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The seventh edition of the TNM Classification of Malignant Tumors (TNM-7)1, 2 contains several new and modified component classifications. The purpose of this communication was to briefly summarize these changes, which became effective in January 2010. Among the new classifications are adrenal cortical carcinoma, appendiceal carcinoma, extrahepatic bile duct carcinoma, esophagogastric junction carcinoma, gastrointestinal stromal tumors (GISTs), intrahepatic cholangiocarcinoma, melanoma of the upper aerodigestive tract, Merkel cell carcinoma, neuroendocrine tumors of the lung and gastrointestinal tract, and uterine sarcomas. Among the classifications with major alterations are carcinomas of the esophagus, stomach, lung, skin, vulva, and prostate. In addition, there are several general rules that have been modified or established.

MX

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

The category “MX: Distant metastasis cannot be assessed” has been a source of misinterpretation and its use,3 especially by pathologists (ie, pMX), has had the unintended consequence of preventing stage grouping by cancer registries. Cancer registrars do not stage a case if distant metastasis cannot be assessed. Surgical pathologists, when assessing a resected specimen, usually have sufficient information to provide a pT and a pN classification, but rarely have information regarding distant metastasis. Consequently, they may assign MX, meaning that they cannot assess distant metastasis. However, it is the patient's clinician, not the pathologist, who is in the position to make this assessment, usually by clinical examination. If there are no obvious signs of metastasis, M0 or cM0 classifications are appropriate. In other words, once clinically examined, a patient is M0 until proven otherwise. If a liver nodule is detected radiographically in a patient with colon carcinoma, the disease may be considered cM1. If the nodule is biopsied and proven malignant, it is pM1; if it is found to be a hemangioma, it is classified as cM0, not pM0, pMX, or cMX. pM0 indicates there is no pathological evidence of cancer in the patient, a situation that occurs only after a complete autopsy (and then would be designated as aM0, not pM0). To prevent pathologists and clinicians from using MX or pMX, these designations have been deleted from TNM-7, thereby encouraging the assignment of M0 and facilitating stage grouping. Cancer registries will be the immediate beneficiaries of this change.

Isolated Tumor Cells

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

The subject of isolated tumor cells (ITCs) in regional lymph nodes and distant sites, which originally referred to single cells and small clusters,5 has now evolved into a proposal to include a single cluster of <200 cells in a single histological cross section. ITCs still refer to single tumor cells or small clusters of cells measuring ≤0.2 mm in greatest extent that can be detected by routine hematoxylin and eosin stains or immunohistochemistry. ITCs do not typically demonstrate evidence of metastatic activity (eg, proliferation or stromal reaction) or penetration of vascular or lymphatic sinus walls. Cases with ITC in lymph nodes or at distant sites are considered to be a subset of N0 or M0.

Stage Grouping and Prognostic Grouping

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

The International Union Against Cancer (UICC) TNM-7 edition has taken a new approach to separate anatomical stage groupings from prognostic groupings, in which other prognostic factors are added to the T (tumor), N (lymph node), and M (metastasis) categories. These new prognostic groupings, as well as the traditional anatomical groupings, are presented for esophageal and prostate carcinomas in the UICC TNM system; only prognostic groupings (termed anatomical prognostic groupings) appear in the American Joint Committee on Cancer (AJCC) TNM system. Except for this dual presentation, the UICC TNM Classification of Malignant Tumors2 is identical to that published in the AJCC Cancer Staging Manual.1 As more nonanatomical prognostic factors become available, this approach may provide a means of separating extent of disease staging from prognostic grouping.

Head and Neck Tumors

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

Mucosal melanoma

A major addition to this chapter is the introduction of a new classification for malignant melanoma of the upper aerodigestive tract. These highly malignant tumors are now classified in a manner similar to anaplastic thyroid carcinoma (ie, omitting the T1 and T2 classifications and keeping only stages III and IV).

Except for changes in the T1 and T2 categories of nasopharyngeal carcinoma, the other head and neck sections of TNM-7 are essentially unchanged.

Esophagus

Carcinoma of the esophagus has undergone a major modification between the sixth edition (TNM-6) and TNM-7. T1 and T4 have been subdivided to provide greater detail, regional lymph nodes (N) are subdivided by the number of involved lymph nodes, and distant metastasis (M) has been simplified to M1 rather than subdivided by location. Stage grouping has been divided into: 1) purely anatomical stages applicable to all types of carcinomas and 2) prognostic groups that separate squamous from adenocarcinoma and add histological grade and tumor location to the T, N, and M categories. The first approach (appearing only in the UICC TNM classification) preserves the pure anatomic extent of disease concept and allows direct stage-by-stage comparisons of behavior between tumors of different histological types and location; the second recognizes the prognostic influence of grade and tumor location.6 The use of the terms stage grouping and prognostic grouping distinguishes the 2.

