix
Diagnosis Date = 02.01.04 & 04.07.04
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Case 4Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8140/6 (ICD10) M8140/3 (ICD0)
ICD Code = C78.6
Site in Text = Unknown primary peritoneum
Diagnosis Date = 15.04.06
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Case 4 - REGISTRIES’ ANSWERS
No of Primaries : 12 x 1: 1 x 2
Site in Text : Ovary x 6UKP x 2Malignant Ascites x 2UKP/Mets/Ovary x 1UKP/Peritoneum x 1
Morphology: -
Adenocarcinoma x 13
Incidence Date: -
15.04.06 x 13
Basis of Dx:
Cytology
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Case 5Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8140/3 ICD Code = C57.8
Site in Text = Overlapping genital organ
Diagnosis Date = 02.12.04
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Case 5
Coding & Classification Group
Comment:
Text states “involving lower part of
uterus & the cervix therefore point of
origin cannot be established – code as
overlapping.
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Case 5 - REGISTRIES’ ANSWERS
No. of Primaries = ONE
Morphology code = M8140/3
ICD Code = C57.8
Diagnosis Date = 02.12.04
Basis of Dx. = Histology
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Cancer Registry
Site in Text Codes
ECRIC Lower Uterus C54.0 M8140/3Comments : Adenocarcinoma of lower uterus with spread into cervix.
Northern Ireland Uterus C55 M8140/3
NWCIS (LO) Isthmus uteri M8140/3
NWCIS (MO) Endo LR Uterus Cx C53.9 C55.9(LR) C54.0 M8140/3
Comment: Site Specification?
NYCRIS Endometrium M8140/3
Comments: Extending into cervix
Oxford Overlapping lesion of Female Genital Tract C57.8 M8140/3
Scotland Lower part of uterus C54.0 M8140/3Southern Ireland Overlapping Lesion of Uterus C54.8 M8140/3
Comment: Spread to Cervix
SWCIS Overlapping lesion of Female Genital Tract M8140/3
Comments: Involves uterus & cervix but no indication of origin of tumour.
Thames Endometrium C54.1 M8140/3Comments: Macro implies that tumour arose in the body of uterus. Typical presentation for
endometrial ca.
Trent Uterus C55 M8140/3
Wales Involves lower uterus and cervix C54.0 M8140/3WMCIU Overlapping genital organ C57.8 M8140/3
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Case 7Coding & Classification Group
No. of Primaries = TWO
Morphology code = a) M8077/2 &/or b) M8140/2 ICD02 Code
or M8148/2 ICD03 Code
ICD10 a) D06.9 & D06.9ICD0 b) C53.9 & C53.9 Site in Text a) Cervix in situ
b) Cervix in situ
Dx Date a) 27.02.05 b) 15.04.05
New term in ICD03 – agreed at C&CG 08.02.08
GINIII or high grade GIN
CGINIII or high grade CGIN
Two morphologies in different morphology groups (see training manual part 3)
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Case 7 - REGISTRIES’ ANSWERS
No. of Primaries = 7 x ONE Morphology = M8560/2 = 6 X TWO
Morphology code = a) M8077/2 &/or b) M8140/2 ICD02 Code
or M8148/2 ICD03 CodeICD10 a) D06.9 & D06.9ICD0 b) C53.9 & C53.9 Site in Text a) Cervix in situ
b) Cervix in situ
Dx Date a) 27.02.05 b) 15.04.05
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Case 7Site in Text No. Classn Codes Incidence
Date Basis of Diagnosis
Exocervix 1 ICD10 D06.1 M8560/2 27.02.05 histology
In situ Endocervix 1 ICD10 D06.0 M8010/2 27.02.05 histology
Cervix NOS 1 ICDO2 M8560/2 27.02.05 Histol of prim
Cervix 2 ICD02 C53.9 M8140/2
M8077/2
27.02.0515.04.05
Histology
Endo-cx-in-situ 1 ICD10 M8560/2 27.02.05 Histopath
CIS Cervix CIS Endocervix
2 ICD10 D06.0 M8140/2 D06.9 M8077/2
15.04.0527.02.05
Histology Histology
Cervix 2 ICD10 D06.9 M8077/2 D06.9 M8140/2*
27.02.0515.04.05
Path Path
Cervix NOS 1 ICD03 C53.9 M8148/2 27.02.05 Pathology
Cervix – Endocervix
2 ICD10 M8077/2 M8560/2 27.02.0515.04.05
Histo Histo
Cervix NOS 2 ICD02 C53.9 M8077/2 M8148/2
27.02.0515.04.05
Histology
Cervix 1 ICD10 D06.9 M8560/2 Mixed CGIN & CINIII
tumour
27.02.05 Histology
Cervix 1 ICD10 D06.7 M8560/2 Mixed CGIN & CINIII
27.02.05 Histology
CINIII & CGINIII 2 ICD10 D06.1 M8077/2 D06.0 M8140/2
27.02.05 15.04.05
Histology Histology
No Problems with
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Case 10
Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8020/3
ICD Site Codes = C56 or C56.9
Site in text = Ovary
Diagnosis Date = 19.06.07
Coded as ovarian origin as the report states “probable” – a registerable term, see Training Manual part 3, Page 21 (training group version
C&CG agree this could be interpreted as “female genital tract or UKP peritoneum” – not all cases have a black and white answer!!
