Protocol for the Examination of Resection Specimens from Patients with Invasive Carcinoma of

the Breast
College of American Pathologists; March 2023

pTNM CLASSIFICATION (AJCC 8th Edition) (Note N)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

Modified Classification (required only if applicable) (select all that apply)

___ Not applicable
___ y (post-neoadjuvant therapy)
___ r (recurrence)

pT Category
# For the purposes of this checklist, these categories should only be used in the setting of preoperative (neoadjuvant) therapy for which a previously diagnosed invasive carcinoma is no longer present
after treatment. Patients with pathological complete response (absence of residual invasive carcinoma in both the breast and lymph nodes) should be categorized as ypT0N0 or ypTisN0, not ypTX.
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor#
___ pTis (DCIS): Ductal carcinoma in situ#
## Carcinomas in the breast parenchyma associated with Paget disease are categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget disease should
still be noted.
___ pTis (Paget): Paget disease of the nipple NOT associated with invasive carcinoma and / or
carcinoma in situ (DCIS) in the underlying breast parenchyma##
pT1: Tumor less than or equal to 20 mm in greatest dimension
___ pT1mi: Tumor less than or equal to 1 mm in greatest dimension
### Round any measurement greater than 1.0-1.9 mm to 2 mm
___ pT1a: Tumor greater than 1 mm but less than or equal to 5 mm in greatest dimension###
___ pT1b: Tumor greater than 5 mm but less than or equal to 10 mm in greatest dimension
___ pT1c: Tumor greater than 10 mm but less than or equal to 20 mm in greatest dimension
___ pT1 (subcategory cannot be determined)
___ pT2: Tumor greater than 20 mm but less than or equal to 50 mm in greatest dimension
___ pT3: Tumor greater than 50 mm in greatest dimension
#### Invasion of the dermis alone does not qualify as pT4.
pT4: Tumor of any size with direct extension to the chest wall and / or to the skin (ulceration or skin nodules)####
___ pT4a: Extension to the chest wall; invasion or adherence to pectoralis muscle in the absence of
invasion of chest wall structures does not qualify as T4
___ pT4b: Ulceration and / or ipsilateral satellite nodules and / or edema (including peau d'orange) of the
skin which do not meet the criteria for inflammatory carcinoma
___ pT4c: Both T4a and T4b are present
##### Inflammatory carcinoma requires the presence of clinical findings of erythema and edema involving at least one-third or more of the skin of the breast. (Note M)
___ pT4d: Inflammatory carcinoma#####
___ pT4 (subcategory cannot be determined)

T Suffix (required only if applicable)

___ Not applicable
___ (m) multiple primary synchronous tumors in a single organ

pN Category
Choose a category based on lymph nodes received with the specimen; immunohistochemistry and / or molecular studies are not required.
If internal mammary lymph nodes, infraclavicular nodes, or supraclavicular lymph nodes are included in the specimen, consult the AJCC Cancer Staging Manual for additional lymph node categories.
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
# Isolated tumor cells (ITCs) are defined as small clusters of cells not greater than 0.2 mm or single tumor cells, or a cluster of fewer than 200 cells in a single histologic cross-section. ITCs may be
detected by routine histology or by immunohistochemical (IHC) methods. Nodes containing only ITCs are excluded from the total positive node count when determining the N category but should be
included in the total number of nodes evaluated.
___ pN0: No regional lymph node metastasis identified or ITCs only#
___ pN0 (i+): ITCs only (malignant cell clusters no larger than 0.2 mm) in regional lymph node(s)
___ pN0 (mol+): Positive molecular findings by reverse transcriptase polymerase chain reaction (RT- PCR); no ITCs detected
___ pN1mi: Micrometastases (approximately 200 cells, larger than 0.2 mm, but none larger than 2.0 mm)
## Approximately 1000 tumor cells are contained in a 3-dimensional 0.2-mm cluster. Thus, if more than 200 individual tumor cells are identified as single dispersed tumor cells or as a nearly confluent
elliptical or spherical focus in a single histologic section of a lymph node, there is a high probability that more than 1000 cells are present in the lymph node. In these situations, the node should be
classified as containing a micrometastasis (pN1mi). Cells in different lymph node cross-sections or longitudinal sections or levels of the block are not added together; the 200 cells must be in a single node
profile even if the node has been thinly sectioned into multiple slices. It is recognized that there is substantial overlap between the upper limit of the ITC and the lower limit of the micrometastasis
categories due to inherent limitations in pathologic nodal evaluation and detection of minimal tumor burden in lymph nodes. Thus, the threshold of 200 cells in a single cross-section is a guideline to help
pathologists distinguish between these 2 categories. The pathologist should use judgment regarding whether it is likely that the cluster of cells represents a true micrometastasis or is simply a small group
of isolated tumor cells.
___ pN1a: Metastases in 1-3 axillary lymph nodes, at least one metastasis larger than 2.0 mm##
___ pN1b: Metastases in ipsilateral internal mammary sentinel nodes, excluding ITCs
___ pN1c: pN1a and pN1b combined
___ pN2a: Metastases in 4-9 axillary lymph nodes (at least one tumor deposit larger than 2.0 mm)##
___ pN2b: Metastases in clinically detected internal mammary lymph nodes with or without microscopic
confirmation; with pathologically negative axillary nodes
___ pN3a: Metastases in 10 or more axillary lymph nodes (at least one tumor deposit larger than 2.0
mm)##; or metastases to the infraclavicular (Level III axillary lymph) nodes
___ pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary nodes by imaging); or pN2a in the presence of pN1b
___ pN3c: Metastases in ipsilateral supraclavicular lymph nodes

N Suffix (required only if applicable) (select all that apply)

The (sn) modifier is added to the N category when a sentinel node biopsy is performed (using either dye or tracer) and fewer than six lymph nodes are removed (sentinel and nonsentinel). The (f) modifier
is added to the N category to denote confirmation of metastasis by fine needle aspiration / core needle biopsy with NO further resection of nodes.
___ Not applicable
___ (sn): Sentinel node(s) evaluated. If 6 or more nodes (sentinel or nonsentinel) are removed, this
modifier should not be used
___ (f): Nodal metastasis confirmed by fine needle aspiration or core needle biopsy

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Histologically proven metastases larger than 0.2 mm
+Specify Case Number (if from a previous procedure): _________________
Protocol for the Examination of Resection Specimens From Patients with Phyllodes Tumor of the
Breast
College of American Pathologists; September 2022

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note G)

Staging applies only to malignant phyllodes tumors. pT and pN categories should not be assigned for benign and borderline tumors.

