Histology Override (MORPH)

I. Edits of the type, Diagnostic Confirmation, Behavior Code, differ in the use of ICD-O-2 or ICD-O-3 and check that, for in situ cases (Behavior = 2), Diagnostic Confirmation specifies microscopic confirmation (1, 2 or 4). The distinction between in situ and invasive is very important to a registry, since prognosis is so different. Since the determination that a neoplasm has not invaded surrounding tissue, i.e. is in situ, is made microscopically, cases coded in situ in behavior should have a microscopic confirmation code. Note: Very rarely, a physician will designate a case noninvasive or in situ without microscopic evidence.

If an edit of the type, Diagnostic Confirmation, Behavior Code, gives an error message or warning, check that Behavior Code and Diagnostic Confirmation have been coded correctly. Check carefully for any cytologic or histologic evidence that may have been missed in coding.

II. Edits of the type, Morphology-Type/Behavior, perform the following overrideable check:

• Codes listed in ICD-O-2 or ICD-O-3 with behavior codes of only 0 or 1 are considered valid, since use of the behavior matrix of ICD-O-2 and ICD-O-3 allows for the elevation of the behavior of such histologies when the tumor is in situ or malignant. This edit forces review of these rare cases to verify that they are indeed in situ or malignant.

If a Morphology-Type/Behavior edit produces an error or warning message and the case is one in which the 4-digit morphology code is one that appears in ICD-O-2 or ICD-O-3 only with behavior codes of 0 or 1, verify the coding of morphology and that the behavior should be coded malignant or in situ. The registrar may need to consult a pathologist or medical advisor in problem cases.

Exceptions to the above: If year of Date of Diagnosis > 2000, then a behavior code of 1 is valid for the following ICDO-2 histologies and no override flag is needed: 8931, 9393, 9538, 9950, 9960-9962, 9980-9984, 9989. Similarly, the following ICD-O-3 histologies are valid with a behavior code of 1: 8442, 8451, 8462, 8472, and 8473.

Note: The Morphology-Type/Behavior edits are complex and perform several additional types of checks. No other aspects of their checks are subject to override.

Instructions for Coding

• Leave blank if the EDITS program does not generate an error message for the edits of the types Diagnostic Confirmation, Behavior Code or Morphology-Type/Behavior

• Leave blank and correct any errors for the case if an item is discovered to be incorrect.

• Code 1, 2 or 3 as indicated if review of all items in the error or warning message confirms that all are correct.