Keywords: Genetics; ICD-O; international statistical classification; oncology; orthopaedic codes; tumour biology; Turkish version of ICD-O
The first step at clinical oncology is taking biopsy
specimen from the tumour then sending it to the
pathology department for histologic diagnosis. Pathological
diagnosis is the most important step in clinical
oncology, orienting the treatment and prognosis of
the patient. This diagnosis must firstly be reliable and
scientific; secondly, it must be reported in a language
that can be understood worldwide. This coding system
is updated regularly as it is dependent on the new
information gathered from scientific developments,
especially the genetic studies, so enhancing the reliability of pathology diagnostics from accredited
pathology departments. This coding system firstly
enables us to make a correct diagnosis, prognosis because
of regular updates on both cancer terms and biological
behaviour of tumours, and secondly gives us
the chance to report it at a common language "coding
system" recognized worldwide. This helps clinicians to
adopt uniform terminology so facilitating their communication
with each other.[
Dr. Canda has been working on the Turkish version
of ICD-O for the last three decades,[
The coding usage has been made obligatory by
WHO since 1976. Besides public health, especially in
the fight against cancer in Turkey, its purpose was to get
scientific and social benefit in the field of cancer registry,
and its use was made mandatory by the Turkey Ministry
of Health in 2015, in all hospitals, healthcare facilities
and university hospitals within Turkey.[
ICD-O Third Edition First Revision
Definition
ICD-O consists of three sections, Topography index,
Morphology index and an alphabetic index.
Topography code includes four character code between
C00.0-C80.9 (C "site"."subsite").
Example C40. 2 hand. carpal bone.
A separate last digit describes the degree of the
histologic differentiation (1 well, 2 moderate, 3 less, 4
none, 9 not defined).[
M- ----(cell type)/-(behaviour)-(differentiation)
Example: 9186/3 Osteosarcoma/malign.
Topography Codes of the Musculoskeletal
System[
• C49: Connective tissue (adipose, aponeurosis, vessels,
fascia, fibrous tissue, ligaments, lymphatics,
muscle, synovia, subcutaneous tissue, tendon)
C49.1 Upper extremity, shoulder connective tissue
C49.2 Lower extremity, hip connective tissue
C49.5 Pelvis
Morphology Codes of the Musculoskeletal System
[
889-892 Myomatous "e.g.: Leiomyosarcomas"
904 Synovium,
• Bone-cartilage tumours (918-924).
Osteosarcoma: Chondroblastic, fibroblastic, telangiectatic,
secondary to Paget disease, small cell, central,
intraosseous-well differentiated, parosteal, periosteal,
high grade superficial, intracortical.
Chondrosarcoma: Juxtacortical, myxoid, mesenchymal,
clear cell, de-differentiated
• Giant cell tumours (925)
The alphabetic index is used to code both topography
and morphology terms. It is located after topography
and morphology indices. First stage is that the
pathologist puts the relevant updated diagnosis and
sends the diagnosis to the surgeon. Diagnosis, e.g., central
osteosarcoma, could be further searched at alphabetic
index depending on both the noun "osteosarcoma"
or the adjective "central". Possible morphology and topography
codes are listed under the bold keyword.
Further detailed topography or morphology codes can
then be searched and found through the topography or
morphology indices, and then the final 10 digit code
can be reported.
Example: Pathology report: Humerus central osteosarcoma:
Topography index:
Acromioclavicular joint
Orthopaedic Tumors Update at 3rd Edition First
Revision of ICD-O
International Classification of Diseases for Oncology
(ICD-O) third edition first revision has been created
by WHO in 2013. Many revisions have been made at
this most recent edition, especially for the morphologic
codes of the tumours. It is a classification of
tumours consisting of a coding system that includes
10 digits, which consist of the topography section (4
digits) and the morphology section (6 digits; "4 digits;
cell type" "histology", 1 digit; biologic behaviour, 1
digit; differentiation or degree of neoplasm).[
Topography code gives the origin of the tumour,
while morphology code gives the biological activity of
the tumour.
Morphology code is a code number that is between
8000/0 and 9989/1, consisting of six digits. The first
four digits describe the tumor cell type, the fifth digit
after the slash describes the biologic behaviour codes
(/0 benign, /1 unknown, /2 In situ, /3 malign, /4 metastasis,
/9 malign primary or metastatic unknown).
• C40: Bone, joint and cartilage
C40.0: Upper extremity long bones, scapula, related
joints, C40.1: Upper extremity short bones and
joints "thumb, wrist, hand"). C40.2 lower extremity long
bones, 3: Lower extremity short bones.
