Gallbladder

TNM 7 classification

TNM 6 classification

1. Rules for Classification

The classification applies only to carcinomas. There should be histological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories.

T categories. Physical examination, imaging, and/or surgical exploration
N categories. Physical examination, imaging, and/or surgical exploration
M categories. Physical examination, imaging, and/or surgical exploration

2. Regional Lymph Nodes

The regional lymph nodes are the cystic duct node and the pericholedochal, hilar, peripancreatic (head only), periduodenal, periportal, coeliac, and superior mesenteric nodes.

3. TNM Clinical Classification

3.1. T - Primary Tumour

TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Tis. Carcinoma in situ
T1. Tumour invades lamina propria or muscle layer
     T1a. Tumour invades lamina propria
     T1b. Tumour invades muscle layer
T2. Tumour invades perimuscular connective tissue, no extension beyond serosa or into liver
T3. Tumour perforates serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, e.g., stomach, duodenum, colon, pancreas, omentum, extrahepatic bile ducts
T4. Tumour invades main portal vein or hepatic artery, or invades two or more extrahepatic organs or structures

3.2. N - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Regional lymph node metastasis

3.3. M - Distant Metastasis

MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis

4. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories. pN0 Histological examination of a regional lymphadenectomy specimen will ordinarily include 3 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.

5. G Histopathological Grading

GX. Grade of differentiation cannot be assessed
G1. Well differentiated
G2. Moderately differentiated
G3. Poorly differentiated
G4. Undifferentiated

6. Stage Grouping

Stage 0 Tis N0 M0 Stage IA T1 N0 M0 Stage IB T2 N0 M0 Stage IIA T3 N0 M0 Stage IIB T1, T2, T3 N1 M0 Stage III T4 Any N M0 Stage IV Any T Any N M1

7. Summary

Gallbladder T1 Gallbladder wall T1a Lamina propria T1b Muscle T2 Perimuscular connective tissue T3 Serosa, one organ and/or liver T4 Portal vein, hepatic artery, or two or more extrahepatic organs N1 Regional