Pathologic Stage Classification (pTNM, AJCC 8th Edition) (required only if the tumor is malignant)
Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.
___ Not applicable (tumor is not graded as malignant)
___ Tumor is malignant
The following section applies only if the tumor is malignant. Do not assign pT and pN stage categories for benign or borderline tumors.
TNM Descriptors (select all that apply)
___ Not applicable
___ m (multiple)
___ r (recurrent)
___ y (post treatment)
pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
___ pT1: Tumor 5 cm or less in greatest dimension
___ pT2: Tumor more than 5 cm but not more than 10 cm
___ pT3: Tumor more than 10 cm but not more than 15 cm
___ pT4: Tumor more than 15 cm in greatest dimension
pN Category
When no lymph nodes are present, the pathologic 'N' category is not assigned (pNX is not used and should not be reported)
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN1: Regional lymph node metastasis
pM Category (required only if confirmed pathologically)
___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis
Protocol for the Examination of Specimens From Patients With Carcinomas of the Thyroid Gland
College of American Pathologists; March 2023

pTNM CLASSIFICATION (AJCC 8th Edition) (Note N)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

Modified Classification (required only if applicable) (select all that apply)

___ Not applicable
___ y (post-neoadjuvant therapy)
___ r (recurrence)

pT Category
# Salivary gland-type carcinomas, thymic tumors within the thyroid and thyroid carcinomas of uncertain cytogenesis may be staged using this scheme, recognizing lack of validation for such neoplasms.
Low-risk follicular cell-derived thyroid neoplasms are not required to be staged.
___ For malignant follicular cell-derived thyroid neoplasms including follicular thyroid carcinoma, invasive follicular variant papillary thyroid carcinoma, papillary
thyroid carcinoma, oncocytic carcinoma of the thyroid, high-grade differentiated thyroid carcinomas, poorly differentiated thyroid carcinoma and anaplastic follicular
cell-derived thyroid carcinoma#
pT Category
There is no category of carcinoma in situ (pTis) relative to carcinomas of thyroid gland.
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Tumor size less than or equal to 2 cm in greatest dimension, limited to thyroid
___ pT1a: Tumor less than or equal to 1 cm in greatest dimension, limited to the thyroid.
___ pT1b: Tumor greater than 1 cm but less than or equal to 2 cm in greatest dimension, limited to the
thyroid
___ pT1 (subcategory cannot be determined)
___ pT2: Tumor greater than 2 cm but less than or equal to 4 cm in greatest dimension, limited to
thyroid
pT3: Tumor greater than 4 cm limited to the thyroid, or gross extrathyroidal extension invading only strap muscles
___ pT3a: Tumor greater than 4 cm limited to the thyroid
___ pT3b: Gross extrathyroidal extension invading only strap muscles (sternohyoid, sternothyroid,
thyrohyoid, or omohyoid muscles) from a tumor of any size
___ pT3 (subcategory cannot be determined)
pT4: Includes gross extrathyroidal extension beyond the strap muscles
___ pT4a: Gross extrathyroidal extension invading subcutaneous soft tissues, larynx, trachea,
esophagus, or recurrent laryngeal nerve from a tumor of any size
___ pT4b: Gross extrathyroidal extension invading prevertebral fascia or encasing the carotid artery or
mediastinal vessels from a tumor of any size
___ pT4 (subcategory cannot be determined)

T Suffix (required only if applicable)

___ Not applicable
___ (m) multiple primary synchronous tumors in a single organ

___ For medullary thyroid carcinoma

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Tumor size less than or equal to 2 cm in greatest dimension, limited to thyroid
___ pT1a: Tumor less than or equal to 1 cm in greatest dimension, limited to the thyroid.
___ pT1b: Tumor greater than 1 cm but less than or equal to 2 cm in greatest dimension, limited to the
thyroid
___ pT1 (subcategory cannot be determined)
___ pT2: Tumor greater than 2 cm but less than or equal to 4 cm in greatest dimension, limited to
thyroid
pT3: Tumor greater than 4 cm or with extrathyroidal extension
___ pT3a: Tumor greater than 4 cm in greatest dimension limited to the thyroid
___ pT3b: Tumor of any size with gross extrathyroidal extension invading only strap muscles
(sternohyoid, sternothyroid, thyrohyoid or omohyoid muscles)
___ pT3 (subcategory cannot be determined)
pT4: Advanced disease
___ pT4a: Moderately advanced disease; tumor of any size with gross extrathyroidal extension into the
nearby tissues of the neck, including subcutaneous soft tissue, larynx, trachea, esophagus, or
recurrent laryngeal nerve
___ pT4b: Very advanced disease; tumor of any size with extension toward the spine or into nearby
large blood vessels, gross extrathyroidal extension invading the prevertebral fascia, or encasing the
carotid artery or mediastinal vessels
___ pT4 (subcategory cannot be determined)

T Suffix (required only if applicable)

___ Not applicable
___ (m) multiple primary synchronous tumors in a single organ

pN Category#
# N0b is defined as no radiologic or clinical evidence of locoregional lymph node metastasis
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
pN0: No evidence of locoregional lymph node metastasis
___ pN0a: One or more cytologically or histologically confirmed benign lymph nodes
___ pN0 (subcategory cannot be determined)#
pN1: Metastasis to regional nodes
___ pN1a: Metastasis to level VI or VII (pretracheal, paratracheal, or prelaryngeal / Delphian, or upper mediastinal) lymph nodes. This can be unilateral or bilateral
disease.
___ pN1b: Metastasis to unilateral, bilateral, or contralateral lateral neck lymph nodes (levels I, II, III, IV, or V) or retropharyngeal lymph nodes
___ pN1 (subcategory cannot be determined)

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis
Protocol for the Examination of Resection Specimens From Patients With Primary Carcinoma of
the Colon and Rectum
College of American Pathologists; June 2022

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note L)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

TNM Descriptors (select all that apply)

___ Not applicable: _________________
___ m (multiple primary tumors)
___ r (recurrent)
___ y (post-treatment)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
___ pTis: Carcinoma in situ, intramucosal carcinoma (involvement of lamina propria with no extension through muscularis mucosae)
___ pT1: Tumor invades the submucosa (through the muscularis mucosa but not into the muscularis propria)
___ pT2: Tumor invades the muscularis propria
___ pT3: Tumor invades through the muscularis propria into pericolorectal tissues
pT4: Tumor invades the visceral peritoneum or invades or adheres to adjacent organ or structure
___ pT4a: Tumor invades# through the visceral peritoneum (including gross perforation of the bowel through tumor and continuous invasion of tumor through
areas of inflammation to the surface of the visceral peritoneum)
___ pT4b: Tumor directly invades# or adheres## to adjacent organs or structures
___ pT4 (subcategory cannot be determined)#, ##
# Direct invasion in T4 includes invasion of other organs or other segments of the colorectum as a result of direct extension through the serosa, as confirmed on microscopic examination (for example,
invasion of the sigmoid colon by a carcinoma of the cecum) or, for cancers in a retroperitoneal or subperitoneal location, direct invasion of other organs or structures by virtue of extension beyond the
muscularis propria (i.e., respectively, a tumor on the posterior wall of the descending colon invading the left kidney or lateral abdominal wall; or a mid or distal rectal cancer with invasion of prostate,
seminal vesicles, cervix, or vagina).
## Tumor that is adherent to other organs or structures, grossly, is classified cT4b. However, if no tumor is present in the adhesion, microscopically, the classification should be pT1-4a depending on the
anatomical depth of wall invasion. The V and L classification should be used to identify the presence or absence of vascular or lymphatic invasion whereas the PN prognostic factor should be used for
perineural invasion.

