Recently, a new clinical staging system, the INRGSS, has been proposed and increasingly adopted.6 Unlike the INSS, which relies on postsurgical data, the INRGSS relies only on pretreatment imaging, patient age, and clinical extent of disease. The INRGSS can be summarized as localized disease (stage L1), regional disease (stage L2), metastatic disease (stage L3), and “special stage” (stage MS, similar to the INSS stage 4S). However, this schema relies heavily on image-defined risk factors* and may be difficult for pathologists to implement.