Scenario:
- 09-01-2024 CT Abdomen/Pelvis: A 1.8 cm left superior pole complex cystic lesion with hyper enhancing solid nodular component with washout concerning for renal cell carcinoma (Bosniak IV). No retroperitoneal lymphadenopathy. Bilateral renal veins are patent.
- 09-15-2024 H&P: 51 YO Married White Non-Hispanic Female with 1.8 cm left renal lesion concerning for renal cell carcinoma -Plan: To OR for left partial nephrectomy
- 09-15-2024 Op Note: Left partial nephrectomy: 2-cm left anterior superior cystic mass excised with grossly negative margins
- 09-15-2024 Path Report: Left Partial Nephrectomy- 1.8cm Clear cell papillary renal cell carcinoma G2 limited to kidney, margins negative pT1a pNx
Question: Can this patient be clinically staged cT1a, cN0 cM0 Stage 1?
- Yes
- No
Answer: Yes
Even though there was no definitive diagnosis of RCC, the mass was known prior to resection. Our registry rules for date of diagnosis sometimes do not align with AJCC staging rules-at the date of surgery the mass was clinically known. Remember not to mix and match the rules for different fields. Don’t get hung up on the fact that the scans used ambiguous terminology, that is not an issue for AJCC Staging in this case. Yes, the date of diagnosis will be 09-15-2024 because that is the first date there was terminology used diagnostic of malignancy. However, the case is still eligible for clinical stage because the physician thought this was going to be cancer prior to the definitive surgical resection, it wasn’t a total incidental finding or surprise at surgery. We can use the information from the 9-01-2024 scan to clinically stage this kidney case.
Review AJCC 8th Edition Chapter 1 page 14 the section on Known or suspected tumor, to clinically stage, the cancer must be suspected, and the workup must at least include a history and physical examination.
Review AJCC 8th Editon Chapter 60 Kidney, the rules for clinical classification of renal cell carcinoma of the kidney- only a clinical exam or imaging is required, a biopsy may not be necessary if surgical resection is planned as was in our scenario.
Review the Do Not Use Registry Ambiguous Terminology for AJCC Staging webinar which explains why registry ambiguous terminology is not appropriate for AJCC staging and cannot be used, you must look at the whole picture.