Grade Post Therapy Clin (yc) (Brain (V9 2023+))

Note 1 Leave Grade Post Therapy Clin (yc) blank when

• No neoadjuvant therapy

• Clinical or pathological case only

• Neoadjuvant therapy completed, no microscopic exam is done prior to surgery/resection of primary tumor

• 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 Assign the highest grade from the microscopically sampled specimen of the primary site following neoadjuvant therapy or primary systemic/radiation therapy.

Note 3 If there are multiple tumors with different grades abstracted as one primary, code the highest grade.

Note 4 Codes 1-4 take priority over A-D, L and H.

Note 5 CNS WHO classifications use a grading scheme that is a "malignancy scale" ranging across a wide variety of neoplasms rather than a strict histologic grading system that can be applied equally to all tumor types.

• Code the WHO grading system for selected tumors of the CNS as noted in the AJCC 8th edition Table 72.2 when WHO grade is not documented in the record
  + A list of the histologies that have a default grade can also be found in the Brain/Spinal Cord CAP Protocol in Table 1 WHO Grading System for Some of the More Common Tumors of the CNS, Table 2 WHO Grading System for Diffuse Infiltrating Astrocytomas and Table 3 WHO Grading Meningiomas
  https//www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates

• For *benign tumors ONLY (behavior 0), * code 1 can be automatically assigned for all histologies
  + This was confirmed by the CAP Cancer Committee

Note 6 Code 9 (unknown) when

• Microscopic exam is done after neoadjuvant therapy and grade from the primary site is not documented

• Microscopic exam 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