Breast - CS Extension

Note 1: Changes such as dimpling of the skin, tethering, and nipple retraction are caused by tension on Cooper's ligament(s), not by actual skin involvement. They do not alter the classification.
Note 2: Consider adherence, attachment, fixation, induration, and thickening as clinical evidence of extension to skin or subcutaneous tissue, code 200.
Note 3: Consider fixation, NOS as involvement of pectoralis muscle, code 300.
Note 4: If CS Extension code is 000, then Behavior code must be 2; if CS Extension code is 050 or 070, then Behavior code may be 2 or 3; and if CS Extension code is 100, then Behavior code must be 3.
Note 5: Inflammatory Carcinoma: AJCC includes the following text in the Cancer Staging Manual 7th Edition: "Inflammatory carcinoma is a clinicopathologic entity characterized by diffuse erythema and edema (peau d'orange) of the breast, often without an underlying palpable mass. These clinical findings should involve the majority of the skin of the breast. Classically, the skin changes arise quickly in the affected breast. Thus the term of inflammatory carcinoma should not be applied to a patient with neglected locally advanced cancer of the breast presenting late in the course of her disease. On imaging, there may be a detectable mass and characteristic thickening of the skin over the breast. This clinical presentation is due to tumor emboli within dermal lymphatics, which may or may not be apparent on skin biopsy. The tumor of inflammatory carcinoma is classified T4d. It is important to remember that inflammatory carcinoma is primarily a clinical diagnosis. Involvement of the dermal lymphatics alone does not indicate inflammatory carcinoma in the absence of clinical findings. In addition to the clinical picture, however, a biopsy is still necessary to demonstrate cancer either within the dermal lymphatics or in the breast parenchyma itself."
Note 6: For CS coding, the abstractor should record a stated diagnosis of inflammatory carcinoma, and also record any clinical statement of the character and extent of skin involvement in the text area. Code 600 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement is less than one-third (33%) of the skin of the breast. Code 725 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement is greater than or equal to one-third (33%) and less than or equal to one-half (50%) of the skin of the breast. Code 730 should be used if there is a stated diagnosis of inflammatory carcinoma and a clinical description of the skin involvement in more than one-half (50%) (majority or diffuse) of the skin of the breast. Cases with a stated diagnosis of inflammatory carcinoma but no such clinical description should be coded 750. A clinical description of inflammation, erythema, edema, peau d'orange, or other terms describing skin changes without a stated diagnosis of inflammatory carcinoma should be coded 512-585 depending on described extent of the condition.

^ For CS Extension codes 100-140, 200, and 300 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this schema.
* For CS Extension codes 100-140, 200, and 300 ONLY, the T category is assigned based on value of CS Tumor Size as shown in the Extension Size Table for this schema.
** For CS Extension codes 050 and 070 ONLY, Summary Stage 1977 and Summary Stage 2000 are assigned based on the value of Behavior Code ICD-O-3 as shown in the Extension Behavior Table for this schema.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
000	In situ: noninfiltrating; intraepithelial Intraductal WITHOUT infiltration Lobular neoplasia	Tis	Tis	IS	IS
050	Paget disease of nipple WITHOUT underlying tumor	Tis	Tis	**	**
070	Paget Disease disease of nipple WITHOUT underlying invasive carcinoma pathologically	Tis	Tis	**	**
100	Confined to breast tissue and fat including nipple and/or areola Localized, NOS	^	*	L	L
110	Stated as T1mi with no other information on extension	^	*	L	L
120	Stated as T1a with no other information on extension	^	*	L	L
130	Stated as T1b with no other information on extension	^	*	L	L
140	Stated as T1c with no other information on extension	^	*	L	L
170	Stated as T1 [NOS] with no other information on extension or size	T1NOS	T1NOS	L	L
180	Stated as T2 with no other information on extension or size	T2	T2	L	L
190	Stated as T3 with no other information on extension or size	T3	T3	L	L
200	Invasion of subcutaneous tissue Local infiltration of dermal lymphatics adjacent to primary tumor involving skin by direct extension Skin infiltration of primary breast including skin of nipple and/or areola	^	*	RE	RE
300	Attachment or fixation to pectoral muscle(s) or underlying tissue Deep fixation Invasion of (or fixation to) pectoral fascia or muscle	^	*	RE	RE
380	OBSOLETE DATA CONVERTED V0203 See code 790 Stated as T4 [NOS] with no other information on extension	ERROR	ERROR	ERROR	ERROR
390	OBSOLETE DATA CONVERTED V0203 See code 410 Stated as T4a with no other information on extension	ERROR	ERROR	ERROR	ERROR
400	Invasion of (or fixation to): Chest wall Intercostal or serratus anterior muscle(s) Rib(s) See codes 610 (obsolete), 612-615, and 620 (obsolete) for combinations with this code	T4a	T4a	RE	RE
