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

World Journal of Gastroenterology 2013年第8期19卷 1152-1157页

作者： giacomo puppa Graeme Poston Per Jess Guy F Nash Kenneth Coenegrachts Axel Stang Service de Pathologie Clinique Hpitaux Universitaires de Genève1211 GenevaSwitzerland Department of Surgery Aintree University HospitalsLiverpool L9 7ALUnited Kingdom Department of Surgery Roskilde HospitalUniversity of Copenhagen2200 CopenhagenDenmark Department of Colorectal Surgery Poole General HospitalPoole BH15 2JBUnited Kingdom Department of Radiology AZ St.-Jan Brugge-Oostende AVB-8000 BrugesBelgium Department of Oncology Hematology and Palliative CareAsklepios Hospital Hamburg-Barmbek22291 HamburgGermany

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 *** 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 *** 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 *** 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 *** particular the interplay between clinical,radiological and pathological staging,which are usually conducted independently,is *** integrated approach shows that there are both advantages and disadvantages to abandoning the MX *** avoid ambiguity arising both by applying and interpreting MX category for stage assigning,its abandoning seems *** recognition of the importance of small lesion characterization raises the need for applying a separate category;therefore a proposal for their categorization is put *** 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

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