AJCC and NCDB Announce New AJCC T, N, and M Categories implemented in 2016 for cases diagnosed 1/1/16 forward. This includes a “c” clinical and “p” pathologic designation available in the registry software so registrars can comply with the AJCC staging rules. This will take effect for the NAACCR 16 compliant software upgrades for registry software. More information will be coming in the future as we receive information.
According to the AJCC manual and trainings, the appropriate T, N, and M categories should be assigned based on the above AJCC rules. This may entail allowing, e.g., the pathologic staging M category to be properly assigned as cM1. However, cancer registry abstracting software is currently set up to code two separate and mutually exclusive clinical and pathologic strings of T, N, M, and stage categories, with an implied “c” in the clinical TNM string, and an implied “p” in the pathologic TNM string. Upon abstraction, the registrar has no way of recording the appropriate M category for the pathologic stage if it is cM1. This discrepancy between registry software data items and AJCC staging classification rules causes a dilemma for registrars when abstracting the T, N, and M data items and results in inconsistent coding practices and data loss.
As a result, this issue will be addressed upon implementation of NAACCR version 16-compliant software with the addition of new AJCC T, N, and M categories for the AJCC T, N, and M data items [940, 950, 960, 880, 890, and 900]. The new categories have been generated by adding the prefixes of ‘c’ and ‘p’ to existing valid clinical and pathologic T, N, and M categories respectively, and by modifying, adding, and deleting specific existing categories newly prefixed with a ‘c’ or ‘p’. For example, the addition of pTis to the clinical classification T category will enable its use for in situ patients in accordance with the AJCC rules (serves as a reminder that the in situ diagnosis cannot be made on imaging alone). FORDS Revised for 2016, will include listings of valid categories and instructions for coding.
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