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. 2020 May 29;12(6):1402. doi: 10.3390/cancers12061402

Table 1.

Eighth edition American Joint Committee on Cancer (AJCC) Tumor Nodes Metastasis (TNM) staging for gastric neoplasms with suggested imaging for staging (adapted from Amin et al. [12] and from the National Comprehensive Cancer Network (NCCN) Guidelines [13]).

8th AJCC Gastric Cancer TNM Staging Definition Imaging
T
TX Primary tumor cannot be assessed EUS is the modality of choice in assessing the invasion depth of gastric cancer.
T0 No evidence of primary tumor
Tis Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria
T1 Tumor invades lamina propria, muscularis mucosae, or submucosa
T1a Tumor invades lamina propria or muscularis mucosae
T1b Tumor invades submucosa
T2 Tumor invades muscularis propria
T3 Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures
T3 tumors also include those extending into the gastrocolic or gastrohepatic ligaments or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures
T4 Tumor invades serosa (visceral peritoneum) or adjacent structures CT is more useful in advanced T stages to evaluate the tumor nodularity outside
T4a Tumor invades serosa (visceral peritoneum) the stomach or invasion of the adjacent organs.
T4b Tumor invades adjacent structures, such as the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum
N
NX Regional lymph node(s) cannot be assessed CT, PET/CT, and EUS can be used for nodal staging.
Radiological criterion for nodal involvement is lymph node enlargement.
N0 No regional lymph node metastasis
N1 Metastasis in 1 to 2 regional lymph nodes
N2 Metastasis in 3 to 6 regional lymph nodes
N3 Metastasis in 7 or more regional lymph nodes
N3a Metastasis in 7–15 regional lymph nodes
N3b Metastasis in 16 or more regional lymph nodes
M
M0 No distant metastasis CT or PET/CT are recommended to assess metastatic disease.
M1 Distant metastasis

CT, computed tomography; MRI, magnetic resonance imaging; PET/CT, 18F-fluorodeoxyglucose positron emission tomography; EUS, endoscopic ultrasound.