pN Category
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
pN1: One to three regional lymph nodes are positive (tumor in lymph nodes measuring greater than or equal to 0.2 mm), or any number of tumor deposits are present and all identifiable lymph nodes are
negative
___ pN1a: One regional lymph node is positive
___ pN1b: Two or three regional lymph nodes are positive
___ pN1c: No regional lymph nodes are positive, but there are tumor deposits in the subserosa, mesentery, nonperitonealized pericolic or
perirectal / mesorectal tissues
___ pN1 (subcategory cannot be determined)
pN2: Four or more regional nodes are positive
___ pN2a: Four to six regional lymph nodes are positive
___ pN2b: Seven or more regional lymph nodes are positive
___ pN2 (subcategory cannot be assessed)

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
pM1: Metastasis to one or more distant sites or organs or peritoneal metastasis is identified
___ pM1a: Metastasis to one site or organ is identified without peritoneal metastasis
___ pM1b: Metastasis to two or more sites or organs is identified without peritoneal metastasis
___ pM1c: Metastasis to the peritoneal surface is identified alone or with other site or organ metastases
___ pM1 (subcategory cannot be determined)
Protocol for the Examination of Resection Specimens From Patients With Gastrointestinal Stromal
Tumor (GIST)
College of American Pathologists; December 2022

pTNM CLASSIFICATION (AJCC 8th Edition) (Note F)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

Modified Classification (required only if applicable) (select all that apply)

___ Not applicable
___ y (post-neoadjuvant therapy)
___ r (recurrence)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
___ pT1: Tumor 2 cm or less
___ pT2: Tumor more than 2 cm but not more than 5 cm
___ pT3: Tumor more than 5 cm but not more than 10 cm
___ pT4: Tumor more than 10 cm in greatest dimension

T Suffix (required only if applicable)

___ Not applicable
___ (m) Multiple primary synchronous tumors in a single organ

pN Category (Notes E,F)

# When no lymph nodes are present (as is often the case with resection for GIST), the pathologic ‘N’ category is not assigned (pNXis not used for GIST) and should not be reported.
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN1: Regional lymph node metastasis
pM Category (required only if confirmed pathologically) (Notes E,F)
___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis
Protocol for the Examination of Specimens From Patients With Carcinoma of the Small Intestine
College of American Pathologists; June 2021

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note E)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the
AJCC (Chapter 1, 8th Ed.) it is the managing physician’s responsibility to establish the final pathologic stage based upon all pertinent information,
including but potentially not limited to this pathology report.

TNM Descriptors (select all that apply)

___ Not applicable
___ m (multiple primary tumors)
___ r (recurrent)
___ y (post-treatment)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
___ pTis: High-grade dysplasia / carcinoma in situ
pT1: Tumor invades the lamina propria or submucosa
___ pT1a: Tumor invades the lamina propria
___ pT1b: Tumor invades the submucosa
___ pT1 (subcategory cannot be determined)
___ pT2: Tumor invades the muscularis propria
# For T3 tumors, the nonperitonealized perimuscular tissue is, for the jejunum and ileum, part of the mesentery and, for the duodenum in areas where
serosa is lacking, part of the interface with the pancreas.
___ pT3: Tumor invades through the muscularis propria into the subserosa, or extends into nonperitonealized
perimuscular tissue (mesentery or retroperitoneum) without serosal penetration#
___ pT4: Tumor perforates the visceral peritoneum or directly invades other organs or structures (e.g., other loops of
small intestine, mesentery of adjacent loops of bowel, and abdominal wall by way of serosa; for duodenum only, invasion
of pancreas or bile duct)

pN Category
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN1: Metastasis in one or two regional lymph nodes
___ pN2: Metastasis in three or more regional lymph nodes

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis
Protocol for the Examination of Specimens From Patients With Carcinoma of the Stomach
College of American Pathologists; March 2023

pTNM CLASSIFICATION (AJCC 8th Edition) (Note J)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

Modified Classification (required only if applicable) (select all that apply)

___ Not applicable
___ y (post-neoadjuvant therapy)
___ r (recurrence)
pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
___ pTis: Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria, high-grade dysplasia
pT1: Tumor invades the lamina propria, muscularis mucosae, or submucosa
___ pT1a: Tumor invades the lamina propria or muscularis mucosae
___ pT1b: Tumor invades the submucosa
___ pT1 (subcategory cannot be determined)
# A tumor may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum
covering these structures. In this case, the tumor is classified as T3. If there is perforation of the visceral peritoneum covering the gastric ligaments or the omentum, the tumor should be classified as T4.
___ pT2: Tumor invades the muscularis propria#
## The adjacent structures of the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum.
### Intramural extension to the duodenum or esophagus is not considered invasion of an adjacent structure, but is classified using the depth of the greatest invasion in any of these sites.
___ pT3: Tumor penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures##, ###
pT4: Tumor invades the serosa (visceral peritoneum) or adjacent structures##, ###
___ pT4a: Tumor invades the serosa (visceral peritoneum)
___ pT4b: Tumor invades adjacent structures / organs
___ pT4 (subcategory cannot be determined)

T Suffix (required only if applicable)

___ Not applicable
___ (m) multiple primary synchronous tumors in a single organ

pN Category#
# Metastatic tumor deposits in the subserosal fat adjacent to a gastric carcinoma, without evidence of residual lymph node tissue, are considered regional lymph node metastases for purposes of gastric
cancer staging.
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN1: Metastasis in one or two regional lymph nodes
___ pN2: Metastasis in three to six regional lymph nodes
pN3: Metastasis in seven or more regional lymph nodes
___ pN3a: Metastasis in seven to 15 regional lymph nodes
___ pN3b: Metastasis in 16 or more regional lymph nodes
___ pN3 (subcategory cannot be determined)

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis
Protocol for the Examination of Resection Specimens from Patients with Invasive Carcinoma of
Renal Tubular Origin
College of American Pathologists; June 2021

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note I)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the
AJCC (Chapter 1, 8th Ed.) it is the managing physician’s responsibility to establish the final pathologic stage based upon all pertinent information,
including but potentially not limited to this pathology report.

