CTR Coding Break – AJCC pN Exceptions


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The AJCC Cancer Staging Manual 8th edition has several disease site chapters noting specific instructions for coding cN0 in the pN category. General instructions regarding coding N are described in Chapter 1. The designation of category use of ‘NX or N0’ resulting in a stage group other than 99, is also discussed. 

Node status is NOT required in rare circumstances. If not determined to be positive for tumor; N category should be designated as cN0. Assignment of cN0 ensures no confusion with cases where nodes were microscopically proven to not contain tumor, designated as pN0. 

During this session, several disease site chapter instructions are reviewed and discussed with questions and answers, including Breast, Bladder, Endometrium, and Melanoma. We also review the Soft Tissue Sarcoma as well as Thyroid pathologic N category instructions. As an example, Chapter 73 Thyroid, instructions are provided stating pathologic confirmation of lymph node status is not required for staging purposes. 

A helpful link to AJCC critical clarifications for staging including Node status not required in circumstances where ln involvement is rare: https://www.facs.org/quality-programs/cancer/ajcc/staging-education/registrar

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