KidneyParenchyma. Kidney (Renal Parenchyma)

Transcription

1 for TNM 7 - Revised 01/21/2010 Kidney (Renal Parenhyma) C64.9 C64.9 Kidney, NOS (Renal parenhyma) Note: Laterality must be oded for this site. CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval CS Site-Speifi Fator 1 Invasion Beyond Capsule CS Site-Speifi Fator 2 Vein Involvement CS Site-Speifi Fator 3 Ipsilateral Adrenal Gland Involvement CS Site-Speifi Fator 4 Saromatoid Features CS Site-Speifi Fator 5 Histologi Tumor Nerosis CS Site-Speifi Fator 6 Fuhrman Nulear Grade Revision Info List of Shemas CS Site-Speifi Fator 7 Size of Metastasis in Lymph Nodes CS Site-Speifi Fator 8 Extranodal Extension of Regional Lymph Nodes CS Site-Speifi Fator 9 = 988 CS Site-Speifi Fator 10 = 988 CS Site-Speifi Fator 11 = 988 CS Site-Speifi Fator 12 = 988 CS Site-Speifi Fator 13 = 988 CS Site-Speifi Fator 14 = 988 CS Site-Speifi Fator 15 = 988 CS Site-Speifi Fator 16 = 988 CS Site-Speifi Fator 17 = 988 CS Site-Speifi Fator 18 = 988 CS Site-Speifi Fator 19 = 988 CS Site-Speifi Fator 20 = 988 CS Site-Speifi Fator 21 = 988 CS Site-Speifi Fator 22 = 988 CS Site-Speifi Fator 23 = 988 CS Site-Speifi Fator 24 = 988 CS Site-Speifi Fator 25 = 988 Histology Inlusion Table AJCC 7th ed. Histology Exlusion Table AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage Extension Size Table AJCC 6 Extension Size Table AJCC 7 1

2 for TNM 7 - Revised 09/30/2009 [ Shema ] CS Tumor Size Note: the speifi tumor size as doumented in the medial reord. If the ONLY information regarding tumor size is the physiian's statement of the T ategory, assign ode 994, 995, 996 or 997. (Refer to the CS Extension table for instrutions on oding extension). 000 No mass/tumor found millimeters (ode exat size in millimeters) millimeters or larger 990 Mirosopi fous or foi only and no size of fous given 991 Desribed as "less than 1 m" 992 Desribed as "less than 2 m," or "greater than 1 m," or "between 1 m and 2 m" 993 Desribed as "less than 3 m," or "greater than 2 m," or "between 2 m and 3 m" 994 Desribed as "less than 4 m," or "greater than 3 m," or "between 3 m and 4 m" Stated as T1a with no other information on tumor size 995 Desribed as "less than 5 m," or "greater than 4 m," or "between 4 m and 5 m" Stated as T1b with no other information on tumor size 996 Desribed as "7 m or less" Stated as T1 [NOS] with no other information on tumor size 997 Desribed as "greater than 7 m" Stated as T2 [NOS] or T2a with no other information on tumor size 998 Desribed as "greater than 10 m" Stated as T2b with no other information on tumor size 999 Unknown; size not stated 2

3 Page 1 of 3 for TNM 7 - Revised 01/19/2010 [ Shema ] CS Extension Note 1: The parenhyma of the kidney inludes the following strutures: ortex (outer layer of kidney) and renal olumns; medulla, medullary rays, renal pyramids, and renal papillae; nephrons (renal orpusle, loops of Henle, proximal and distal tubules, olleting dut), glomerulus, and Bowman's apsule. The most ommon site for renal parenhymal aner to develop is in the proximal onvoluted tubule. Tumor extension from one of these strutures into another would be oded to 100 unless there were further signs of involvement. Note 2: Information about invasion beyond the apsule, venous involvement, and ipsilateral adrenal gland involvement is olleted in this field and in Site-Speifi Fators 1, 2 and 3 beause beyond ontributing to the overall assessment of extent of tumor, these fators an have an independent effet on prognosis. Note 3: ONLY assign ode 300 (loalized, NOS) when no further information is available to assign ode 100, 200 or Note 4: If the ONLY information regarding tumor extension is the physiian's statement of the T ategory, assign ode , 605, 610, 620, 625 or 810. (Refer to CS Tumor Size table for instrutions on oding tumor size if assigning ode ). TNM 7 TNM 6 SS77 SS In situ TX TX IS IS 100 Invasive aner onfined to kidney ortex and/or medulla 200 Invasion of renal apsule Renal pelvis or alyes involved Separate fous of tumor in renal pelvis/alyx ^ * L L ^ * L L 300 Loalized, NOS ^ * L L 310 Stated as T1a with no other information on extension 320 Stated as T1b with no other information on extension 330 Stated as T1 [NOS] with no other information on extension 340 Stated as T2a with no other information on extension 350 Stated as T2b with no other information on extension 360 Stated as T2 [NOS] with no other information on extension 390 OBSOLETE DATA CONVERTED V0200 ^ * L L ^ * L L ^ * L L ^ * L L ^ * L L ^ * L L ERROR ERROR ERROR ERROR 3