TNM Descriptors (select all that apply)

___ Not applicable: _________________
___ m (multiple primary tumors)
___ r (recurrent)
___ y (post-treatment)

Primary Tumor (pT)

___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Tumor less than or equal to 7 cm in greatest dimension, limited to the kidney
___ pT1a: Tumor less than or equal to 4 cm in greatest dimension, limited to the kidney
___ pT1b: Tumor greater than 4 cm but less than or equal to 7 cm in greatest dimension limited to the kidney
___ pT1 (subcategory cannot be determined)
pT2: Tumor greater than 7 cm in greatest dimension, limited to the kidney
___ pT2a: Tumor greater than 7 cm but less than or equal to 10 cm in greatest dimension, limited to the kidney
___ pT2b: Tumor greater than 10 cm, limited to the kidney
___ pT2 (subcategory cannot be determined)
pT3: Tumor extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia
___ pT3a: Tumor extends into the renal vein or its segmental branches, or invades the pelvicalyceal system, or invades
perirenal and / or renal sinus fat but not beyond Gerota’s fascia
___ pT3b: Tumor extends into the vena cava below the diaphragm
___ pT3c: Tumor extends into the vena cava above the diaphragm or invades the wall of the vena cava
___ pT3 (subcategory cannot be determined)
___ pT4: Tumor invades beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland)

Regional Lymph Nodes (pN)

___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN1: Metastasis in regional lymph node(s)

Distant Metastasis (pM)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis
Protocol for the Examination of Radical Prostatectomy Specimens From Patients With Carcinoma
of the Prostate Gland
College of American Pathologists; November 2021

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note L)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the
AJCC (Chapter 1, 8th Ed.) it is the managing physician’s responsibility to establish the final pathologic stage based upon all pertinent information,
including but potentially not limited to this pathology report.

TNM Descriptors (select all that apply)

___ Not applicable: _________________
___ m (multiple)
___ r (recurrent)
___ y (post-treatment)

pT Category#
# There is no pathologic T1 classification.
___ pT2: Organ confined
pT3: Extraprostatic extension
___ pT3a: Extraprostatic extension or microscopic invasion of bladder neck
___ pT3b: Tumor invades seminal vesicle(s)
___ pT3 (subcategory cannot be determined)
___ pT4: Tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter, rectum,
bladder, levator muscles, and / or pelvic wall

pN Category
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No positive regional nodes
___ pN1: Metastasis in regional nodes

pM Category (required only if confirmed pathologically)#

# When more than 1 site of metastasis is present, the most advanced category is used. M1c is most advanced.
___ Not applicable - pM cannot be determined from the submitted specimen(s) pM1: Distant metastasis
___ pM1a: Nonregional lymph node(s)
___ pM1b: Bone(s)
___ pM1c: Other site(s) with or without bone disease
___ pM1 (subcategory cannot be determined)
Protocol for the Examination of Specimens From Patients With Carcinoma and Carcinosarcoma of
the Endometrium
College of American Pathologists; December 2022

pTNM CLASSIFICATION (AJCC 8th Edition) (Note K)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.), it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

Modified Classification (required only if applicable) (select all that apply)

___ Not applicable
___ y (post-neoadjuvant therapy)
___ r (recurrence)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Tumor confined to the corpus uteri, including endocervical glandular involvement
___ pT1a: Tumor limited to endometrium or invading less than half the myometrium
___ pT1b: Tumor invading one half or more of the myometrium
___ pT1 (subcategory cannot be determined)
___ pT2: Tumor invading the stromal connective tissue of the cervix but not extending beyond the uterus. Does NOT include only endocervical glandular
involvement.
pT3: Tumor involving serosa, adnexa, vagina, or parametrium
___ pT3a: Tumor involving serosa and / or adnexa (direct extension or metastasis)
___ pT3b: Vaginal involvement (direct extension or metastasis) or parametrial involvement
___ pT3 (subcategory cannot be determined)
___ pT4: Tumor invading bladder mucosa and / or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4)#
# Tumor must involve the mucosal surface

T Suffix (required only if applicable)

___ Not applicable
___ (m) multiple primary synchronous tumors in a single organ
pN Category
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm
pN1: Regional lymph node metastasis to pelvic lymph nodes
# Even one metastasis greater than 2.0 mm would qualify the classification as pN1a and pN2a.
___ pN1mi: Regional lymph node metastasis (greater than 0.2 mm but not greater than 2.0 mm in diameter) to pelvic lymph nodes#
___ pN1a: Regional lymph node metastasis (greater than 2.0 mm in diameter) to pelvic lymph nodes
___ pN1 (subcategory cannot be determined)
pN2: Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes
___ pN2mi: Regional lymph node metastasis (greater than 0.2 mm but not greater than 2.0 mm in diameter) to para-aortic lymph nodes, with or without positive
pelvic lymph nodes#
___ pN2a: Regional lymph node metastasis (greater than 2.0 mm in diameter) to para-aortic lymph nodes, with or without positive pelvic lymph nodes
___ pN2 (subcategory cannot be determined)

N Suffix (required only if applicable)

Suffix (sn) is added to the N category when metastasis is identified only by sentinel lymph node biopsy. If after a sentinel node biopsy, the patient then undergoes a complete lymph node dissection, the
(sn) suffix is not used.
___ Not applicable
___ (sn)

pM Category
___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis (includes metastasis to inguinal lymph nodes, intraperitoneal disease, lung, liver, or bone. It excludes metastasis to pelvic or para-
aortic lymph nodes, vagina, uterine serosa, or adnexa)

FIGO STAGE
+FIGO Stage (2018 FIGO Cancer Report)
___ I: Tumor confined to the corpus uteri
___ IA: No or less than half myometrial invasion
___ IB: Invasion equal to or more than half of the myometrium
___ II: Tumor invades cervical stroma, but does not extend beyond the uterus
___ III: Local and / or regional spread of the tumor
___ IIIA: Tumor invades the serosa of the corpus uteri and / or adnexae
___ IIIB: Vaginal and / or parametrial involvement
___ IIIC: Metastases to pelvic and / or para-aortic lymph nodes
___ IIIC1: Positive pelvic nodes
___ IIIC2: Positive para-aortic nodes with or without positive pelvic lymph nodes
___ IV: Tumor invades bladder and / or bowel mucosa, and / or distant metastases
___ IVA: Tumor invasion of bladder and / or bowel mucosa
___ IVB: Distant metastasis, including intra-abdominal metastases and / or inguinal nodes
Protocol for the Examination of Specimens From Patients With Primary Tumors of the Ovary,
Fallopian Tube, or Peritoneum
College of American Pathologists; March 2023

pTNM CLASSIFICATION (AJCC 8th Edition) (Note L)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

Modified Classification (required only if applicable) (select all that apply)

