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. Assign Grade Post Therapy Path (yp) using the applicable generic grade codes (A-D).

• Example Neoadjuvant therapy completed. Biopsy shows a GIST tumor. Grade stated as Low based on less than 5 mitoses per 5 square mm. The surgical resection states a moderately differentiated GIST tumor
• Code Grade Post Therapy Clin (yc) as L since grade is based on the mitotic rate, which is the preferred grading system
• Code Grade Post Therapy Path (yp) as B for moderately differentiated, per the Coding Guidelines for Generic Grade Categories

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 Codes L and H take priority over A-D.

Note 6 Record the mitotic rate as Low or High as indicated on the pathology report or CAP protocol. Assume the denominator is 5 square mm if not specified.

• Low 5 or fewer mitoses per 5 square mm (L)
• High Over 5 mitoses per 5 square mm (H)

Note 7 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 8 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

Note 9 If you are assigning an AJCC 8th edition stage group

• Grade is required to assign stage group
• Codes A-D are treated as an unknown grade when assigning AJCC stage group
• An unknown grade may result in an unknown stage group