Staging colorectal cancer with the TNM 7^(th):The presumption of innocence when applying the M category  

作　　者：Giacomo Puppa Graeme Poston Per Jess Guy F Nash Kenneth Coenegrachts Axel Stang 

机构地区：[1]Service de Pathologie Clinique,Hpitaux Universitaires de Genève,1211 Geneva,Switzerland [2]Department of Surgery,Aintree University Hospitals,Liverpool L9 7AL,United Kingdom [3]Department of Surgery,Roskilde Hospital,University of Copenhagen,2200 Copenhagen,Denmark [4]Department of Colorectal Surgery,Poole General Hospital,Poole BH15 2JB,United Kingdom [5]Department of Radiology,AZ St.-Jan Brugge-Oostende AV,B-8000 Bruges,Belgium [6]Department of Oncology,Hematology and Palliative Care,Asklepios Hospital Hamburg-Barmbek,22291 Hamburg,Germany

出　　处：《World Journal of Gastroenterology》2013年第8期1152-1157,共6页世界胃肠病学杂志（英文版）

摘　　要：One of the main changes of the current TNM-7 is the elimination of the category MX,since it has been a source of ambiguity and misinterpretation,especially by pathologists.Therefore the ultimate staging would be better performed by the patient's clinician who can classify the disease M0(no distant metastasis) or M1(presence of distant metastasis),having access to the completeness of data resulting from clinical examination,imaging workup and pathology report.However this important change doesn't take into account the diagnostic value and the challenge of small indeterminate visceral lesions encountered,in particular,during radiological staging of patients with colorectal cancer.In this article the diagnosis of these lesions with multiple imaging modalities,their frequency,significance and relevance to staging and disease management are described in a multidisciplinary way.In particular the interplay between clinical,radiological and pathological staging,which are usually conducted independently,is discussed.The integrated approach shows that there are both advantages and disadvantages to abandoning the MX category.To avoid ambiguity arising both by applying and interpreting MX category for stage assigning,its abandoning seems reasonable.The recognition of the importance of small lesion characterization raises the need for applying a separate category;therefore a proposal for their categorization is put forward.By using the proposed categorization the lack of consideration for indeterminate visceral lesions with the current staging system will be overcome,also optimizing tailored follow-up.One of the main changes of the current TNM-7 is the elimination of the category MX,since it has been a source of ambiguity and misinterpretation,especially by pathologists.Therefore the ultimate staging would be better performed by the patient's clinician who can classify the disease M0(no distant metastasis) or M1(presence of distant metastasis),having access to the completeness of data resulting from clinical examination,imaging workup and pathology report.However this important change doesn't take into account the diagnostic value and the challenge of small indeterminate visceral lesions encountered,in particular,during radiological staging of patients with colorectal cancer.In this article the diagnosis of these lesions with multiple imaging modalities,their frequency,significance and relevance to staging and disease management are described in a multidisciplinary way.In particular the interplay between clinical,radiological and pathological staging,which are usually conducted independently,is discussed.The integrated approach shows that there are both advantages and disadvantages to abandoning the MX category.To avoid ambiguity arising both by applying and interpreting MX category for stage assigning,its abandoning seems reasonable.The recognition of the importance of small lesion characterization raises the need for applying a separate category;therefore a proposal for their categorization is put forward.By using the proposed categorization the lack of consideration for indeterminate visceral lesions with the current staging system will be overcome,also optimizing tailored follow-up.

关 键 词：COLORECTAL cancer STAGING INDETERMINATE LESIONS Imaging METASTASES 

分 类 号：R735.3[医药卫生—肿瘤]