410	Stated as T4a with no other information on extension	T4a	T4a	RE	RE
510	OBSOLETE DATA RETAINED V0200 Extensive skin involvement, including: Satellite nodule(s) in skin of primary breast Ulceration of skin of breast Any of the following conditions described as involving not more than 50% of the breast, or amount or percent of involvement not stated: Edema of skin En cuirasse Erythema Inflammation of skin Peau d'orange ("pigskin")	ERROR	T4b	RE	RE
512	Extensive skin involvement, including: Satellite nodule(s) in skin of primary breast Ulceration of skin of breast	T4b	T4b	RE	RE
514	Any of the following conditions described as involving less than one-third (33%) of the breast WITHOUT a stated diagnosis of inflammatory carcinoma WITH or WITHOUT dermal lymphatic infiltration: Edema of skin En cuirasse Erythema Inflammation of skin Peau d'orange ("pigskin")	T4b	T4b	RE	RE
516	514 + 512	T4b	T4b	RE	RE
518	Any of the following conditions described as involving one third (33%) or more but less than or equal to half (50%) of the breast WITHOUT a stated diagnosis of inflammatory carcinoma WITH or WITHOUT dermal lymphatic infiltration: Edema of skin En cuirasse Erythema Inflammation of skin Peau d'orange ("pigskin")	T4b	T4b	RE	RE
519	518 + 512	T4b	T4b	RE	RE
520	Any of the following conditions described as involving more than 50% of the breast WITHOUT a stated diagnosis of inflammatory carcinoma WITH or WITHOUT dermal lymphatic infiltration: Edema of skin En cuirasse Erythema Inflammation of skin Peau d'orange ("pigskin")	T4b	T4b	RE	RE
575	520 + 512	T4b	T4b	RE	RE
580	Any of the following conditions with amount or percent of breast involvement not stated and WITHOUT a stated diagnosis of inflammatory carcinoma WITH or WITHOUT dermal lymphatic infiltration: Edema of skin En cuirasse Erythema Inflammation of skin Peau d'orange ("pigskin")	T4b	T4b	RE	RE
585	580 + 512	T4b	T4b	RE	RE
590	OBSOLETE DATA CONVERTED V0203 See code 605 Stated as T4b with no other information on extension	ERROR	ERROR	ERROR	ERROR
600	Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving less than one-third (33%) of the skin of the breast, WITH or WITHOUT dermal lymphatic infiltration	T4b	T4d	RE	RE
605	Stated as T4b with no other information on extension	T4b	T4b	RE	RE
610	OBSOLETE DATA RETAINED V0200 (400) + (510)	ERROR	T4c	RE	RE
612	Any of (512-516) + 400	T4c	T4c	RE	RE
613	Any of (518-519) + 400	T4c	T4c	RE	RE
615	Any of (520-585) + 400	T4c	T4c	RE	RE
620	OBSOLETE DATA RETAINED V0200 (400) + (520)	ERROR	T4c	RE	RE
680	Stated as T4c with no other information on extension	T4c	T4c	RE	RE
710	OBSOLETE DATA RETAINED V0200 Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving not more than 50% of the skin of the breast, WITH or WITHOUT dermal lymphatic infiltration Inflammatory carcinoma, NOS Previous wording (V0100): Diagnosis of inflammatory carcinoma WITHOUT a clinical description of inflammation, erythema, edema, peau d'orange, etc., of more than 50% of the breast, WITH or WITHOUT dermal lymphatic infiltration Inflammatory carcinoma, NOS	ERROR	T4d	RE	RE
715	OBSOLETE DATA RETAINED V0202 Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving not more than one-third (33%) of the skin of the breast, WITH or WITHOUT dermal lymphatic infiltration	T4b	T4d	RE	RE
720	OBSOLETE DATA CONVERTED V0102 Description: Diagnosis of inflammatory carcinoma WITH a clinical diagnosis of inflammation, erythema, edema, peau d'orange, etc., of not more than 50% of the breast, WITH or WITHOUT dermal lymphatic infiltration Inflammatory carcinoma, NOS NOTE: Code 720 has been combined with code 710. Any cases coded to 720 should be re-coded to code 710. Previous wording (V0100): Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc. of LESS THAN OR EQUAL TO 50% of the breast, WITH or WITHOUT dermal lymphatic infiltration	ERROR	ERROR	ERROR	ERROR
725	Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving one-third (33%) or more but less than or equal to one-half (50%) of the skin of the breast, WITH or WITHOUT dermal lymphatic infiltration	T4d	T4d	RE	RE
730	Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., involving more than one-half (50%) of the skin of the breast, WITH or WITHOUT dermal lymphatic infiltration	T4d	T4d	RE	RE
750	Diagnosis of inflammatory carcinoma WITH a clinical description of inflammation, erythema, edema, peau d'orange, etc., but percent of involvement not stated, WITH or WITHOUT dermal lymphatic infiltration. Note: If percentage is known, code to 600, 725, or 730. Diagnosis of inflammatory carcinoma WITHOUT a clinical description of inflammation, erythema, edema, peau d'orange, etc., WITH or WITHOUT dermal lymphatic infiltration Inflammatory carcinoma, NOS	T4d	T4d	RE	RE
780	Stated as T4d with no other information on extension	T4d	T4d	RE	RE
790	Stated as T4 [NOS] with no other information on extension	T4NOS	T4NOS	RE	RE
950	No evidence of primary tumor	T0	T0	U	U
999	Unknown; extension not stated Primary tumor cannot be assessed Not documented in patient record	TX	TX	U	U