___ Not applicable
___ y (post-neoadjuvant therapy)
___ r (recurrence)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Tumor limited to ovaries (one or both) or fallopian tube(s)
# Serous tubal intraepithelial carcinoma (STIC) should be staged as pT1a if it involves one tube only, as pT1b if it involves both tubes, and as pT1c3 if it is accompanied by positive peritoneal washing
washings or ascites. Nonmalignant ascites is not classified. The presence of ascites does not affect staging unless malignant cells are present.
___ pT1a: Tumor limited to one ovary (capsule intact) or fallopian tube, no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal
washings#
___ pT1b: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or
peritoneal washings
___ pT1c: Tumor limited to one or both ovaries or fallopian tubes, with any of the following:
___ pT1c1: Surgical spill
___ pT1c2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
___ pT1c3: Malignant cells in ascites or peritoneal washings
___ pT1 (subcategory cannot be determined)
pT2: Tumor involves one or both ovaries or fallopian tubes with pelvic extension below pelvic brim or primary peritoneal cancer
___ pT2a: Extension and / or implants on the uterus and / or fallopian tube(s) and / or ovaries.
___ pT2b: Extension to and / or implants on other pelvic tissues
___ pT2 (subcategory cannot be determined)
pT3: Tumor involves one or both ovaries or fallopian tubes, or primary peritoneal cancer, with microscopically confirmed peritoneal metastasis outside the pelvis and / or metastasis to the retroperitoneal
(pelvic and / or para-aortic) lymph nodes
___ pT3a: Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes
___ pT3b: Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension with or without metastasis to the retroperitoneal lymph nodes
___ pT3c: Macroscopic peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension with or without metastasis to the retroperitoneal lymph nodes
(includes extension to capsule of liver and spleen without parenchymal involvement of either organ)
___ pT3 (subcategory cannot be determined)

T Suffix (required only if applicable)

___ Not applicable
___ (m) multiple primary synchronous tumors in a single organ

pN Category#
# For ovarian, fallopian tube, or primary peritoneal tumors, lymph nodes designated as pelvic [parametrial, obturator, internal iliac (hypogastric), external iliac, common iliac, sacral, presacral], para-aortic,
and retroperitoneal are considered regional lymph nodes. Although not specifically named by AJCC or FIGO, intra-omental and peri-intestinal lymph nodes are also regarded as regional lymph nodes for
staging purposes. Any other involved nodes should be categorized as metastases (pM1) and reported in the distant metastasis section. Presence of isolated tumor cells no greater than 0.2 mm in regional
lymph node(s) is considered N0(i+).
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN0 (i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm
pN1: Positive retroperitoneal lymph nodes only (histologically confirmed)
___ pN1a: Metastasis up to 10 mm in greatest dimension
___ pN1b: Metastasis more than 10 mm in greatest dimension
___ pN1 (subcategory cannot be determined)

N Suffix (required only if applicable)

___ Not applicable
___ (sn) metastasis is identified only by sentinel lymph node biopsy
___ (sn) (i-)
___ (sn) (i+)
___ (f) metastasis is identified only by FNA or core biopsy

pM Category (required only if confirmed pathologically)

Parenchymal liver or splenic metastasis is classified as stage IV disease, whereas liver or splenic capsule metastasis is classified as stage III disease. Non-regional lymph node metastases (such as
inguinal, supraclavicular, and axillary nodes) are considered M1. Involvement of diaphragm surface is considered pT3; however, involvement of diaphragm skeletal muscle or abdominal wall tissue beyond
the peritoneum is considered distant metastasis (M1).
___ Not applicable - pM cannot be determined from the submitted specimen(s)
pM1: Distant metastasis, including pleural effusion with positive cytology; liver or splenic parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes
outside the abdominal cavity); and transmural involvement of intestine
___ pM1a: Pleural effusion with positive cytology
___ pM1b: Liver or splenic parenchymal metastases; metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the
abdominal cavity); transmural involvement of intestine
___ pM1 (subcategory cannot be determined)

FIGO STAGE
+FIGO Stage (2018 FIGO Cancer Report)
___ I: Tumor limited to ovaries (one or both) or fallopian tube(s)
___ IA: Tumor limited to one ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or
peritoneal washings
___ IB: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or
peritoneal washings
___ IC: Tumor limited to one or both ovaries or fallopian tube(s), with any of the following subcategories below
___ IC1: Surgical spill
___ IC2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
___ IC3: Malignant cells present in the ascites or peritoneal washings
___ II: Tumor involves one or both ovaries or fallopian tubes with pelvic extension (below pelvic brim) or primary peritoneal cancer
___ IIA: Extension and / or implants on the uterus and / or fallopian tube(s) and / or ovaries
___ IIB: Extension to and / or implants in other pelvic tissues
___ III: Tumor involves one or both ovaries or fallopian tubes, or primary peritoneal cancer, with microscopically confirmed peritoneal metastasis outside the pelvis
and / or retroperitoneal lymph node involvement
___ IIIA: Metastasis to the retroperitoneal lymph nodes with or without microscopic peritoneal involvement beyond the pelvis
___ IIIA1: Positive (microscopically confirmed) retroperitoneal lymph nodes only
# This is tumor dimension and not lymph node dimension.
___ IIIA1(i): Metastasis less than or equal to 10 mm in greatest dimension#
___ IIIA1(ii): Metastasis greater than 10 mm in greatest dimension#
___ IIIA2: Microscopic peritoneal metastasis beyond the pelvis with or without positive retroperitoneal lymph nodes
## Includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ.
___ IIIB: Macroscopic peritoneal metastases beyond the pelvic brim less than or equal to 2 cm in greatest dimension with or without positive retroperitoneal lymph
nodes##
___ IIIC: Macroscopic peritoneal metastases beyond the pelvic brim greater than 2 cm in greatest dimension including extension to liver capsule or spleen without
parenchymal involvement of those organs and with or without positive retroperitoneal lymph nodes##
### Stage IV distant metastasis excludes peritoneal metastases if that is the only finding.
___ IV: Distant metastasis including cytology-positive pleural effusion; liver or splenic parenchymal involvement; extra-abdominal organ involvement excluding
inguinal lymph nodes; transmural intestinal involvement###
___ IVA: Pleural effusion with positive cytology
#### Parenchymal metastases are stage IVB. Disease invading through the bowel wall and into the mucosa increases the stage to IVB, and transmural involvement of a visceral structure also represents
stage IVB disease.
___ IVB: Liver or splenic parenchymal metastasis; metastasis to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside the abdominal
cavity); transmural involvement of intestine####
Protocol for the Examination of Resection Specimens FromPatients With Primary Carcinoma of
the Uterine Cervix
College of American Pathologists; April 2023

pTNM CLASSIFICATION (AJCC 9th Version) (Note G)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