4 Page 2 of 3 See ode 625 Stated as T3, NOS 400 OBSOLETE DATA RETAINED V0200 Adrenal (suprarenal gland), ipsilateral relassified in AJCC 7th Edition; see odes 450 and 630 Adrenal (suprarenal) gland, ipsilateral Perirenal (perinephri) tissue/fat Renal (Gerota's) fasia Renal sinus fat Retroperitoneal soft tissue 450 Perirenal (perinephri) tissue/fat Renal (Gerota's) fasia Renal sinus fat Retroperitoneal soft tissue 600 OBSOLETE DATA RETAINED V0200 Blood vessels relassified in AJCC 7th Edition; see odes 601 and 610 Blood vessels: Extrarenal portion of renal vein or segmental (musle ontaining) branhes Hilar blood vessel Inferior vena ava below diaphragm Perirenal vein Renal artery Renal vein, NOS Tumor thrombus in a renal vein, NOS 601 Blood vessels: Extrarenal portion of renal vein or segmental (musle ontaining) branhes Hilar blood vessel Perirenal vein Renal artery Renal vein, NOS Tumor thrombus in a renal vein, NOS 605 Stated as T3a with no other information on extension 610 Inferior vena ava below diaphragm Stated as T3b with no other information on extension 620 Vena ava above diaphragm or invades the wall of the vena ava ERROR T3a RE RE T3a T3a RE RE ERROR T3b RE RE T3a T3b RE RE T3a T3a RE RE T3b T3b RE RE T3 T3 RE RE Stated as T3 with no other information on extension 4

5 Page 3 of Vena ava, NOS T3NOS T3NOS RE RE Stated as T3 [NOS] with no other information on extension 630 Ipsilateral adrenal (suprarenal) gland (nonontiguous ipsilateral adrenal gland involvement is oded in CS Mets at DX) (605 and/or 610) Ipsilateral adrenal gland plus blood vessels listed in ode 605 and/or inferior vena ava below diaphragm Ipsilateral adrenal gland plus vena ava above diaphragm/wall of vena ava 650 Extension beyond Gerota's fasia to: Asending olon from right kidney Desending olon from left kidney Diaphragm Duodenum from right kidney Peritoneum Tail of panreas Ureter, inluding implant(s), ipsilateral Beyond Gerota's fasia, NOS 670 Extension beyond Gerota's fasia to: Psoas musle Quadratus lumborum musle T4 T3a RE RE T4 T3b RE RE T4 T3 RE RE T4 T4 RE RE T4 T4 D RE 700 Ribs T4 T4 D D 750 Liver Spleen Stomah 800 Further ontiguous extension Aorta Other diret extension 810 Stated as T4 with no other information on extension T4 T4 D D T4 T4 D D T4 T4 RE RE 950 No evidene of primary tumor T0 T0 U U 999 Unknown extension Primary tumor annot be assessed TX TX U U ^ For odes 100, 200, 300, 310, 320, 330, 340, 350, and 360 ONLY, the T ategory for AJCC 7 is assigned based on the value of tumor size, as shown in the Extension Size Table AJCC 7 for this site. * For odes 100, 200, 300, 310, 320, 330, 340, 350, and 360 ONLY, the T ategory for AJCC 6 is assigned based on the value of tumor size, as shown in the Extension Size Table AJCC 6 for this site. 5

