AJCC 8th Edition Spotlight – General Rule Changes


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AJCC 8th Edition Spotlight –  General Rule Changes

(Chapter 1 pages 3-30)

  • Required for all cases diagnosed 1/1/2018 and later
    • No conversion between the 7th edition and 8th edition
  • All New AJCC 8th edition stage data items: Three sets of stage items:
    • Clinical
    • Pathological
      • Previous editions: Pathologic staging
      • 8th edition: Changed to Pathological staging
    • Post-therapy
      • Starts after completion of systemic/ radiation therapy
      • Does not use ANY information from clinical stage
      • Evaluates residual or remaining tumor after neoadjuvant therapy.
  • Format for T, N, M and Stage Group:
    • Emphasize T,N and M as categories.
      • T category, not T stage
    • New term for stage groups
      • 7th edition: anatomic stage/ prognostic groups
      • 8th edition: prognostic stage groups
    • Length changed from 4 to 15 Characters to record these items exactly as they are written in the AJCC 8th edition manual.
      • ypTis(DCIS)
      • pN0(mol+)
      • cM1b(0)
  • Descriptor Data Items for 2018:
    • Shifted stage prefix to new yp stage data item
    • Incorporated E into stage group, S is no longer used.
    • Developed new suffix data items for T&N
      • T suffix-3 new data items:           
        • m – Multiple synchronous tumors OR for thyroid differentiated and anaplastic only, Multifocal tumor
        • s – For thyroid differentiated and anaplastic only, Solitary tumor
        • Blank – No information available; not recorded
  • N Suffix-3 new data items to record how the N was evaluated:
    • sn – Sentinel node procedure without resection of nodal basin
    • f – FNA or core needle biopsy without resection of nodal basin
    • Blank – no suffix needed or appropriate; not recorded
  • Three new grade data items (grade clinical, grade pathological and grade post-therapy)
    • Patients will have only 1 or 2 grades coded because you can never qualify for all 3.
    • Grade data item for each stage classification
    • Incorporates both AJCC and standard registry coding
    • Grade tables specific for each disease site
    • Prioritizes AJCC specified grade
    • Some sites require the grade to assign a stage group

Quiz Questions

(Make sure you use the AJCC 8th edition manual as well as the 2018 Grade Manual to answer the questions below):

  1.  A 50 year old female has a mass found on imaging in the R UOQ breast.  2/9/17 R breast biopsy: Infiltrating ductal ca, moderately differentiated.  2/17/17 Neoadjuvant chemotherapy started. 3/21/17 R breast simple mastectomy: Infiltrating ductal carcinoma, Nottingham score of 9, margins negative, 1 SLN negative for mets.  Using 2018 grade rules, assign the grade code(s) based on the scenario above.

a. Clinical Grade Code: 3

b. Clinical Grade Code: B, Post-therapy Grade Code: 3

c. Clinical Grade Code: B, Pathological Grade Code: 3, Post-therapy Grade Code: 3

d. Pathological Grade Code: 3

2. 30 year old male is diagnosed with prostate cancer by biopsy: Adenocarcinoma, Gleason Score 7.   Pt went on to have a Prostatectomy: Adenocarcinoma, Gleason Score (4+4), organ confined disease. Using 2018 grade rules, assign the grade code(s) based on the scenario above.

                          a. Clinical Grade Code: E, Pathological Grade Code: 4

                          b. Pathological Grade Code:

                          c. Clinical Grade Code: 3, Pathological Grade Code 3

                          d.  Clinical Grade Code: 2, Pathological Grade Code: 3

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