Modified Classification (required only if applicable) (select all that apply)

___ Not applicable
___ y (post-neoadjuvant therapy)
___ r (recurrence)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Carcinoma is strictly confined to the cervix (extension to the corpus should be disregarded).
pT1a: Invasive carcinoma that can be diagnosed only by microscopy with maximum depth of invasion less than or equal to 5 mm.
# The LAST definition of superficial invasive squamous cell carcinoma (SISCCA) conforms to T1a1.
___ pT1a1: Measured stromal invasion less than or equal to 3 mm in depth#
___ pT1a2: Measured stromal invasion greater than 3 mm and less than or equal to 5 mm in depth
___ pT1a (subcategory cannot be determined)
pT1b: Invasive carcinoma with measured deepest invasion greater than 5 mm (greater than stage IA); lesion limited to the cervix uteri with size measured by maximum tumor diameter. Note: The
involvement of lymphatic and / or vascular spaces should not change the staging. The lateral extent of the lesion is no longer considered.
___ pT1b1: Invasive carcinoma greater than 5 mm depth of stromal invasion and less than or equal to 2 cm in greatest dimension
___ pT1b2: Invasive carcinoma greater than 2 cm and less than or equal to 4 cm in greatest dimension
___ pT1b3: Invasive carcinoma greater than 4 cm in greatest dimension
___ pT1b (subcategory cannot be determined)
___ pT1 (subcategory cannot be determined)
pT2: Carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall.
pT2a: Involvement limited to the upper two-thirds of the vagina without parametrial invasion.
___ pT2a1: Invasive carcinoma less than or equal to 4 cm in greatest dimension
___ pT2a2: Invasive carcinoma greater than 4 cm in greatest dimension
___ pT2a (subcategory cannot be determined)
___ pT2b: With parametrial invasion but not up to the pelvic wall
___ pT2 (subcategory cannot be determined)
pT3: Carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney. Note: The pelvic wall is defined as the muscle, fascia,
neurovascular structures, and skeletal portions of the bony pelvis. Cases with no cancer-free space between the tumor and pelvic wall by rectal examination are FIGO III.
___ pT3a: Carcinoma involves lower third of the vagina, with no extension to the pelvic wall
___ pT3b: Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)
___ pT3 (subcategory cannot be determined)
## Tumor should involve the mucosal surface.
___ pT4: Carcinoma has involved (biopsy-proven) the mucosa of the bladder or rectum, or has spread to adjacent organs. (Bullous edema, as such, does not
permit a case to be assigned to stage 4.)##

T Suffix (required only if applicable)

___ Not applicable
___ (m) multiple primary synchronous tumors in cervix

pN Category
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN0(i+): Isolated tumor cells in regional lymph node(s) less than or equal to 0.2 mm, or single cells or clusters of cells less than or equal to 200 cells in a
single lymph node cross section
pN1: Regional lymph node metastasis to pelvic lymph nodes only.
___ pN1mi: Regional lymph node metastasis (greater than 0.2 mm but less than or equal to 2.0 mm) to pelvic lymph nodes
___ pN1a: Regional lymph node metastasis (greater than 2.0 mm diameter) to pelvic lymph nodes
___ pN1 (subcategory cannot be determined)
pN2: Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes.
___ pN2mi: Regional lymph node metastasis to para-aortic lymph nodes (greater than 0.2 mm but less than or equal to 2.0 mm), with or without positive pelvic
lymph nodes
___ pN2a: Regional lymph node metastasis to para-aortic lymph nodes (greater than 2.0 mm in diameter), with or without positive pelvic lymph nodes
___ pN2 (subcategory cannot be determined)

N Suffix (required only if applicable)

___ Not applicable
___ (sn) metastasis is identified only by sentinel lymph node biopsy
___ (sn)(i-)
___ (sn)(i+)
___ (f) metastasis is identified only by FNA or core biopsy

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
# Uterine serosa and adnexa involvement are considered M1 disease. (Note G)
___ pM1: Distant metastasis (includes metastasis to inguinal lymph nodes, intraperitoneal disease, lung, liver, or bone) (excludes metastasis to pelvic or para-
aortic lymph nodes, or vagina).#

FIGO STAGE (Note G)

+FIGO Stage (2018 FIGO Cancer Report)#
# Please note that this section includes the Corrigendum to Revised FIGO staging for carcinoma of the cervix uteri. See the appropriate reference in Note G.
___ I: Carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)
# For FIGO IA cancers, the depth of invasion should not be more than 5.0 mm taken from the base of the epithelium, either surface or glandular, from which it originates. Vascular space invasion does not
alter the staging.
___ IA: Invasive cancer identified only microscopically (All gross lesions even with superficial invasion are stage IB cancers) Invasion is limited to measured
stromal invasion with a maximum depth of 5.0 mm#
## The LAST definition of superficial invasive squamous cell carcinoma (SISCCA) conforms to FIGO IA1.
___ IA1: Measured stromal invasion of 3.0 mm or less in depth##
___ IA2: Measured stromal invasion of more than 3.0 mm and not more than 5.0 mm
### Lymphatic and / or vascular space invasion does not alter the staging.
___ IB: Invasive carcinoma with measured stromal invasion greater than 5.0 mm (greater than stage IA) and limited to the uterus###
___ IB1: Invasive carcinoma with measured stromal invasion greater than 5.0 mm and 2 cm or less in greatest dimension
___ IB2: Invasive carcinoma greater than 2 cm but 4 cm or less in greatest dimension
___ IB3: Invasive carcinoma greater than 4 cm in greatest dimension
___ II: Carcinoma extends beyond the uterus but has not extended onto the pelvic sidewall or to the lower third of vagina
___ IIA: Carcinoma involves the upper two-thirds of the vagina without parametrial invasion
___ IIA1: Invasive carcinoma 4 cm or less in greatest dimension
___ IIA2: Invasive carcinoma greater than 4 cm in greatest dimension
___ IIB: Parametrial involvement but not involving the pelvic sidewall
___ III: Carcinoma involves the lower third of the vagina and / or extends to the pelvic sidewall and / or causes hydronephrosis or nonfunctioning kidney and / or
involves pelvic and / or para-aortic lymph nodes
___ IIIA: Involvement of the lower third of the vagina but no extension onto pelvic sidewall
___ IIIB: Extension onto the pelvic sidewall, and / or causing hydronephrosis / nonfunctioning kidney (unless known to be due to another cause)
#### Isolated tumor cells do not change the stage, but their presence should be recorded. Notations r refers to imaging and p refers to pathology.
___ IIIC: Involvement of pelvic and / or para-aortic lymph nodes (including micrometastases), irrespective of tumor size and extent (with r and p notations)####
___ IIIC1: Pelvic lymph node metastasis only
___ IIIC2: Para- aortic lymph node metastasis
##### Involvement of the uterine or pelvic serosa and / or fallopian tubes alone does not constitute FIGO Stage IV disease, but is considered M1 disease in the AJCC / UICC system. (Note G)
___ IV: Carcinoma extends beyond the true pelvis or involves (biopsy proven) the mucosa of the bladder and / or rectum (bullous edema is not sufficient) or
spread to distant organs#####
___ IVA: Spread to adjacent organs, i.e., tumor invading the mucosa of the bladder and / or rectum (biopsy proven) and / or extending beyond the true pelvis
(bullous edema is not sufficient)
___ IVB: Spread to distant organs
Protocol for the Examination of Specimens From Patients With Primary Sarcoma of the Uterus
College of American Pathologists; March 2022

