Pathologic Staging (pTNM)

CAP Approved Endocrine • Thyroid Gland 4.0.0.0(AJCC 8th ed.)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

For Papillary, Follicular, Poorly Differentiated, Hurthle Cell and Anaplastic Thyroid Carcinoma

Primary Tumor (pT)

___ pTX:        Primary tumor cannot be assessed

___ pT0:        No evidence of primary tumor

___ pT1:        Tumor ≤2 in greatest dimension, limited to the thyroid

___ pT1a:        Tumor ≤1 cm in greatest dimension limited to the thyroid

___ pT1b:        Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid

___ pT2:        Tumor >2 cm, but ≤4 cm in greatest dimension, limited to thyroid

___ pT3:        Tumor >4 cm limited to the thyroid, or gross extrathyroidal extension invading only strap muscles

___ pT3a:        Tumor >4 cm limited to the thyroid

___ pT3b:        Gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid, thyrohyoid, or omohyoid muscles) from a tumor of any size

___ pT4:        Includes gross extrathyroidal extension beyond the strap muscles

___ pT4a:        Gross extrathyroidal extension invading subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve from a tumor of any size

___ pT4b:        Gross extrathyroidal extension invading prevertebral fascia or encasing the carotid artery or  mediastinal vessels from a tumor of any size

Note: There is no category of carcinoma in situ (pTis) relative to carcinomas of thyroid gland.

For Medullary Thyroid Carcinoma

Primary Tumor (pT)

___ pTX:        Primary tumor cannot be assessed

___ pT0:        No evidence of primary tumor

___ pT1:        Tumor ≤2 in greatest dimension, limited to the thyroid

___ pT1a:        Tumor ≤1 cm in greatest dimension limited to the thyroid

___ pT1b:        Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid

___ pT2:        Tumor >2 cm, but ≤4 cm in greatest dimension, limited to thyroid

___ pT3:        Tumor >4 cm or with extrathyroidal extension

___ pT3a:        Tumor >4 cm in greatest dimension limited to the thyroid

___ pT3b:        Tumor of any size with gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid, thyrohyoid or omohyoid muscles)

___pT4:        Advanced disease

___pT4a:         Moderately advanced disease; tumor of any size with gross extrathyroidal extension into the nearby tissues of the neck, including subcutaneous soft tissue, larynx, trachea, esophagus, or recurrent laryngeal nerve 

___pT4b:      Very advanced disease; tumor of any size with extension toward the spine or into nearby large blood vessels, gross extrathyroidal extension invading the prevertebral fascia, or encasing the carotid artery or mediastinal vessels

For All Carcinomas of the Thyroid

Regional Lymph Nodes (pN)#

___ pNX:        Regional lymph nodes cannot be assessed

___ pN0a:        One or more cytologically or histologically confirmed benign lymph nodes

___ pN1:        Metastasis to regional nodes

___ pN1a:        Metastasis to level VI or VII (pretracheal, paratracheal, or prelaryngeal/Delphian, or upper mediastinal) lymph nodes. This can be unilateral or bilateral disease.

___ pN1b:        Metastasis to unilateral, bilateral, or contralateral lateral neck lymph nodes (levels I, II, III, IV, or V) or retropharyngeal lymph nodes

# N0b is defined as no radiologic or clinical evidence of locoregional lymph node metastasis.

For All Carcinomas of the Thyroid

Distant Metastasis (pM) (required only if confirmed pathologically in this case)

___ pM1:        Distant metastasis

       Specify site(s), if known: ____________________________

Thyroid CAP 4.0.0.0 Summary of pTNM changes AJCC 7th to 8th ed.

• Minor  (microscopic only) extrathyroidal extension was removed from the definition of T3 disease. As a result, minor extrathyroidal extension does not affect either T category or overall stage.
• T3a is a new category and refers to a tumor >4 cm in greatest dimension limited to the thyroid gland.
• T3b is a new category and is defined as a tumor of any size with gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid, thyrohyoid or omohyoid muscles).
• The definition of central neck (N1a) was expanded to include both level VI and level VII (upper mediastinal) lymph node compartments.
• The pN0a designation is clarified as one or more cytologically or histologically confirmed benign lymph node(s).
• Unlike previous editions where all anaplastic tumors were classified as having T4 disease, the T category for anaplastic thyroid cancers will now use the same definitions used for differentiated thyroid cancers.
• Separate primary tumor staging for medullary carcinoma

Endocrine

Comments

Click here to leave feedback