6 CS Tumor Size/Ext Eval Staging Basis 0 Does not meet riteria for AJCC pathologi staging: No surgial resetion done. Evaluation based on physial examination, imaging examination, or other non-invasive linial evidene. No autopsy evidene used. 1 Does not meet riteria for AJCC pathologi staging: No surgial resetion done. Evaluation based on endosopi examination, diagnosti biopsy, inluding fine needle aspiration biopsy, or other invasive tehniques, inluding surgial observation without biopsy. No autopsy evidene used. 2 Meets riteria for AJCC pathologi staging: No surgial resetion done, but evidene derived from autopsy (tumor was suspeted or diagnosed prior to autopsy) p 3 Either riteria meets AJCC pathologi staging: Surgial resetion performed WITHOUT pre-surgial systemi treatment or radiation OR surgial resetion performed, unknown if pre-surgial systemi treatment or radiation performed AND Evaluation based on evidene aquired before treatment, supplemented or modified by the additional evidene aquired during and from surgery, partiularly from pathologi examination of the reseted speimen. No surgial resetion done. Evaluation based on positive biopsy of highest T lassifiation. p 5 Does not meet riteria for AJCC y-pathologi (yp) staging: Surgial resetion performed AFTER neoadjuvant therapy and tumor size/extension based on linial evidene, unless the pathologi evidene at surgery (AFTER neoadjuvant) is more extensive (see ode 6). 6 Meets riteria for AJCC y-pathologi (yp) staging: Surgial resetion performed AFTER neoadjuvant therapy AND tumor size/extension based on pathologi evidene, beause pathologi evidene at surgery is more extensive than linial evidene before treatment. yp 8 Meets riteria for autopsy (a) staging: Evidene from autopsy only (tumor was unsuspeted or undiagnosed prior to autopsy) a 9 Unknown if surgial resetion done Not assessed; annot be assessed Unknown if assessed 6

7 for TNM 7 - Revised 09/30/2009 [ Shema ] CS Lymph Nodes Note 1: only regional nodes and nodes, NOS, in this field. Distant nodes are oded in the field Mets at DX. Note 2: Regional nodes inlude unilateral, bilateral or ontralateral involvement of named node(s). TNM 7 TNM 6 SS77 SS No regional lymph node involvement N0 N0 NONE NONE 100 Single regional lymph node: Aorti, NOS: Lateral (lumbar) Para-aorti Periaorti Preaorti Retroaorti Renal hilar Retroperitoneal, NOS Regional lymph node(s), NOS 110 Single regional lymph node: Interaortoaval Periaval, NOS Paraaval Preaval Retroaval Single regional lymph node as speified in ode 110 plus single regional lymph node as speified in ode More than one regional lymph node other than as defined in ode Regional lymph node(s), NOS Stated as N1 with no other information on regional lymph nodes N1 N1 RN RN N1 N1 D RN N1 N2 D RN N1 N2 D RN N1 N1 RN RN 800 Lymph nodes, NOS N1 N1 RN RN 999 Unknown; not stated Regional lymph nodes annot be assessed NX NX U U 7

8 CS Lymph Nodes Eval Note 1: This field is used primarily to derive the staging basis for the N ategory in the TNM system. It reords how the ode for the item "CS Lymph Nodes" was determined based on the diagnosti methods employed and their intent. Note 2: In the 7th edition of the AJCC manual, the linial and pathologi lassifiation rules for the N ategory were hanged to reflet urrent medial pratie. The N is designated as linial or pathologi based on the intent (workup versus treatment) mathing with the assessment of the T lassifiation. When the intent is workup, the staging basis is linial, and when the intent is treatment, the staging basis is pathologi. A. Mirosopi assessment inluding biopsy of regional nodes or sentinel nodes if being performed as part of the workup to hoose the treatment plan, is therefore part of the linial staging. When it is part of the workup, the T ategory is linial, and there has not been a resetion of the primary site adequate for pathologi T lassifiation (whih would be part of the treatment). B. Mirosopi assessment of regional nodes if being performed as part of the treatment is therefore part of the pathologi staging. When it is part of the treatment, the T ategory is pathologi, and there has been a resetion of the primary site adequate for pathologi T lassifiation (all part of the treatment). Note 3: Mirosopi assessment of the highest N ategory is always pathologi (ode 3). Note 4: If lymph node dissetion is not performed after neoadjuvant therapy, use ode 0 or 1. Note 5: Only odes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy. Does not meet riteria for AJCC pathologi staging: 0 No regional lymph nodes removed for examination. Evidene based on physial examination, imaging examination, or other non-invasive linial evidene. No autopsy evidene used. 1 Does not meet riteria for AJCC pathologi staging based on at least one of the following riteria: No regional lymph nodes removed for examination. Evidene based on endosopi examination, or other invasive tehniques inluding surgial observation, without biopsy. No autopsy evidene used. OR Fine needle aspiration, inisional ore needle biopsy, or exisional biopsy of regional lymph nodes or sentinel nodes as part of the diagnosti workup, WITHOUT removal of the primary site adequate for pathologi T lassifiation (treatment). 8