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th ed.) (Note C)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

TNM Descriptors (select all that apply)

___ Not applicable: _________________
___ r (recurrent)
___ y (post-treatment)

pT Category
___ For All Sarcomas Excluding Adenosarcoma (including Leiomyosarcoma, Endometrial Stromal Sarcoma, and Undifferentiated Endometrial Sarcoma / Uterine
Sarcoma).
pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Tumor limited to the uterus
___ pT1a: Tumor 5 cm or less in greatest dimension
___ pT1b: Tumor more than 5 cm
___ pT1 (subcategory cannot be determined)
pT2: Tumor extends beyond the uterus, within the pelvis
___ pT2a: Tumor involves adnexa
___ pT2b: Tumor involves other pelvic tissues
___ pT2 (subcategory cannot be determined)
pT3: Tumor infiltrates abdominal tissues
___ pT3a: Tumor infiltrates abdominal tissues in one site
___ pT3b: Tumor infiltrates abdominal tissues in more than one site
___ pT3 (subcategory cannot be determined)
___ pT4: Tumor invades bladder or rectum
___ For Adenosarcoma
pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor
pT1: Tumor limited to the uterus
___ pT1a: Tumor limited to the endometrium / endocervix
___ pT1b: Tumor invades to less than half of the myometrium
___ pT1c: Tumor invades one half or more of the myometrium
___ pT1 (subcategory cannot be determined)
pT2: Tumor extends beyond the uterus, within the pelvis
___ pT2a: Tumor involves adnexa
___ pT2b: Tumor involves other pelvic tissues
___ pT2 (subcategory cannot be determined)
pT3: Tumor infiltrates abdominal tissues
___ pT3a: Tumor infiltrates abdominal tissues in one site
___ pT3b: Tumor infiltrates abdominal tissues in more than one site
___ pT3 (subcategory cannot be determined)
___ pT4: Tumor invades bladder or rectum

pN Category
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm
___ pN1: Regional lymph node metastasis

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis (excluding adnexa, pelvic, abdominal tissues, and regional lymph nodes)

FIGO STAGE

+FIGO Stage (2018 FIGO Cancer Report) for All Sarcomas Except Adenosarcoma#
# Including leiomyosarcoma, endometrial stromal sarcoma, and undifferentiated endometrial sarcoma / uterine sarcoma
___ I: Tumor limited to uterus
___ IA: Less than or equal to 5 cm
___ IB: More than 5 cm
___ II: Tumor extends beyond the uterus, within the pelvis
___ IIA: Adnexal involvement
___ IIB: Involvement of other pelvic tissues
___ III: Tumor invades abdominal tissues (not just protruding into the abdomen)
___ IIIA: One site
___ IIIB: More than one site
___ IIIC: Metastasis to pelvic and / or para-aortic lymph nodes
___ IV: Tumor invades bladder and / or rectum and / or distant metastasis
___ IVA: Tumor invades bladder and / or rectal mucosa
___ IVB: Distant metastasis

+FIGO Stage (2018 FIGO Cancer Report) for Adenosarcoma

___ I: Tumor limited to uterus
___ IA: Tumor limited to endometrium / endocervix with no myometrial invasion
___ IB: Less than or equal to half myometrial invasion
___ IC: More than half myometrial invasion
___ II: Tumor extends beyond the uterus, within the pelvis
___ IIA: Adnexal involvement
___ IIB: Tumor extends to extrauterine pelvic tissue
___ III: Tumor invades abdominal tissues (not just protruding into the abdomen)
___ IIIA: One site
___ IIIB: More than one site
___ IIIC: Metastasis to pelvic and / or para-aortic lymph nodes
___ IV: Tumor invades bladder and / or rectum and / or distant metastasis
___ IVA: Tumor invades bladder and / or rectal mucosa
___ IVB: Distant metastasis
Protocol for the Examination of Specimens from Patients with Cutaneous Squamous Cell
Carcinoma of the Head and Neck
College of American Pathologists; September 2022

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note H)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.) it is the managing
physician’s responsibility to establish the final pathologic stage based upon all pertinent information, including but potentially not limited to this pathology report.

TNM Descriptors (select all that apply)

___ Not applicable
___ m (multiple primary tumors)
___ r (recurrent)
___ y (post-treatment)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pTis: Carcinoma in situ
___ pT1: Tumor smaller than or equal to 2 cm in greatest dimension
___ pT2: Tumor larger than 2 cm, but smaller than or equal to 4 cm in greatest dimension
#Deep invasion is defined as invasion beyond the subcutaneous fat (i.e., to underlying microanatomic landmarks such as fascia, muscle, perichondrium, and / or periosteum) or greater than 6 mm (as
measured from the granular layer of adjacent normal epidermis to the base of the tumor); perineural invasion for T3 classification is defined as tumor cells within the nerve sheath of a nerve lying deeper
than the dermis or measuring 0.1 mm or larger in caliber, or presenting with clinical or radiographic involvement of named nerves without skull base invasion or transgression.
___ pT3: Tumor larger than 4 cm in maximum dimension or minor bone erosion or perineural invasion or deep invasion#
pT4: Tumor with gross cortical bone / marrow, skull base invasion and / or skull base foramen invasion
___ pT4a: Tumor with gross cortical bone / marrow invasion
___ pT4b: Tumor with skull base invasion and / or skull base foramen involvement
___ pT4 (subcategory cannot be determined)

pN Category#
# A designation of “U” or “L” may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L). Similarly, clinical and pathological
ENE should be recorded as ENE(−) or ENE(+).
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis
___ pN1: Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(-)
pN2: Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(+); or larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(-); or metastases in
multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(-); or in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension, ENE(-)
___ pN2a: Metastasis in single ipsilateral node 3 cm or smaller in greatest dimension and ENE(+); or a single ipsilateral node larger than 3 cm but not larger than 6
cm in greatest dimension and ENE(-)
___ pN2b: Metastases in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(-)
___ pN2c: Metastases in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(-)
___ pN2 (subcategory cannot be determined)
pN3: Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(-); or in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral,
or bilateral nodes, any with ENE(+); or a single contralateral node of any size and ENE(+)
___ pN3a: Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(-)
___ pN3b: Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral, or bilateral nodes, any
with ENE(+); or a single contralateral node of any size and ENE(+)
___ pN3 (subcategory cannot be determined)

pM Category (required only if confirmed pathologically)