Stomach

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

Similar to carcinoma of the esophagus, carcinoma of the stomach also has undergone modifications between the TNM-6 and TNM-7. T1 was subdivided so that mucosal and submucosal depth of invasion could be delineated. T2a and T2b were separated into T2 (muscularis propria) and T3 (subserosa). The former T3 and T4 categories were changed to T4a (perforates serosa) and T4b (invades adjacent structures). The division of regional lymph node metastasis by number of involved lymph nodes conforms to that of the esophagus. Thus, the gastric T, N, and M categories are now essentially identical to those of the esophagus (and esophagogastric junction).

Esophagogastric (Gastroesophageal) Junction

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

The staging of carcinomas of the esophagogastric/gastroesophageal (GE) junction has been addressed. It is based on the following new TNM rule: a tumor in which the epicenter is within 5 cm of the GE junction and also extends into the esophagus is classified and staged using the esophageal carcinoma scheme, whereas tumors with an epicenter in the stomach that are >5 cm from the GE junction or those within 5 cm of the GE junction without extension into the esophagus are classified and staged using the gastric carcinoma scheme.

Appendix

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

Carcinoma of the appendix had been included in the staging of colorectal carcinoma in TNM-6. In TNM-7, it is staged separately. The basic T and N categories are essentially similar to those of the colon. The separation of mucinous from nonmucinous carcinomas is required and T4 and M1 are modified to address the particular nature of mucinous carcinomas. Grading has been introduced to distinguish between low-grade and high-grade mucinous carcinomas because of differences in their behavior and management. Stage IV subgroups are dependent on these grades. The carcinoma staging scheme also applies to goblet cell carcinoids, but not to typical carcinoids.

Carcinoids/Well-Differentiated Neuroendocrine Tumors

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

For the first time, the TNM classification has addressed carcinoids and other neuroendocrine tumors (NETs). In the lung and pancreas, NETs are covered by the same criteria as carcinomas. Gastrointestinal carcinoids/NETs (appendiceal, gastric, small bowel, and large bowel) have separate classifications. Merkel cell carcinoma also has a separate classification.

Large Intestine

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

Carcinoma of the large intestine has undergone relatively few basic modifications between the TNM-6 and TNM-7, and therefore the main T, N, and M categories and stages I, II, III, and IV can be compared with those of the previous 2 editions. Except for the subdivision of T4 (T4a indicates perforation of the visceral peritoneum and T4b indicates direct invasion of other organs or structures), the T categories remain unchanged. The 2 N categories, with their breakpoint between 3 and 4 lymph nodes, remain unchanged, but there is an expansion of each category for those who wish a finer distinction. An important change concerns the categorization of tumor deposits, or satellites, in the mesentery of T1 or T2 tumors without positive lymph nodes that simulate lymph node metastasis without histological evidence of residual lymph node in the nodule. These may represent discontinuous (possibly lymphatic) spread, venous invasion with extravascular spread, or a totally replaced lymph node. If such deposits are observed in the absence of other lymph node metastasis, then the nodule(s) is recorded as N1c. This was an attempt to not deprive such patients of adjuvant chemotherapy by classifying them as having stage III disease. It also was aimed at identifying such cases to provide data to study their frequency and significance. The M category was subdivided into those cases with distant metastasis confined to 1 organ (ie, those that might be amenable to surgical resection) versus those with metastasis in >1 organ or the peritoneum. The subdivisions of the T, N, and M categories are expressed in subdivisions of the stage groupings. Despite this expansion, all the substages can be collapsed back into the original 4 stages of previous TNM classifications covering a 30-year span and are compatible with the original Dukes classification, thus ensuring backwards compatibility.

Intrahepatic Cholangiocarcinoma

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

Intrahepatic bile duct carcinomas were included with hepatocellular carcinomas in TNM-6. In TNM-7, there is a separate classification. The staging system applies to intrahepatic cholangiocarcinoma, cholangiocellular carcinoma, and combined hepatocellular and cholangiocarcinoma (mixed hepatocellular/cholangiocellular carcinoma).

Extrahepatic Bile Ducts

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

The extrahepatic bile duct carcinoma classification of TNM-6 has been divided into perihilar and distal bile duct classifications in TNM-7. The perihilar classification applies to carcinomas of the right, left, and common hepatic ducts (ie, those proximal to the origin of the cystic duct [Klatskin tumor]). The distal classification applies to carcinomas of the extrahepatic bile ducts distal to the insertion of the cystic duct.

