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Table 1 Staging system for neuroendocrine tumor of the ampulla of Vater

From: Clinicopathological features and surgical outcomes of neuroendocrine tumors of ampulla of Vater

WHO classification (2010)
  Grade 1 <2 mitoses/10 HPF and <3% Ki–67
  Grade 2 2–20 mitoses/10 HPF or 3–20% Ki–67
  Grade 3 >20 mitoses/10 HPF or >20% Ki–67
TNM staging system  
  ENETS (2006) UICC (7th edition, 2009)
T – primary tumor
 Tx Primary tumour cannot be assessed  
 T0 No evidence of primary tumour  
 T1 Invasion of lamina propria or submucosa and size ≤ 1 cm Limited to ampulla of Vater or sphincter of Oddi
 T2 Invasion of muscularis propria or size > 1 cm Invasion of the duodenum wall
 T3 Invasion of the pancreas or retroperitoneum Invasion of the pancreas
 T4 Invasion of the peritoneum or other organs Invasion in peripancreatic soft tissues or other adjacent organs or structures
N – regional lymph nodes
 Nx Regional lymph nodes cannot be assessed  
 N0 No regional lymph node metastasis  
 N1 Regional lymph node metastasis present  
M – distant metastasis
 Mx Distant metastasis cannot be assessed  
 M0 No distant metastasis  
 M1 Distant metastasis present  
Staging Stage I T1 N0 M0 Stage Ia T1 N0 M0
  Stage IIa T2 N0 M0 Stage Ib T2 N0 M0
  Stage IIb T3 N0 M0 Stage IIa T3 N0 M0
  Stage IIIa T4 N0 M0 Stage IIb T1–3 N1 M0
  Stage IIIb Any T N1 M0 Stage III T4 Any N M0
  Stage IV Any T Any N M1 Stage IV Any T Any N M1
  1. ENETS European Neuroendocrine Tumour Society staging system, HPF high power fields, UICC International Union Against Cancer staging system, WHO World Health Organisation classification