CAP Soft.Tissue\_4.1.0.0.REL\_CAPCP Approved

TNM Grading 8th The edition of the American Joint Committee on Cancer (AJCC) and International Union Against Cancer (UICC) staging system for soft tissue tumors recommends the FNCLCC 3-tiered system but effectively grade.6,8 collapses into high grade and low This means that FNCLCC grade 2 and grade 3 tumors are considered “high grade” for the purposes of stage grouping.

References

- 1. Eilber FC, Brennan MF, Eilber FR, et al. Validation of postoperative normograms for 12-year sarcoma-specific mortality. Cancer. 2004;101:2270-2275.
- 2. Oliveira AM, Nascimento AG. Grading in soft tissue tumors: principles and problems. Skeletal Radiol. 2001;30(10):543-559.
- 3. Coindre JM. Grading of soft tissue sarcomas: review and update. Arch Pathol Lab Med. 2006;130:1448-1453.
- 4. Costa J, Wesley RA, Glatstein E, Rosenberg SA. The grading of soft tissue sarcomas: results of a clinicohistopathologic correlation in a series of 163 cases. Cancer. 1984;53(3):530-541.
- 5. Guillou L, Coindre JM, Bonichon F, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol. 1997;15(1):350-362.
- 6. Amin MB, Edge SB, Greene FL, et al, eds. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017.
- 7. WHO Classification of Tumours Editorial Board. Soft Tissue and Bone Tumors. Lyon (France): International Agency for Research on Cancer; 2020. (WHO classification of tumours series, 5th ed.; vol. 3)
- 8. Brierley JD, Gospodarowicz MK, Wittekind C, et al, eds. TNM Classification of Malignant Tumours. 8th ed. Oxford, UK: Wiley; 2016.
- F. Response to Chemotherapy/Radiation Therapy Effect

Although agreement has not been reached about measuring the effect of preoperative (neoadjuvant) chemotherapy/radiation therapy in soft tissue tumors, an attempt should be made to quantify these effects, especially in the research setting. Therapy response is expressed as a percentage of total tumor area that is viable. Nonliquefied tumor tissue from a cross-section through the longest axis of the tumor should be sampled. At least 1 section of necrotic tumor (always with a transition to viable tumor) should be sampled to verify the gross impression of necrosis. Nonsampled necrotic areas should be included in the estimate of necrosis and the percentage of tumor necrosis reported. The gross appearance can be misleading, and areas that appear grossly necrotic may actually be myxoid or edematous. Additional sections from these areas should be submitted for histologic examination. When estimates of gross necrosis exceed those of histologic necrosis, the greater percentage of necrosis should be recorded on the surgical pathology report.

### G. Lymphovascular Invasion

Lymphovascular invasion (LVI) indicates whether microscopic lymphovascular invasion is identified. LVI includes lymphatic invasion, vascular invasion, or lymphovascular invasion. By AJCC/UICC convention, LVI does not affect the T category indicating local extent of tumor unless specifically included in the definition of a T category.

- H. Margins

The The most important predictor of local recurrence is the status of surgical excision Therefore, detailed reporting of surgical margins is a critical role of the pathologist. It has been recommended that for all margins located less than 2 cm, the distance of the tumor from the margin be reported in centimeters.2 However, there is a lack of agreement on this issue. We recommend specifying the location of all margins located less than 2 cm and the distance of the closest margin that is less than 2 cm from the

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