Transitioning the Annotated Histology List to Cancer PathCHART



  • Richard Moldwin, MD, PhD, Lead Physician Informaticist College of American Pathologists
  • Michelle Esterly, RHIA, CTR, Katmai Government Services Contractor to the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control  National Program of Cancer Registries (NPCR)

NAACCR is proud to be involved with Cancer PathCHART, a multi‐organizational project alongside eleven other global organizations.

Cancer PathCHART (CPC) is a multi-organizational project involving eleven North American and global organizations, including NAACCR, that validates and converts data standards from many cancer registry sources into a centrally accessible database. An internet portal provides access to the database. The NAACCR Annotated List (AL) contains a large amount of standardized information for reporting and histology coding and is used to power registry software. The AL‐CPC project team is converting the AL to a more computer‐readable format for use in CPC.

History of the Current Annotated Histology List

The AL has been posted on the NAACCR website and is primarily used as a resource for the cancer registry community. The intent of the AL is to:

  1. Help registry software vendors use pick-lists or quality control of existing pick-lists for ICD‐O3 histologies
  2. Provide helpful annotations to cancer registrars for use in abstracting and coding validation.

This file has been maintained by the Registry Plus team at CDC’s NPCR for several years and reflects modifications to ICD‐O‐3 implemented by North American cancer registries over time. The AL is comprehensive and includes codes that were replaced or made obsolete over time. One histologic term is flagged as the preferred term, and synonyms and related terms are incorporated. Multiple entries with permutations of words are listed multiple times with different word order to account for variations specified in medical documentation. Data sources include ICD‐O‐3.2, NAACCR ICD‐O‐3 Implementation Guidelines and documentation, and WHO Classification of Tumours (Who Blue Books). The AL is updated for each NAACCR version based on content changes identified in recently published WHO Blue Books and approved by the NAACCR ICD‐O‐3 Workgroup.

Current Activities

The AL has been used for the CPC Annotated List. Work is underway to harmonize and integrate the information into a standardized relational database of tumor histology terminology to serve all standard‐setting organizations throughout the cancer registry community.

The following tasks are being performed:

  • Validating content against original NAACCR, NPCR, WHO, and SEER source material.
  • Developing connections with other CPC database tables to standardize new and historical registry data.
  • Merging AL‐CPC‐derived database tables into a common and compatible CPC format.
  • Transforming AL data into highly specific new data columns that precisely reflect the varied kinds of information in the AL annotations. Examples include: columns for reporting start/stop dates, term types (e.g., new synonyms and related terms for existing codes), and code/behavior reclassification.
  • Reviewing synonyms and validating terms with appropriate resources such as the ICDO‐3.2 list, and new entries derived from the WHO Blue Books.

Future Plans

The target initial implementation for the first group of CPC products for the NAACCR community is January 2024.

Cancer PathCHART will help cancer registrars, clinicians, pathologists, researchers, and developers use the same coding standards, helping cancer surveillance more accurately reflect medical practice.

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