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)
- Emphasize T,N and M as categories.
- 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
- T suffix-3 new data items:
- 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):
- 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