• Soft tissue tumours
880 (sarcomas),
881-883 Fibromatous neoplasms "e.g., fibrosarcoma,
fibromatosis",
884 Myxomatous lesions,
885-888 Lipomatous lesions "e.g., liposarcomas well
differentiated, myxoid, round cell, pleomorphic,
mixed, fibroblastic, differentiated",
912-916 Vessels "e.g.: Angiosarcomas",
917 Lymphatics "e.g.: Hemangiomas".
• Other bone tumours (926) "e.g.: 9260/3 Ewing sarcoma".
Alphabetic index:
O "letter"
Osteosarcoma
,9186/3 central (C40._, C41._)
9186/3 central, conventional
9181/3 chondroblastic (C40._, C41._)
9182/3 fibroblastic (C40._, C41._)
9184/3 in Paget disease, bone (C40._, C41._)
C40.0 Long bones of upper limb, scapula and associated
joints.
Bone of arm
Bone of forearm
Bone of shoulder
Elbow joint
Humerus
Radius
Scapula
Shoulder girdle
Shoulder joint
Ulna
Final code is 9186/3 (C.40.0).
While all topography or localization codes remain the
same as in the previous second edition, morphology or
histopathology codes have been thoroughly reviewed
and, where necessary, revised to increase their diagnostic
precision and prognostic value due to recent cellular
and genetic studies.[
Cancer registry centres and health statistics must depend on true data driven from true diagnosis. These codes and/or pathologic diagnosis are updated regularly dependent on recent immune-histopathologic, genetic studies. Thus, this coding system, common language worldwide, the sign of scientific development, enables clinicians to detect cancer early and true diagnosis.
Clinicians and pathologists must share this common
language to build the true cancer data registry.
The first step is true pathology diagnosis dependent on this updated system incorporating recent diagnostic
terms and cancer types and then reporting this as
a pathology result, in this well-known and worldwide
shared coding system to the treating surgeon or oncologist
then starting appropriate treatment and this team
(pathologist and oncologist or surgeon) will then report
this case at this particular system to build up national
or international database. The recent studies still
show inconsistencies between sarcoma codes reported
by the treating surgeon and pathology reports. That
only 61.8% of the cases were correctly coded by ICD-9
and ICD-10 codes and 59.8% of cases were correctly
coded by ICD-O-3. By subspecialty, only 72% of orthopaedic
oncology codes were coded accurately. Most
wrong coding"s were made due to organ site rather than
type of malignancy (e.g., gastric cancer instead of gastric
gastrointestinal stromal tumour).[
Japan registry, one of the biggest cancer registries in
the world, depending on ICD-O codes, reported chondrogenic
tumours, especially the osteochondromas,
as the most common benign bone tumour, peaking in
10-19 years of age. The most common malignant bone
tumour was osteogenic tumours, in long bones of the
lower limb at teenagers, the second was chondrogenic
tumours. They cited giant cell tumours as intermediate
tumours peaking at 20-29 years of age.[
This was similar for Turkey in that regional prevalence
studies also pointed out cartilaginous tumours as
number one for benign bone tumour while osteosarcoma
for malign tumours.[
Being one of the oldest tumour registry, build in
1958, depending on ICD codes, the Swedish registry
also pointed out diagnostic differences from time
to time that from 1958 to 1982 ratio of malignant to
benign giant cell dropped from 1.3 to 0.09, probably
due to failure of distinguishing giant cell containing
osteosarcomas with malignant giant cell tumours.[
One of the most useful advantages of using the ICD-O
coding system and keeping pathologists and treating
physicians updated about the most recent information
present at the regularly updated ICD-O coding system
is giving countries a chance to build their own tumour
registries. Like the above mentioned epidemiological
studies performed in developed countries dependent
on their national tumour registry by the usage of ICD-O
coding system they must also be built and started to be
used at developing countries later that would let them be
able to talk the international language.
National tumour registries have to be built up that
are dependent on data driven from worldwide accepted,
regularly updated coding system and coded together by teams at least consisting of treating clinician
and pathologist.
This coding system not only enables us to share the common language among clinicians and researchers, also permits us to build national cancer data, with the new codes and diagnostic terms introduced being also important in influencing patient"s treatment and prognosis.
Peer-review: Externally peer-reviewed.
Conflict of Interest: Authors declare no conflict of interest.
Financial Support: No financial support has been used for this study.
