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Staging (Pleural Mesothelioma)
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Staging (Pleural Mesothelioma)
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Pathologic Stage Classification (pTNM, AJCC 8th edition) CAP Approved Pleural Mesothelioma 4.0.0.0
TNM Descriptors (required only if applicable) (select all that apply)
___ r (recurrent) ___ y (posttreatment) Primary Tumor (pT)
___ pTX: Primary tumor cannot be assessed ___ pT0: No evidence of primary tumor
___ pT1: Tumor limited to the ipsilateral parietal pleura with or without involvement of: • visceral pleura • mediastinal pleura • diaphragmatic pleura
___ pT2: Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: • involvement of diaphragmatic muscle • extension of tumor from visceral pleura into the underlying pulmonary parenchyma
___ pT3: Describes locally advanced but potentially resectable tumor Tumor involving all the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: • involvement of the endothoracic fascia • extension into the mediastinal fat • solitary, completely resectable focus of tumor extending into the soft tissues of the chest wall • nontransmural involvement of the pericardium
___ pT4: Describes locally advanced technically unresectable tumor Tumor involving all the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: • diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction • direct transdiaphragmatic extension of tumor to the peritoneum • direct extension of tumor to the contralateral pleura • direct extension of tumor to mediastinal organs • direct extension of tumor into the spine • tumor extending through to the internal surface of the pericardium with or without a pericardial effusion; or tumor involving the myocardium
Regional Lymph Nodes (pN)
___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastases
___ pN1: Metastases in the ipsilateral bronchopulmonary hilar or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal) lymph nodes
___ pN2: Metastases in the contralateral mediastinal, ipsilateral, or contralateral supraclavicular lymph nodes Distant Metastasis (pM) (required only if confirmed pathologically in this case)
___ pM1: Distant metastasis present Specify site(s), if known: ____________________________
Summary of changes AJCC 7th to 8th Edition
- pT1 no longer subdivided into pT1a and pT1b
- removal of specimen integrity