Serosal surfaces, @entity3558 pools, and deposits, Oh my: challenges in staging XXXX .

@entity5 @entity3 @entity3558 @entity14
@entity14 is the third most common @entity5 in the United States. Proper and standardized pathologic staging is vital for prognostic assessment and impacts therapeutic decisions. The @entity5 Node @entity3 (TNM) staging system was developed by the American Joint Committee on Cancer (AJCC) to be a data-driven, evidence-based staging system providing an accurate prediction of outcome. The AJCC 7th edition (2010) included several changes clarifying some issues and leading to new controversies. We aim to address selected challenging issues in @entity5 T staging, neoadjuvant treatment effects in @entity5 , and definition of lymph node vs @entity5 deposit. Serosal involvement in @entity14 is staged as T4, which is associated with decreased survival and may impact additional therapy decisions. Although careful sampling and sectioning are helpful, challenges remain in interpretation of @entity5 within 1   mm of serosal surface with a reaction. Elastic stain as a surrogate marker for serosal invasion has been studied, but its usefulness remains unclear. Some unique issues in @entity5 include the presence of serosa in proximal but not in distal @entity5 and post-neoadjuvant effects. @entity5 should be staged based on @entity5 cells rather than acellular @entity3558 pools. Additionally, @entity5 response should be graded only in primary @entity5 but not in lymph nodes or metastatic sites. The distinction between @entity5 deposits and lymph nodes has been modified in AJCC TNM from using size in the 5th edition, to the round contour in the 6th edition, to only features of residual lymph node architecture in the 7th edition. Interobserver variability remains but @entity5 deposits should be documented when present. The number of deposits should not be added to the total number of positive lymph nodes, and the N1c designation should only be used in cases without any positive lymph nodes. Future clarification will likely evolve as more data become available.
