Solid Tumor Rules Changes for 2022 – Breast

Misalignment of the Eyes Whats That -2

Effective September 1, 2021, for all cases diagnosed January 1, 2022 and forward. 

One of the most popular manuals used daily by cancer registrars is the Solid Tumor Rules. This manual helps determine which histology to use and the number of primaries to abstract when a patient has multiple biopsies and diagnoses. The Solid Tumor Rules manual, previously known as “The 2007 Multiple Primary and Histology Coding Rules” was “developed to promote consistent and standardized coding by cancer registrars.” With the newer, Solid Tumor Rules manual, rules were developed “to provide coding instructions to ensure accurate data collection,” by all registrars while abstracting. 2018 saw major changes among eight top sites. In September 2021, newer more updated changes were made for cases effective, January 1, 2022. These changes effected head and neck, colon, lung, kidney, urinary, breast and other sites. Last week we covered several of the changes made for the head and neck cancer section. This week we will be covering several changes made to the breast cancer section. 

Per the “September 2021 Revision History for Solid Tumor Rules” and the “Breast Solid Tumor Rules,” the following new changes have been revised for the breast section. 

Terms that are NOT Equivalent or Equal 

  • NEW Terms Added: “Invasive carcinoma, NST with lobular features is not equivalent to invasive carcinoma with ductal and lobular features” 

Table 3: Specific Histologies, NOS/ NST, and Subtypes/Variants

  • Carcinoma NST 8500 row: 
    • NEW Synonyms added (See synonyms column):
      • Carcinoma/carcinoma NST with neuroendocrine features
      • DCIS of high nuclear grade 8500/2
      • DCIS of intermediate nuclear grade 8500/2
      • DCIS of low nuclear grade 8500/2
      • Duct/ductal carcinoma with neuroendocrine features
      • Invasive carcinoma with medullary features 8500/3
      • Invasive carcinoma with neuroendocrine features 8500/3
      • Invasive mammary carcinoma NST with neuroendocrine features 8500/3 
    • NEW Subtype/variants added (See subtypes/variants column): 
      • Ductal carcinoma in situ, solid type/intraductal carcinoma, solid type 8230/2 
      • Solid carcinoma/solid adenocarcinoma 8230/3 Carcinoma NST 8500 row:
    • NEW Synonym added for cribriform carcinoma 8201/3:
      • Ductal carcinoma, cribriform type 
  • Lobular carcinoma 8520 row:
    • NEW Synonym added (See synonyms column):
      • Florid lobular carcinoma 8520/2
  • Papillary carcinoma 8503 row:
    • NEW Synonyms added (See synonyms column):
      • Invasive ductal papillary carcinoma 8503/3
      • Papillary carcinoma of breast, NOS 8503/3 
    • NEW Subtype/variant added (See subtypes/variants column): 
      • Tall cell carcinoma with reverse polarity 8509/3
  • Sarcoma NOS 8800/3 row:
    • Angiosarcoma note modified: “Hemangiosarcoma” removed from note (it is not a subtype of angiosarcoma, it is a synonym)
    • NEW Synonym added for angiosarcoma 9120/3:
      • Epithelioid angiosarcoma 

Histology Rules 

  • H rule: Code metaplastic carcinoma, NOS, or subtype/variant of metaplastic carcinoma, NOS when invasive carcinoma…
    • “Or invasive lobular carcinoma” added to rule statement


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