9 2 Meets riteria for AJCC pathologi staging: No regional lymph nodes removed for examination, but evidene derived from autopsy (tumor was suspeted or diagnosed prior to autopsy). p 3 Meets riteria for AJCC pathologi staging based on at least one of the following riteria: Any mirosopi assessment of regional nodes (inluding FNA, inisional ore needle bx, exisional bx, sentinel node bx or node resetion), WITH removal of the primary site adequate for pathologi T lassifiation (treatment) or biopsy assessment of the highest T ategory. OR Any mirosopi assessment of a regional node in the highest N ategory, regardless of the T ategory information. p 5 Does not meet riteria for AJCC y-pathologi (yp) staging: Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph node evaluation based on linial evidene, unless the pathologi evidene at surgery (AFTER neoadjuvant) is more extensive (see ode 6). 6 Meets riteria for AJCC y-pathologi (yp) staging: Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph node evaluation based on pathologi evidene, beause the pathologi evidene at surgery is more extensive than linial evidene before treatment. yp 8 Meets riteria for AJCC autopsy (a) staging: Evidene from autopsy; tumor was unsuspeted or undiagnosed prior to autopsy. a 9 Unknown if lymph nodes removed for examination Not assessed; annot be assessed Unknown if assessed 9

10 for TNM 7 - Revised 09/30/2009 [ Shema ] CS Mets at DX TNM 7 TNM 6 SS77 SS No; none M0 M0 NONE NONE 10 Distant lymph node(s) M1 M1 D D 40 Nonontiguous ipsilateral adrenal (suprarenal) gland metastasis (ontiguous involvement is oded in CS Extension ode 630) Distant metastases exept distant lymph node(s) (ode 10) Carinomatosis Other distant metastases plus distant lymph node(s) 60 Distant metastasis, NOS Stated as M1 with no other information on metastases 99 Unknown if distant metastasis Distant metastasis annot be assessed M1 M1 D D M1 M1 D D M1 M1 D D M0 MX U U 10

11 CS Mets Eval Note: This item reflets the validity of the lassifiation of the item CS Mets at DX only aording to the diagnosti methods employed. Staging Basis Does not meet riteria for AJCC pathologi staging of distant metastasis: 0 Evaluation of distant metastasis based on physial examination, imaging examination, and/or other non-invasive linial evidene. No pathologi examination of metastati tissue performed or pathologi examination was negative. 1 Does not meet riteria for AJCC pathologi staging of distant metastasis: Evaluation of distant metastasis based on endosopi examination or other invasive tehnique, inluding surgial observation without biopsy. No pathologi examination of metastati tissue performed or pathologi examination was negative. 2 Meets riteria for AJCC pathologi staging of distant metastasis: No pathologi examination of metastati speimen done prior to death, but positive metastati evidene derived from autopsy (tumor was suspeted or diagnosed prior to autopsy). p 3 Meets riteria for AJCC pathologi staging of distant metastasis: Speimen from metastati site mirosopially positive WITHOUT pre-surgial systemi treatment or radiation OR speimen from metastati site mirosopially positive, unknown if pre-surgial systemi treatment or radiation performed OR speimen from metastati site mirosopially positive prior to neoadjuvant treatment. p 5 Does not meet riteria for AJCC y-pathologi (yp) staging of distant metastasis: Speimen from metastati site mirosopially positive WITH pre-surgial systemi treatment or radiation, BUT metastasis based on linial evidene. 6 Meets riteria for AJCC y-pathologi (yp) staging of distant metastasis: Speimen from metastati site mirosopially positive WITH pre-surgial systemi treatment or radiation, BUT metastasis based on pathologi evidene. yp 8 Meets riteria for AJCC autopsy (a) staging of distant metastasis: Evidene from autopsy based on examination of positive metastati tissue AND tumor was unsuspeted or undiagnosed prior to autopsy. a 9 Not assessed; annot be assessed Unknown if assessed 11

