December 17, 2024

Onco Professional Services — Did You Know — Multiple Primary Intraepithelial Neoplasia

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ONCO > Onco Professional Services — Did You Know — Multiple Primary Intraepithelial Neoplasia

Onco Professional Services provides Management, Quality Control, Abstracting, Casefinding, and Follow-Up to help facilities achieve their goals. Periodically, our Onco Professional Services Staff share education and training documents internally on various topics related to the Cancer Registry; we call these bite-sized educational topics, “Did You Knows?”.  Did You Knows are a valuable resource for our team, helping our staff stay up to date on registry-related topics. Going forward, we will share some of these via our blog periodically.  We hope you find them as beneficial as our team does.

 

Background: Not all reporting bodies require the reporting of intraepithelial neoplasia of certain primary sites, because of this there can be confusion in how to determine when multiple primaries exist. Today’s “Did You Know” will address how to determine multiple primaries related to intraepithelial neoplasia.

 

Information: There must be a completely disease-free interval to accession multiple -IN II/III primaries. Completely disease free means no interval intraepithelial neoplasia, which includes HGSIL, HSIL, -IN-I, -IN-II, or -IN-III. If there is biopsy/path proving an interval -IN-I even, the patient is not disease free.

 

  • Example: Patient diagnosed with AIN III in 09/2019, AIN II/III in 02/2020, AIN II/III in 03/2021, AIN II-III in 11/2021, AIN I in 09/2022, followed by AIN II/III in 04/2023.
    • While patient didn’t have AIN II/III between 11/2021 and 04/2023, the patient DID have residual AIN I in 2022. Therefore, the patient has not been disease free for >1 yr.
    • Any evidence of intraepithelial neoplasia means the patient has persistent disease per SEER.

 

Note: Review your state manual to determine if -IN II and/or -IN III is reportable
Examples include: VIN II, VIN III, VAIN II, VAIN III, AIN II, AIN III

 

Reference(s):

SINQ 20210015

Question: Solid Tumor Rules (2007/2021)/Multiple Primaries–Anus: Have the disease free interval criteria been met for the following case scenario. A patient was diagnosed with anal intraepithelial neoplasia (AIN) III in 7/2018 that was treated with local tumor destruction, followed by Pap smears and biopsies that prove AIN I or AIN II through 2020, before being diagnosed with a reportable AIN II or AIN III in 2021.
Discussion: Since AIN I is not reportable and AIN II is not reportable until 2021, we are not sure if we can say the patient was disease free because there was no intervening reportable tumor (AIN III), or was never disease free because there was evidence of related disease (lower grade dysplasia).
Answer: The 2021 AIN III is not a new primary. According to our GI pathology expert, findings of AIN I and/or AIN II following a diagnosis of AIN III indicates the patient was never NED and indicates persistent disease.