Lung

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

A major revision of the lung carcinoma classification appears in TNM-7. It is the result of a retrospective study of >80,000 cases performed by a committee of the International Association for the Study of Lung Cancer (IASLC) working closely with the UICC and the AJCC. The lung classification provides a single scheme that is applicable to all histological types of lung carcinoma and carcinoids, all histological grades, and central versus peripheral sites based on a purely anatomical (TNM) format. There are important changes in the T3, T4, and M categories as well as with regard to stage grouping.9

Skin

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

For skin carcinoma, there are changes in T categories and especially in the regional lymph node classification to specifically accommodate skin tumors of the head and neck. The AJCC has added several high-risk factors that could change T1/stage I tumors to T2/stage II. Initial differences between the AJCC and the UICC regarding the subdivision of pT1 in the classification of cutaneous melanoma have been resolved; both the AJCC and the UICC now will follow the AJCC subdivision based on ulceration and mitotic rate. If the mitotic rate cannot be accurately determined, Clark level can be used. A new classification for Merkel cell carcinoma also has been introduced.

Gynecologic Tumors

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

Major changes concern the classification of vulvar carcinoma and the introduction of classifications for uterine sarcomas (adenosarcoma, leiomyosarcoma, and endometrial stromal sarcoma).10, 11 The classification of gynecological tumors corresponds to that of the International Federation of Gynecology and Obstetrics (FIGO).

Prostate

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES

A dual (anatomic vs prognostic) approach to staging is available in the classification of prostate carcinoma, in which there is a purely TNM-based stage grouping and a prognostic grouping that combines TNM classification, prostate-specific antigen values, and Gleason score. The AJCC classification presents the prognostic grouping, whereas the UICC classification presents both the anatomical and prognostic options. A correction to Prognostic Group IIA in both the UICC and AJCC publications is shown in Table 1.

Table 1. Correction to Prognostic Group IIA
  1. PSA indicates prostate-specific antigen.

T1a–cN0PSA <20 ng/mLGleason score 7
T1a–cN0PSA ≥10 to <20 ng/mLGleason score ≤6
T2aN0PSA ≥10 to <20 ng/mLGleason score ≤6
T2aN0PSA <20 ng/mLGleason score 7
T2bN0PSA <20 ng/mLGleason score ≤7

REFERENCES

  1. Top of page
  2. MX
  3. Pn: Perineural Invasion
  4. Isolated Tumor Cells
  5. Stage Grouping and Prognostic Grouping
  6. Head and Neck Tumors
  7. Stomach
  8. Esophagogastric (Gastroesophageal) Junction
  9. GISTs
  10. Appendix
  11. Carcinoids/Well-Differentiated Neuroendocrine Tumors
  12. Large Intestine
  13. Intrahepatic Cholangiocarcinoma
  14. Extrahepatic Bile Ducts
  15. Lung
  16. Bone and Soft Tissue
  17. Skin
  18. Breast
  19. Gynecologic Tumors
  20. Penis
  21. Prostate
  22. Adrenal Cortex
  23. Ophthalmic Tumors
  24. CONFLICT OF INTEREST DISCLOSURES
  25. REFERENCES
  • 1
    Edge SB, Byrd DR, Carducci MA, et al, eds. American Joint Committee on Cancer (AJCC) Cancer Staging Manual. 7th ed. New York: Springer; 2009.
  • 2
    Sobin LH, Gospodarowicz MK, Wittekind Ch, eds. International Union Against Cancer (UICC) TNM Classification of Malignant Tumors. 7th ed. Oxford, UK: Wiley-Blackwell; 2009.
  • 3
    Greene FL, Brierley J, O'Sullivan B, Sobin LH, Wittekind C; International Union Against Cancer and the American Joint Committee on Cancer. On the use and abuse of X in the TNM classification. Cancer. 2005; 103: 647-649.
  • 4
    Wittekind Ch, Henson DE, Hutter RVP, Sobin LH, eds. TNM Supplement: A Commentary on Uniform Use. 2nd ed. New York: Wiley-Liss; 2001: 96.
  • 5
    Hermanek P, Hutter RV, Sobin LH, Wittekind C. International Union Against Cancer. Classification of isolated tumor cells and micrometastasis. Cancer. 1999; 86: 2668-2673.
  • 6
    Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol. 2010; 17: 1721-1724.
  • 7
    Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol. 2005; 29: 52-68.
  • 8
    Miettinen M, Makhlouf H, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up. Am J Surg Pathol. 2006; 30: 477-489.
  • 9
    Goldstraw P, Crowley J, Chansky K, et al. International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007; 2: 706-714.
  • 10
    Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet. 2009; 104: 177-178.
  • 11
    FIGO Committee on Gynecological Oncology Report. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet. 2009; 104: 179.
  • 12
    Wittekind Ch, Greene FL, Henson DE, Hutter RVP, Sobin LH, eds. TNM Supplement: A Commentary on Uniform Use. 3rd ed. New York: Wiley-Liss; 2003: 130-131.