___ Not applicable - pM cannot be determined from the submitted specimen(s)
___ pM1: Distant metastasis
Brigham and Women's (BWH) Tumor Classification System (Note H)
+High-risk Factors (select all that apply)
___ Tumor diameter greater than or equal to 2 cm
___ Poorly differentiated histology
___ Perineural invasion greater than or equal to 0.1 mm in caliber
___ Tumor invasion beyond subcutaneous fat (excluding bone invasion, which upgrades tumor to BWH stage T3)
+BWH Tumor Classification
___ T1: 0 high-risk factor
___ T2a: 1 high-risk factor
___ T2b: 2-3 high-risk factors
___ T3: Greater than or equal to 4 risk factors or bone invasion
Protocol for the Examination of Excision Specimens From Patients With
Melanoma of the Skin
College of American Pathologists; November 2021

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note G)

Reporting of pT, pN, and (when applicable) pM categories is based on information available to the pathologist at the time the report is issued. As per the
AJCC (Chapter 1, 8th Ed.) it is the managing physician’s responsibility to establish the final pathologic stage based upon all pertinent information,
including but potentially not limited to this pathology report.

In general, CAP cancer protocol case summaries are intended to guide reporting on the specimen that the pathologist is evaluating at that time.
However, melanoma cases frequently include multiple procedures. Because of this, a prior procedure that was performed may affect the pathologic
classification of the tumor. In order to represent this appropriately in the pathology report, information from prior procedures may be incorporated into the
assignment of pathologic classification if it is available. When information from a prior procedure is included in this report, details of that procedure
should be documented in the report as well.
___ Classification assigned in this report includes information from a prior procedure (explain): _________________

TNM Descriptors (select all that apply)

___ Not applicable: _________________
___ m (multiple)
___ r (recurrence or retreatment)
___ y (posttherapy or post neoadjuvant therapy)

pT Category
___ pT not assigned (cannot be determined based on available pathological information)
___ pT0: No evidence of primary tumor (e.g., unknown primary or completely regressed melanoma)
pT1: Melanoma 1.0 mm or less in thickness, ulceration status unknown or unspecified (see Note D)
___ pT1a: Melanoma less than 0.8 mm in thickness, no ulceration
___ pT1b: Melanoma less than 0.8 mm in thickness with ulceration; or Melanoma 0.8 to 1.0 mm in thickness with or
without ulceration
___ pT1 (subcategory cannot be determined)
pT2: Melanoma greater than 1.0 to 2.0 mm in thickness, ulceration status unknown or unspecified
___ pT2a: Melanoma greater than 1.0 to 2.0 mm in thickness, no ulceration
___ pT2b: Melanoma greater than 1.0 to 2.0 mm in thickness, with ulceration
___ pT2 (subcategory cannot be determined)
pT3: Melanoma greater than 2.0 to 4.0 mm in thickness, ulceration status unknown or unspecified
___ pT3a: Melanoma greater than 2.0 to 4.0 mm in thickness, no ulceration
___ pT3b: Melanoma greater than 2.0 to 4.0 mm in thickness, with ulceration
___ pT3 (subcategory cannot be determined)
pT4: Melanoma greater than 4.0 mm in thickness, ulceration status unknown or unspecified
___ pT4a: Melanoma greater than 4.0 mm in thickness, no ulceration
___ pT4b: Melanoma greater than 4.0 mm in thickness, with ulceration
___ pT4 (subcategory cannot be determined)

pN Category
#
pN1b, 2b, and 3b subcategories are dependent on clinical information that may be unavailable to the pathologist. If this information is not available,
the parent category (pN1, pN2 or pN3) should be selected.
___ pN not assigned (no nodes submitted or found)
___ pN not assigned (cannot be determined based on available pathological information)
___ pN0: No regional lymph node metastasis detected
pN1: One tumor-involved node or in-transit, satellite, and / or microsatellite metastases with no tumor-involved nodes
___ pN1a: One clinically occult tumor-involved node (i.e., detected by sentinel node biopsy) with no in-transit, satellite
and / or microsatellite metastases
___ pN1b: One clinically detected tumor-involved node with no in-transit, satellite and / or microsatellite metastases#
___ pN1c: Presence of in-transit, satellite and / or microsatellite metastases with no regional lymph node disease
___ pN1 (subcategory cannot be determined)
pN2: Metastasis in two to three regional nodes or in-transit, satellite, and / or microsatellite with one tumor-involved
node
___ pN2a: Two to three clinically occult tumor-involved node (i.e., detected by sentinel node biopsy) with no in-transit,
satellite and / or microsatellite metastases
___ pN2b: Two to three tumor-involved nodes at least one of which was clinically detected with no in-transit, satellite
and / or microsatellite metastases#
___ pN2c: One clinically occult or clinically detected tumor-involved node with presence of in-transit, satellite and / or
microsatellite
___ pN2 (subcategory cannot be determined)
pN3: Metastasis in four or more regional lymph nodes, or in-transit, satellite or microsatellite metastases with two or more tumor-involved nodes or
any number of matted nodes with or without in-transit, satellite or microsatellite metastases
___ pN3a: Four or more clinically occult tumor-involved nodes (i.e., detected by sentinel node biopsy) with no in-transit,
satellite and / or microsatellite metastases
___ pN3b: Four or more tumor-involved nodes, at least one of which was clinically detected, with no in-transit, satellite
and / or microsatellite metastases#
___ pN3c: Two or more clinically occult or clinically detected tumor-involved nodes with in-transit, satellite and / or
microsatellite metastases and / or any number of matted nodes with in-transit, satellite and / or microsatellite
metastases
___ pN3 (subcategory cannot be determined)

pM Category (required only if confirmed pathologically)

AJCC pM category suffixes “(0)” and “(1)”, which denote LDH level of elevation, are NOT included in the surgical pathology report. LDH levels, as
with other clinical parameters, may be included in the final classification by clinicians with access to this data.
___ Not applicable - pM cannot be determined from the submitted specimen(s)
pM1: Distant metastasis (documented in this specimen)
___ pM1a: Distant metastasis in skin, subcutaneous tissues, soft tissues including muscle and / or nonregional lymph
nodes
___ pM1b: Distant metastasis to lung with or without M1a sites of disease
___ pM1c: Distant metastasis to non-CNS visceral sites with or without M1a or M1b sites of disease
___ pM1d: Distant metastasis to CNS with or without M1a, M1b or M1c sites of disease
___ pM1 (subcategory cannot be determined)