Note 1 Leave Grade Post Therapy Path (yp) blank when

• No neoadjuvant therapy
• Clinical or pathological case only
• Neoadjuvant therapy completed; surgical resection not done
• There is only one grade available and it cannot be determined if it is clinical, pathological, post therapy clinical or post therapy pathological

Note 2 There is a preferred grading system for this schema. If the post therapy clinical grade given uses the preferred grading system and the post therapy pathological grade does not use the preferred grading system, do not record the Grade Post Therapy Clin (yc) in the Grade Post Therapy Path (yp) field.

• Example Neoadjuvant therapy completed. Biopsy reports states moderately differentiated adenocarcinoma. The surgical resection states a high grade adenocarcinoma. Assign Grade Post Therapy Path (yp) 9
• Code Grade Post Therapy Clin (yc) as 2 since Moderately differentiated (G2) is the preferred grading system
• Code Grade Post Therapy Path (yp) as 9 (unknown) per Note 5. Code H would not be used since the histology was not an urothelial histology

Note 3 Assign the highest grade from the resected primary tumor assessed after the completion of neoadjuvant therapy.

Note 4 If there are multiple tumors with different grades abstracted as one primary, code the highest grade.

Note 5 Priority order for codes

• Urothelial cancers (WHO/ISUP grade) use codes L, H and 9
  + If only G1-G3 are documented, code 9
• Adenocarcinomas and Squamous Cell Carcinomas use codes 1-3, 9
  + If only L or H are documented, code 9

Note 6 G3 includes undifferentiated and anaplastic.

Note 7 For bladder, a TURB does not qualify for surgical resection. A cystectomy, or partial cystectomy, must be performed

Note 8 Use the grade from the post therapy clinical work up from the primary tumor in different scenarios based on behavior or surgical resection

• Behavior
• Tumor behavior for the post therapy clinical and the post therapy pathological diagnoses are the same AND the post therapy clinical grade is the highest grade
• Tumor behavior for post therapy clinical diagnosis is invasive, and the tumor behavior for the post therapy pathological diagnosis is in situ
• Surgical Resection
• Surgical resection is done of the primary tumor after neoadjuvant therapy is completed and there is no grade documented from the surgical resection
• Surgical resection is done of the primary tumor after neoadjuvant therapy is completed and there is no residual cancer

Note 9 Code 9 (unknown) when

• Surgical resection is done after neoadjuvant therapy and grade from the primary site is not documented
• Surgical resection is done after neoadjuvant therapy and there is no residual cancer
• Grade checked "not applicable" on CAP Protocol (if available) and no other grade information is available