HOWEVER
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Case 10- Registries’ AnswersSite in Text No
.Classn Codes Incidence
DateBasis of
Diagnosis
Ovary 1 ICD10 C56 M8020/3 19.06.07 Hist
Ovary 1 ICD10 C56 M8020/3 19.06.07 Hist
Female Genital Tract 1 ICD02 M8020/3 19.06.07 Histology
Female Genital Tract 1 ICD02 C57.9 M8020/3 19.06.07 Histology
Fem Gen NOS 1 ICD10 M8020/3 19.06.07 Histopath
Ovary 1 ICD10 C56X 8020/3 19.06.07 Histology from Mets
Ovary 1 ICD10 C56X M8020/3 19.06.07 Pathology From Mets
Female Genital Tract 1 ICD03 C57.9 M8020/3 19.06.07 Pathology
Ovary 1 ICD10 M8020/3 19.06.07 Pathology
Female Genital Tract NOS
1 ICD03 C57.9 M8020/3 19.06.07 Histology
Ovary 1 ICD10 C56 M8020/3 19.06.07 Histo
Ovary 1 ICD10 C56 M8020/3 19.06.07 Histology
Ovary 1 ICD10 C56 M8020/3 19.06.07 Histology
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Case 11
Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8490/6
ICD Site Codes = C79.6 or C80Site in text = UKP Ovary Diagnosis Date = 02.02.06Krukenberg always metastatic therefore UKP as no primary yet detected.
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Case 11 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence
DateBasis of diagnosis
Secondary Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Hist of Mets
Secondary Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histology
Left Ovary 1 ICD02 M8490/6 02.02.06 Histology of mets
Ovary (Stomach) 1 ICD02 C56.9 M8490/6 02.02.06 Histology
Secondary Ovary 1 ICD10 M8490/6 02.02.06 HM
Secondary Malignant Neoplasm of Ovary
1 ICD10 C79.6 M8490/6 02.02.06 Histology of mets
GI Tract 1 ICD10 C26.9 M8490/6 02.02.06 Pathology
Primary Unknown 1 ICD03 C80.9 M8490/6 02.02.06 pathology
Ovary but goes to C79.6 1 ICD10 C79.6 M8490/6 02.02.06 Hist of Mets
Unknown Primary 1 ICD03 C80.9 M8490/6 02.02.06 Histology
Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histo
Unknown primary 1 ICD10 C79.6 M8490/6 02.02.06 Histo
UKP - Ovary 1 ICD10 C79.6 M8490/6 02.02.06 Histology
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Case 13
Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8461/3
ICD Site Codes = C56
or C56.9
Site in text = Ovary
Diagnosis Date = 12.03.07
LOR – PO/00/04
“The C&CG following advice from gynaecological pathologists and oncologists, recommends that is appropriate to classify mixed tumours as surface epithelial tumours of the ovary.”
