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Staging (Perihilar Bile Duct)
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Staging (Perihilar Bile Duct)
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Pathologic Staging (pTNM) AJCC 8th Edition
CAP Approved Gastrointestinal • Perihilar Bile Ducts 4.0.0.0
TNM Descriptors (required only if applicable) (select all that apply)
___ m (multiple primary tumors)
___ r (recurrent)
___ y (posttreatment)
Primary Tumor (pT)
___ pTX: Primary tumor cannot be assessed
___ pT0: No evidence of primary tumor
___ pTis: Carcinoma in situ/high-grade dysplasia
___ pT1: Tumor confined to the bile duct, with extension up to the muscle layer or fibrous tissue
___ pT2: Tumor invades beyond the wall of the bile duct to surrounding adipose tissue, or tumor invades adjacent hepatic parenchyma
___ pT2a: Tumor invades beyond the wall of the bile duct to surrounding adipose tissue
___ pT2b: Tumor invades adjacent hepatic parenchyma
___ pT3: Tumor invades unilateral branches of the portal vein or hepatic artery
___ pT4: Tumor invades the main portal vein or its branches bilaterally, or the common hepatic artery; or unilateral second-order biliary radicals with contralateral portal vein or hepatic artery involvement
Regional Lymph Nodes (pN)
___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN1: One to three positive regional lymph nodes typically involving the hilar, cystic duct, common bile duct, hepatic artery, posterior pancreatoduodenal, and portal vein lymph nodes
___ pN2: Four or more positive lymph nodes from the sites described for N1
Distant Metastasis (pM) (required only if confirmed pathologically in this case)
___ pM1: Distant metastasis
Specify site(s), if known: _________________________
Summary of changes AJCC 7th to 8th Edition
pN1 and N2 now defined by number of lymph nodes involved