12 for TNM 7 - Revised 01/15/2010 [ Shema ] CS Site-Speifi Fator 1 Invasion Beyond Capsule Note 1: Reord the loation of invasion beyond apsule as doumented in the pathology report. Assign ode 000 if surgial resetion of primary site is performed, pathology report is available for review, and invasion beyond apsule is not mentioned. Note 2: Information about invasion beyond the apsule is olleted in this field and in CS Extension beause beyond ontributing to the overall assessment of extent of tumor, it may be an independent preditor of outome. 000 Invasion beyond apsule not present/not identified 010 Lateral invasion Perinephri fat 020 Medial invasion Renal sinus Perisinus fat Medial invasion plus lateral invasion Renal sinus/perisinus fat invasion plus perinephri fat invasion 888 OBSOLETE DATA CONVERTED V0200 See ode 988 Not appliable for this shema 988 Not appliable: Information not olleted for this ase (May inlude ases onverted from ode 888 used in CSv1 for "Not appliable" or when the item was not olleted. If this item is required to derive T, N, M, or any stage, use of ode 988 may result in an error.) 998 No surgial resetion of primary site 999 Unknown or no information 12

13 for TNM 7 - Revised 12/31/2009 [ Shema ] CS Site-Speifi Fator 2 Vein Involvement Note 1: Reord the involvement of speifi named veins as doumented in the pathology report. Do not ode invasion of small unnamed vein(s) of the type olleted as lymph-vasular invasion. The latter is usually only seen mirosopially. Assign ode 000 if surgial resetion of primary site is performed, pathology report is available for review, and involvement of these speified veins is not mentioned. Note 2: Information about vein involvement is olleted in this field and in CS Extension beause beyond ontributing to the overall assessment of extent of tumor, it an have an independent effet on prognosis. 000 Vein involvement not present/not identified 010 Involvement of renal vein only 020 Involvement of inferior vena ava (IVC) below the diaphragm only 030 Involvement of inferior vena ava (IVC) above the diaphragm only 040 Involvement of inferior vena ava (IVC) NOS only Involvement of IVC below the diaphragm plus involvement of renal vein Involvement of IVC above the diaphragm plus involvement of renal vein Involvement of IVC, NOS plus involvement of renal vein Involvement of IVC above the diaphragm plus involvement of IVC below the diaphragm Involvement of IVC above the diaphragm plus involvement of IVC below the diaphragm plus involvement of renal vein 888 OBSOLETE DATA CONVERTED V0200 See ode 988 Not appliable for this shema 988 Not appliable: Information not olleted for this ase (May inlude ases onverted from ode 888 used in CSv1 for "Not appliable" or when the item was not olleted. If this item is required to derive T, N, M, or any stage, use of ode 988 may result in an error.) 998 No surgial resetion of primary site 999 Unknown or no information 13

14 for TNM 7 - Revised 01/21/2010 [ Shema ] CS Site-Speifi Fator 3 Ipsilateral Adrenal Gland Involvement Note 1: Reord the ipsilateral adrenal gland involvement as doumented in the pathology report. Note 2: Information about ontiguous ipsilateral adrenal gland involvement is olleted in this field and in CS Extension beause beyond ontributing to the overall assessment of extent of tumor, it an have an independent effet on prognosis. Nonontiguous ipsilateral adrenal gland involvement is aptured in this field and CS Mets at DX ode Ipsilateral adrenal gland involvement not present/not identified 010 Contiguous involvement of ipsilateral adrenal gland 020 Nonontiguous involvement of ipsilateral adrenal gland Nonontiguous plus ontiguous involvement of ipsilateral adrenal gland 040 Involvement of ipsilateral adrenal gland, not stated whether ontiguous or nonontiguous 888 OBSOLETE DATA CONVERTED V0200 See ode 988 Not appliable for this shema 988 Not appliable: Information not olleted for this ase (May inlude ases onverted from ode 888 used in CSv1 for "Not appliable" or when the item was not olleted. If this item is required to derive T, N, M, or any stage, use of ode 988 may result in an error.) 999 Unknown or no information 14

15 for TNM 7 - Revised 12/31/2009 [ Shema ] CS Site-Speifi Fator 4 Saromatoid Features Note: Saromatoid morphology may be manifested by any renal ell arinoma. The presene of saromatoid omponent in a renal ell arinoma may be prognostially important. Reord the presene or absene of saromatoid features as doumented anywhere in the pathology report. Assign ode 000 if histologi examination of primary site was performed, pathology report is available for review, and saromatoid features are not mentioned. 000 Saromatoid features not present/not identified 010 Saromatoid features present/identified 888 OBSOLETE DATA CONVERTED V0200 See ode 988 Not appliable for this shema 988 Not appliable: Information not olleted for this ase (May inlude ases onverted from ode 888 used in CSv1 for "Not appliable" or when the item was not olleted. If this item is required to derive T, N, M, or any stage, use of ode 988 may result in an error.) 987 Not appliable; not a renal ell arinoma morphology 998 No histologi examination of primary site 999 Unknown or no information 15