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Case 13 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence Date Basis of
Diagnosis
Ovary 1 ICD10 C56 M8461/3 12.03.07 Hist
Ovary 1 ICD10 C56 M8010/3 12.03.07 Histology
Rt. Ovary ?1 or 2 ICD02 M8460/3
M8380/3
12.03.07 Histol Prim
Ovary 1 ICD02 C56.9 M8460/3 12.03.07 H
Ovary 1 ICD10 M8460/3 12.03.07 HP
Ovary 1 ICD10 C56X M8460/3 12.03.07 Histology
R. Ovary 1 ICD10 C56X M8461/3 12.03.07 Path
Ovary 1 ICD03 C56.9 M8461/3 12.03.07 pathology
Ovary 1 ICD10 M8460/3 12.03.07 Histo
Ovary 1 ICD03 C56.9 M8461/3 12.03.07 HI
Ovary 1 ICD10 C56.9 M8460/3
12.03.07 Histo
Ovary 1 ICD10 C56X M8460/3 12.03.07 Histo
Ovary 1 ICD10 C56 M8461/3 12.03.07 Histology
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Case 14
Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8441/3
ICD Site Codes = C48.2
Site in text = Peritoneum
Diagnosis Date = 30.06.06
C&CG agree that M8461/3 may be allowed as an alternative morphology code
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Case 14 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence
Date Basis ofDiagnosis
Peritoneum 1 ICD10 C48.2 M8460/3 30.06.06 Hist
Peritoneum 1 ICD10 C48.2 M8441/3 30.06.06 Hist
Peritoneum 1 ICD02 M8441/3 30.06.06 Cytol
NK 1 ICD02 C80.9 M8441/3 30.06.06 H
Peritoneum 1 ICD10 M8441/3 30.06.06 HP
Peritoneum 1 ICD10 C48.1 M8441/3 30.06.06 Histology
Peritoneum 1 C48.2 M8441/3 30.06.06 Cytology
Peritoneum/Omentum 1 ICD03 C48.1 M8461/3 30.06.06 Pathology
Peritoneum 1 ICD10 M8441/3 30.06.06 Histo
Peritoneum 1 ICD03 C48.2 M8441/3 30.06.06 HI
Peritoneum 1 ICD10 C48.2 M8460/3 30.06.06 Histo
Peritoneum 1 ICD10 C48.2 M8461/3 30.06.06 Histo
Peritoneum 1 ICD10 C48.2 M8441/3 30.06.06 Histology
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Case 15
Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8441/3
ICD Site Codes = C48.2
Site in text = Peritoneum
Diagnosis Date = 29.11.06
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Case 15
Coding & Classification Group
LOR: Endometrial carcinoma of endometrioma is a tumour containing endometrial tissue: Where a carcinoma occurs wthin ectopic endometrial material inside the peritoneal cavity the cases should be coded with an endometrial morphology M8380/3 but with the primary site of peritoneum C48.2 (C&CG email sent 16.12.05 Nigel Brook).
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Case 15
Coding & Classification Group
No. of Primaries = ONE
Morphology code = M8441/3
ICD Site Codes = C76.3
Site in Text = Rectosigmoid septum
Diagnosis Date = 29.11.06
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Case 15 - REGISTRIES’ ANSWERSSite in Text No. Classn Codes Incidence
DateBasis of Diagnosis
Peritoneum 1 ICD10 C48.2 or C76.3 M8441/3 29.11.06 Histology
Pelvis 1 ICD10 C76.3 M8441/3 29.11.06 Histology
Rectovaginal septum 1 ICD02 M8441/3 29.11.06 Histol Prim
Rectovaginal septum 1 ICD02 C76.3 M8441/3 29.11.06 H
Endometrium 1 ICD10 M8441/3 29.11.06 HP
Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology
Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Path
Rectovaginal septum 1 ICD03 C76.3 M8441/3 29.11.06 pathology
Rectovaginal septum 1 ICD10 M8441/3 29.11.06 Histo
Peritoneum 1 ICD03 C48.2 M8441/3 29.11.06 HI
Rectosigmoid septum 1 ICD10 C76.3 M8441/3 29.11.06 Histo
Rectosigmoid septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology
Rectovaginal septum 1 ICD10 C76.3 M8441/3 29.11.06 Histology
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Summary
We are good at -• Determining how many primaries exist• Selecting correct Incidence Date• Recording correct basis of diagnosis• Interpreting medical terminology to assign
clinical codes.We adhere to Cancer Registration
STANDARDS
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Summary (Cont..)
Here is your very own GOLD STAR
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