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Colorectal cancer staging using TNM 7: is it time to use this new staging system?
  1. V J Doyle,
  2. A C Bateman
  1. Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr A C Bateman, Department of Cellular Pathology, Southampton General Hospital, MP002, Level E, South Block, Tremona Road, Southampton SO16 6YD, UK; adrian.bateman{at}


The authors audited pathological colorectal cancer staging according to tumour node metastasis (TNM) 7 and using TNM 5 as a gold standard. 144 consecutive colorectal cancer resection specimens were staged prospectively using both TNM 5 and TNM 7 criteria during routine reporting by specialist gastrointestinal pathologists within a single institution. The pN stage remained the same under both systems apart from the required subclassification of pN1 and pN2 under TNM 7. The TNM 7 pN1c category was used in only 3% of cases. All cases staged as pT4 underwent reversal of pT4 subclassification using TNM 7 compared with TNM 5. A previous study revealed stage migration from pN1 to pN2 in 32.6% of cases under TNM 7 compared with TNM 5. The difference in frequency of pN stage migration between this study and our audit suggests that the application of TNM 7 to the assessment of discontinuous/satellite tumour foci is subject to significant inter-observer variability.

  • Colorectal cancer
  • staging
  • TNM
  • gut pathology
  • gastric pathology
  • gastric cancer
  • autopsy pathology
  • breast
  • pancreas
  • liver disease

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  • Competing interests ACB is a member of the UK TNM committee.

  • Ethics approval This is an audit and hence ethics approval was not obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.