神经内分泌肿瘤的形态学编码探讨

Morphological Coding Analysis of Neuroendocrine Neoplasms

肿瘤形态学编码是ICD-10肿瘤疾病编码的重要组成部分。神经内分泌肿瘤是一类相对少见但具有高度异质性的肿瘤,可发生在身体的各个器官和组织,其中胃、肠、胰腺等消化系统最为常见。按照传统的五步法编码,许多神经内分泌肿瘤疾病无法找到合适的形态学编码。本文梳理了神经内分泌肿瘤最新的病理诊断分类与分级标准共识,包括分化良好的神经内分泌瘤、分化较差的神经内分泌癌、混合性神经内分泌-非神经内分泌肿瘤三种类型。针对消化系统中的胰腺、肠、胃、肝及非消化系统中肺、乳腺等部位的具体神经内分泌肿瘤类型,按照三种病理类型所包含的各种疾病的病理名称,分别依据《疾病分类与代码国家临床版2.0》肿瘤形态学编码目录一一匹配出合适的形态学编码。这种列举匹配的方法相比传统的肿瘤形态学编码查找步骤,能更好地满足不断更新的神经内分泌肿瘤疾病的形态学编码需求,有利于提高编码准确性。

Tumor morphological coding is an important part of ICD-10 tumor disease coding.Neuroendocrine tumors are relatively rare but highly heterogeneous tumors that can occur in various organs and tissues of the body,among which the digestive system,such as the stomach,intestine,and pancreas,is the most common.Appropriate morphological codes cannot be found for many neuroendocrine tumor diseases following the traditional five-step coding.In this paper,we reviewed the consensus of the latest pathological diagnostic classification and grading criteria of neuroendocrine tumors,including well-differentiated neuroendocrine tumors,poorly differentiated neuroendocrine cancers,and mixed neuroendocrine non-neuroendocrine tumors.For neuroendocrine tumors of the pancreas,intestine,stomach,and liver in the digestive system and lung and breast in the non-digestive system,appropriate morphological codes are matched one by one according to the pathological names of various diseases contained in the three pathological types according to the morphologic coding directory of tumor in National Clinical Edition 2.0 of Classification and Code of Diseases.Compared with the traditional tumor morphological coding search steps,this enumerating and matching method meets the constantly updated morphological coding requirements of neuroendocrine tumors and diseases better and is beneficial to improve the accuracy of coding.