16 for TNM 7 - Revised 12/31/2009 [ Shema ] CS Site-Speifi Fator 5 Histologi Tumor Nerosis Note: Tumor nerosis is an independent preditor of outome for renal ell arinoma. Reord the presene or absene of tumor nerosis as doumented in the pathology report. Assign ode 000 if histologi examination of primary site was performed, pathology report is available for review, and histologi tumor nerosis is not mentioned. 000 No histologi tumor nerosis present/not identified 010 Histologi tumor nerosis present/identified 888 OBSOLETE DATA CONVERTED V0200 See ode 988 Not appliable for this shema 988 Not appliable: Information not olleted for this ase (May inlude ases onverted from ode 888 used in CSv1 for "Not appliable" or when the item was not olleted. If this item is required to derive T, N, M, or any stage, use of ode 988 may result in an error.) 998 No histologi examination of primary site 999 Unknown or no information 16

17 for TNM 7 - Revised 12/31/2009 [ Shema ] CS Site-Speifi Fator 6 Fuhrman Nulear Grade Note: Fuhrman grade is based on nulear size and shape and the prominene of nuleoli. Reord the Fuhrman nulear grade as doumented in the pathology report. 010 Grade Grade Grade Grade OBSOLETE DATA CONVERTED V0200 See ode 988 Not appliable for this shema 987 Not appliable; not a renal ell arinoma morphology 988 Not appliable: Information not olleted for this ase (May inlude ases onverted from ode 888 used in CSv1 for "Not appliable" or when the item was not olleted. If this item is required to derive T, N, M, or any stage, use of ode 988 may result in an error.) 998 No histologi examination of primary site 999 Unknown Fuhrman grade 17

18 for TNM 7 - Revised 09/08/2009 [ Shema ] CS Site-Speifi Fator 7 Size of Metastasis in Lymph Nodes Note: the size of the metastasis in the lymph node as doumented in the pathology report, not the size of the lymph node itself. If the size of the metastasis is not doumented, ode the size of the involved lymph node itself as doumented pathologially or linially with pathology taking priority. Do not ode the size of any node(s) oded in CS Mets at DX. 000 No regional lymph node(s) involved mm (exat size of lymph node metastasis in millimeters) mm or larger 988 Not appliable: Information not olleted for this ase 990 Mirosopi fous or foi only and no size of fous given 991 Desribed as "less than 1 m" 992 Desribed as "less than 2 m" or "greater than 1 m" or "between 1 m and 2 m" 993 Desribed as "less than 3 m" or "greater than 2 m" or "between 2 m and 3 m" 994 Desribed as "less than 4 m" or "greater than 3 m" or "between 3 m and 4 m" 995 Desribed as "less than 5 m" or "greater than 4 m" or "between 4 m and 5 m" 996 Desribed as "less than 6 m" or "greater than 5 m" or "between 5 m and 6 m" 997 Desribed as "more than 6 m" 998 No histologi examination to determine ipsilateral adrenal gland involvement 999 Regional lymph node(s) involved, size not stated Unknown if regional lymph node(s) involved 18

19 for TNM 7 - Revised 11/19/2009 [ Shema ] CS Site-Speifi Fator 8 Extranodal Extension of Regional Lymph Nodes Note 1: the status of extranodal extension whether assessed linially or pathologially of any involved regional lymph node(s) oded in the CS Lymph Nodes field. Do not ode extranodal extension in any nodes oded in CS Mets at DX field. Note 2: A statement of the presene or absene of extranodal extension in a pathology report takes priority over linial assessment. Note 3: If nodes are involved but the linial doumentation and/or pathologi assessment does not indiate extranodal extension, assign ode 010 (no extranodal extension doumented on the available reports). Note 4: If the only doumentation is a referene to linially or pathologially involved nodes with no referene to extranodal extension, assign ode 030 (no physial exam/imaging report and/or no pathology report available). 000 No lymph nodes involved 010 No extranodal extension Nodes desribed as mobile 020 Extranodal extension present Nodes desribed as fixed or matted 030 Nodes involved, unknown if extranodal extension 988 Not appliable: Information not olleted for this ase 999 Unknown if regional lymph node(s) involved, not stated Regional lymph nodes annot be assessed 19