Grade Pathological (Brain)

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
• 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