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R1Microscopic residual tumor

R2Macroscopic residual tumor

For the surgeon, the R classification may be useful to indicate the known or assumed status of the completeness of a surgical excision. For the pathologist, the R classification is relevant to the status of the margins of a surgical resection specimen. That is, tumor involving the resection margin on pathologic examination may be assumed to correspond to residual tumor in the patient and may be classified as macroscopic or microscopic according to the findings at the specimen margin(s).

Vessel Invasion

By AJCC/UICC convention, vessel invasion (lymphatic or venous) does not affect the T category indicating local extent of tumor unless specifically included in the definition of a T category. In all other cases, lymphatic and venous invasion by tumor are coded separately as follows:

Lymphatic (Small Vessel) Invasion (L)

LXLymphatic vessel invasion cannot be assessed

L0No lymphatic vessel invasion

L1Lymphatic vessel invasion

Venous (Large Vessel) Invasion (V)

VXVenous invasion cannot be assessed

V0No venous invasion

V1Microscopic venous invasion

V2Macroscopic venous invasion

Regional Lymph Nodes (pN0): Isolated Tumor Cells

Isolated tumor cells (ITC) are single cells or small clusters of cells not more than 0.2 mm in greatest dimension. Lymph nodes or distant sites with ITC found by either histologic examination, immunohistochemistry,  or nonmorphologic techniques (eg, flow cytometry, DNA analysis, polymerase chain reaction [PCR] amplification of a specific tumor marker) should be classified as N0 or M0, respectively. Specific denotation of the assigned N category is suggested as follows for cases in which ITC are the only evidence of possible metastatic disease.20

pN0No regional lymph node metastasis histologically, no examination for isolated tumor cells (ITCs)

pN0(i-)No regional lymph node metastasis histologically, negative morphologic (any morphologic technique, including hematoxylin-eosin and immunohistochemistry) findings for ITCs

pN0(i+)No regional lymph node metastasis histologically, positive morphologic (any morphologic technique, including hematoxylin-eosin and immunohistochemistry) findings for ITCs

pN0(mol-)No regional lymph node metastasis histologically, negative nonmorphologic (molecular) findings for ITCs

pN0(mol+)No regional lymph node metastasis histologically, positive nonmorphologic (molecular) findings for ITCs

Sentinel Lymph Nodes

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