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Increasing tumour size influences the pathological <jats:styled-content style=\"fixed-case\">pT<\/jats:styled-content> stage category within <jats:styled-content style=\"fixed-case\">pT<\/jats:styled-content>1 and <jats:styled-content style=\"fixed-case\">pT<\/jats:styled-content>2, with cutoffs of 40, 70 and 100\u00a0mm; however, with increasing size also comes a sharp increase in the likelihood of renal sinus or renal vein tributary invasion, such that clear cell <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> rarely reaches 70\u00a0mm without invading one of these. To clarify some previous challenges in assigning tumour stage, the American Joint Committee on Cancer 2016 tumor\u2013node\u2013metastasis classification has removed the requirements than vein invasion be recognised grossly and that vein walls contain muscle for the diagnosis of vein invasion. Renal pelvis invasion has also been added as an additional route to <jats:styled-content style=\"fixed-case\">pT<\/jats:styled-content>3a. Multinodularity or finger\u2010like extensions from a renal mass should be viewed with great suspicion for the possibility of vein or renal sinus invasion, and, as tumour size increases to over 40\u201350\u00a0mm, thorough sampling of the renal sinus interface should always be undertaken. With increasing interest in adjuvant therapy in renal cancer, the pathologist's role in <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> staging will continue to be an important prognostic parameter and a tool for selection of patients for enrolment in clinical trials.<\/jats:p>","DOI":"10.1111\/his.13743","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T01:10:23Z","timestamp":1545181823000},"page":"18-30","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Renal cell carcinoma staging: pitfalls, challenges, and updates"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3898-1460","authenticated-orcid":false,"given":"Sean R","family":"Williamson","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute Henry Ford Health System Detroit MI USA"},{"name":"Department of Pathology and Laboratory Medicine Wayne State University School of Medicine Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanika","family":"Taneja","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute Henry Ford Health System Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6049-5293","authenticated-orcid":false,"given":"Liang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Departments of Pathology and Laboratory Medicine and Urology Indiana University School of Medicine Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,18]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"18","volume-title":"World Health Organization classification of tumours of the urinary system and male genital organs","author":"Moch H","year":"2016"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31802fb4af"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001087"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611406"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00559-6"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31829a85d0"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40618-3_60"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.13200"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)68071-8"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19990201)85:3<689::AID-CNCR19>3.0.CO;2-7"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20010115)91:2<354::AID-CNCR1009>3.0.CO;2-9"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)66075-2"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10255"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2008.03.026"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2003.09.081"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)66437-3"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-010-9707-x"},{"key":"e_1_2_11_19_1","first-page":"235","article-title":"Radiographic size versus surgical size of renal masses: which is the true size of the tumor?","volume":"14","author":"Alicioglu B","year":"2009","journal-title":"J. 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