GIST Tumors and TNM Path N, Reg Nodes Ex – Ed 7 (CoC)

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  • #4137

    Per page 176 in the GIST chapter of AJCC, “Regional Lymph Nodes. Nodal metastasis is very rare and virtually unheard of in GIST, especially if one adheres to its rigorous histologic verification. Surgeons generally agree that nodal dissection is not indicated for GIST. In the absence of information on regional lymph node status, N0/pN0 is appropriate; NX should not be used.” With this statement, it seems that an exception should be included in the TNM Path N, Reg Nodes Ex – Ed 7 (CoC) edit to allow a pN0 with 00 Reg Nodes Examined for the GIST schema.

    Jim Hofferkamp

    Somebody please correct me if i’m wrong, but i think the edit is correct. The issue is how to enter information in the pN data item, when clinical information is used to calculate the stage group.

    From what i understand, it would be appropriate to calculate the pathologic stage for this site/histology even if no lymph nodes were removed. However, we would be using a cN0 to calculate the stage group. A pN0 would only be used if lymph nodes were removed.

    The below is the logic description for the edit TNM Path N, Reg Nodes Ex – Ed 7 (CoC). The edit would pass if the pN data item is a cN0 or blank.

    This edit is skipped if any of the following conditions are true:

    1. Year of Date of Diagnosis is less than 2016, blank (unknown), or invalid
    2. Type of Reporting Source = 6 (Autopsy Only) or 7 (Death Certificate Only)
    3. Behavior Code ICD-O-3 = 0 (benign) or 1 (borderline)
    3. TNM Path N is blank or 88
    4. Regional Nodes Examined = blank

    IF Regional Nodes Examined = 00 or 99
    TNM Path N must = pX, c0, or blank

    AnonymousStephen Slack

    I forgot to mention that c0 is not an option for TNM Path N for this schema according to the options. My initial instinct was to also code as a c0.

    Jim Hofferkamp

    For this case the appropriate thing to do is leave the data item pN blank. The stage can still be calculated based on an implied cN0.

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