Now that we have everyone on board with coding pTis in the clinical T category for AJCC 7th edition, 2018 comes in like a lion and brings along the AJCC 8th edition manual.
Requirements are changing, rules are changing, coding is changing. We as CTR’s are expected to adapt to the new rules and implement these changes.
The “In Situ Rule” is one big change we will all need to adapt to: ALL diagnostic biopsies are cT regardless of in situ or invasive cancer.
- In situ neoplasia and noninvasive papillary ca identified during diagnostic workup on core or incisional biopsy is assigned: cTis or cTa.
- Insitu neoplasia and noninvasive papillary ca identified from surgical resection specified in disease site OR identified microscopically in diagnostic workup with no residual in surgical resection is assigned: pTis or pTa.
Historically:
- pTis emphasized the need for microscopic/histologic evidence of in situ.
- Diagnosis of in situ could never be made on imaging alone.
Changing clinical T category to cTis indicates:
- Diagnosis was made on core needle or incisional biopsy.
- NOT based on complete examination of surgical resection specimen.
Pathologic T category will remain pTis:
- Based on surgical resection of specimen.
In Situ Stage Group 0:
- cTa cN0 cM0 clinical stage 0 or 0is.
- Must have microscopic confirmation.
- pTis cN0 cM0 pathological stage 0 or 0is.
- Must meet primary tumor surgical resection pathological criteria.
- Exception: Lymph node microscopic assessment not required.
Noninvasive Stage Group 0:
- cTa cN0 cM0 clinical stage 0a.
- Must have microscopic confirmation.
- pTa cN0 cM0 pathological stage 0a.
- Must meet primary tumor surgical resection pathological criteria.
- Exception: Lymph node microscopic assessment not required.
In Situ Stage Group with Nodal Involvement:
- Assign factual Tis and appropriate N category.
- Do not adjust according to registry rules or change to T1.
- Do not assign a stage group.
Interested in testing yourself on the changes?
- To request access to a Quiz regarding these changes, please click here.
- To request access to the Quiz answer key, please click here.