| Scenario
{Partial Snips of Synoptic Reports} |
AJCC Path N Category | Rationale |
| Procedure Total thyroidectomy
Tumor Focality Unifocal Tumor Site Left lobe Histologic Type Papillary carcinoma, classic ….. Regional Lymph Node Not applicable (no regional lymph nodes submitted or found) PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) pT Category pT1a pN Category pN not assigned (no nodes submitted or found)
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pNX | Pathologists no longer use TX or NX-since June 2021. For some reason registrars are confusing this practice done by pathologist and leaving the pN Category Blank in the registry abstract. This is incorrect for a registrar. Registrars must use registry rules when assigning AJCC TNM categories in the registry abstract. If the case meets the eligibility criteria for pathologic staging and there are no lymph nodes removed, then a registrar will assign a pNX in the path N category.
Refer to AJCC Registrar Education Blank Vs X definitions and Data Interpretation for AJCC Staging https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/staging-education/registrar/ |
| [Physical exam showed no lymphadenopathy]
Tumor Site Skin of trunk Histologic Type Melanoma, NOS (Breslow) Thickness 0.2mm (residual) mm Ulceration Not identified Anatomic (Clark) Level II REGIONAL LYMPH NODES Regional Lymph Node Status Not applicable (no regional lymph nodes submitted or found) PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) pT Category pT1a pN Category pN not assigned (no nodes submitted or found) |
cN0 | This case does meet the eligibility criteria for pathologic staging-the primary site was resected, but no nodes were removed. In this instance instead of assigning a pNX we can assign a cN0. There are certain site/histology combinations/situations when you can assign a cN0 in the path N category. This is one of those situations, for Melanoma pT1 cases can be assigned a cN0. For a complete list of Sites where Node Status Not required in Rare Circumstances refer to the AJCC Registrar Education refer to Critical Clarifications Document entitled Node Status & AJCC 8th Edition Melanoma Staging https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/staging-education/registrar/
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| CT Ab/Pelvis: Multiple hypoattenuating hepatic masses highly concerning for metastasis. Prominent mesenteric and aortocaval lymph nodes concerning for nodal metastasis
Colonoscopy with biopsy: ULCERATED COLON MASS AT 15 CM, BIOPSY: INVASIVE ADENOCARCINOMA
Liver biopsy: Metastatic colonic adenocarcinoma
Clinical AJCC Stage is cTX cN BLANK pM1a Stage 4A |
Leave it BLANK | This case meets the eligibility requirements for pathologic stage- because there is microscopic proof of mets, therefore we may assign the path T & N categories clinically. [Refer to Chapter 1 of the AJCC Manual top of page 17 2nd column].
The Path Stage will be assigned as cTX pN BLANK pM1a Stage 4A
The reason cTX the colonoscopy does not provide enough information to access how far the tumor extended, please refer to the resources below. AJCC Curriculum for Registrars https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/staging-education/registrar/ • Refer to Lesson 23
The reason cN BLANK is Nodes are positive, but it is unknown the exact number of nodes positive. For Colon & Rectum to properly assign N category need to know # of nodes positive. When using data for analysis, you cannot mix in this type of uncertain data without skewing the results. To make data useful, it must be accurate. Since the registrar does not know the exact #of nodes positive, leave this field BLANK.
Refer to AJCC Registrar Education Blank Vs X definitions and Data Interpretation for AJCC Staging https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/staging-education/registrar/
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| CT Ab/Pelvis: Multiple hypoattenuating hepatic masses highly concerning for metastasis. Prominent mesenteric and aortocaval lymph nodes concerning for nodal metastasis
Colonoscopy with biopsy: ULCERATED COLON MASS AT 15 CM, BIOPSY: INVASIVE ADENOCARCINOMA
Clinical AJCC Stage is cTX cN BLANK cM1a Stage 4A
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Leave it BLANK | Do NOT assign pTX pNX cM1a for path stage- This case does NOT MEET the criteria for pathological stage. No primary site resection, no microscopic evidence of mets, thus leave Path TNM BLANK Stage 99.
Refer to AJCC Registrar Education Blank Vs X definitions and Data Interpretation for AJCC Staging https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/staging-education/registrar/
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Resources to further expand your knowledge on how to assign AJCC TNM Categories and Stage Groups
Refer to AJCC Cancer Registry Education
Critical Clarifications
- Quick 1 page resource
- In situ neoplasia
- Node Status
- AJCC 8th Edition Melanoma Staging
AJCC Curriculum for Registrars
- Module I Introduction Lesson 1-7
- Module II: Beginning Lesson 8-14
- Module III: Intermediate Lesson 15-21
- Module IV Advances Lesson 22-28
AJCC 8th Edition Webinars
- Eighth Edition Overview
- Introduction and Descriptors
- Minor Rule Changes
- Major Rule Changes
- CAnswer Forum and Staging Questions
- Head and Neck Staging
- Breast Staging
- Breast AJCC 8th Edition Staging
- Colon and Rectum AJCC 8th Edition Staging
- Melanoma AJCC 8th Edition Staging
- Prostate AJCC 8th Edition Staging
AJCC Version 9 Webinars
- AJCC Cervix Uteri-Version 9 Cancer Staging System
Principles of Cancer Staging
- Blank vs X Definitions and Data Interpretation for AJCC Staging
- Do Not Use Registry Ambiguous Terminology for AJCC Staging
- AJCC yc Stage Classification and How to Use it