Browse the corpus

©2013 UpToDate ® Print Email 2002 TNM staging classification for breast cancer Primary tumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ Tis (DCIS) Intraductal carcinoma in situ Tis (LCIS) Lobular carcinoma in situ Tis (Paget) Paget disease of the nipple with no tumor; tumor-associated Paget disease is classified according to the size of the primary tumor T1 Tumor 2 cm or less in greatest dimension T1mic Microinvasion 0.1 cm or less in greatest dimension T1a Tumor more than 0.1 but not more than 0.5 cm in greatest dimension T1b Tumor more than 0.5 cm but not more than 1 cm in greatest dimension T1c Tumor more than 1 cm but not more than 2 cm in greatest dimension T2 Tumor more than 2 cm but not more than 5 cm in greatest dimension T3 Tumor more than 5 cm in greatest dimension T4* Tumor of any size with direct extension to (a) chest wall or (b) skin, only as described below: T4a Extension to chest wall T4b Edema (including peau d'orange) or ulceration of the breast skin, or satellite skin nodules confined to the same breast T4c Both (T4a and T4b) T4d Inflammatory carcinoma Regional lymph nodes (N) Clinical classification NX Regional lymph nodes cannot be assessed (eg, previously removed) N0 No regional lymph node metastases N1 Metastasis to movable ipsilateral axillary lymph node(s) N2 Metastasis to ipsilateral axillary lymph node(s) fixed or matted, or in clinically apparent ipsilateral internal mammary nodes in the absence of evident axillary node metastases N2a Metastasis to ipsilateral axillary lymph node(s) fixed to one another (matted) or to other structures N2b Metastasis only in clinically apparent (as detected by imaging studies [excluding lymphoscintigraphy] or by clinical examination or grossly visible pathologically) ipsilateral internal mammary nodes in the absence of evident axillary node metastases N3 Metastasis to ipsilateral infraclavicular lymph node(s) with or without clinically evident axillary lymph nodes, or in clinically apparent ipsilateral internal mammary lymph node(s) and in the presence of clinically evident axillary lymph node metastases, or metastasis in ipsilateral supraclavicular lymph nodes with or without axillary or internal mammary nodal involvement N3a Metastasis to ipsilateral infraclavicular lymph node(s) N3b Metastasis to ipsilateral internal mammary lymph node(s) and clinically apparent axillary lymph nodes N3c

Metastasis to ipsilateral infraclavicular lymph node(s) with or without clinically evident axillary lymph nodes, or in clinically apparent ipsilateral internal mammary lymph node(s) and in the presence of clinically evident axillary lymph node metastases, or metastasis in ipsilateral supraclavicular lymph nodes with or without axillary or internal mammary nodal involvement N3a Metastasis to ipsilateral infraclavicular lymph node(s) N3b Metastasis to ipsilateral internal mammary lymph node(s) and clinically apparent axillary lymph nodes N3c Metastasis in ipsilateral supraclavicular lymph nodes with or without axillary or internal mammary nodal involvement Pathologic classification • pNX Regional lymph nodes cannot be assessed (eg, previously removed, or not removed for pathologic study) pN0 No regional lymph node metastasis; no additional examination for isolated tumor cells (ITCs, defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected only by immunohistochemical or molecular methods but which may be verified on hematoxylin and eosin (H&E) stains. ITCs do not usually show evidence of malignant activity [eg, proliferation or stromal reaction]) pN0(i-) No histologic nodal metastases, and negative by immunohistochemistry (IHC) pN0(i+) No histologic nodal metastases but positive by IHC, with no cluster greater than 0.2 mm in diameter pN0(mol-) No histologic nodal metastases and negative molecular findings (by reverse transcriptase polymerase chain reaction, RT-PCR) pN0(mol+) No histologic nodal metastases, but positive molecular findings (by RT-PCR) pN1 Metastasis in 1 to 3 ipsilateral axillary lymph node(s) and/or in internal mammary nodes with microscopic disease detected by SLND but not clinically apparent pN1mi Micrometastasis (greater than 0.2 mm, none greater than 2.0 mm) pN1a Metastasis in 1 to 3 axillary lymph nodes pN1b Metastasis to internal mammary lymph nodes with microscopic disease detected by SLND but not clinically apparent pN1c Metastasis in 1 to 3 ipsilateral axillary lymph node(s) and in internal mammary nodes with microscopic disease detected by SLND but not clinically apparent. If associated with more than 3 positive axillary nodes, the internal mammary nodes are classified as N3b to reflect increased tumor burden. pN2 Metastasis in 4 to 9 axillary lymph nodes or in clinically apparent internal mammary lymph nodes in the absence of axillary lymph nodes pN2a

Metastasis in 1 to 3 ipsilateral axillary lymph node(s) and in internal mammary nodes with microscopic disease detected by SLND but not clinically apparent. If associated with more than 3 positive axillary nodes, the internal mammary nodes are classified as N3b to reflect increased tumor burden. pN2 Metastasis in 4 to 9 axillary lymph nodes or in clinically apparent internal mammary lymph nodes in the absence of axillary lymph nodes pN2a Metastases in 4 to 9 axillary lymph nodes (at least one tumor deposit >2 mm) pN2b Metastasis in clinically apparent internal mammary lymph nodes in the absence of axillary lymph nodes pN3 Metastasis in 10 or more axillary lymph nodes, or in infraclavicular lymph nodes, or in clinically apparent ipsilateral internal mammary lymph nodes in the presence of one or more positive axillary nodes; or in more than three axillary lymph nodes with clinically negative microscopic metastasis in internal mammary lymph nodes; or in ipsilateral supraclavicular lymph node(s) pN3a Metastasis in 10 or more axillary lymph nodes (at least one tumor deposit greater than 2.0 mm), or metastasis to the infraclavicular lymph nodes pN3b Metastasis in clinically apparent ipsilateral internal mammary lymph nodes in the presence of one or more positive axillary nodes; or in more than three axillary lymph nodes with microscopic metastasis in internal mammary lymph nodes detected by SLND but not clinically apparent pN3c Metastasis in ipsilateral supraclavicular lymph node(s) Distant metastasis (M) MX Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis Stage groupings Stage 0 Tis N0 M0 Stage I T1 (including T1mic) N0 M0 Stage IIA T0 N1 M0 T1 (including T1mic) N1 M0 T2 N0 M0 Stage IIB T2 N1 M0 T3 N0 M0 Stage IIIA T0 N2 M0 T1 (including T1mic) N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0 Stage IIIB T4 N0-2 M0 Stage IIIC Any T N3 M0 Stage IV Any T Any N M1 * Dimpling of the skin, nipple retraction, or any other skin change except those described for T4b and T4d may occur in T1-3 tumors without changing the classification. • Classification is based upon axillary lymph node dissection (ALND) with or without sentinel lymph node dissection (SLND). Classification based solely on SLND without ALND should be designated (sn) [eg, pN0(i+)(sn)].

* Dimpling of the skin, nipple retraction, or any other skin change except those described for T4b and T4d may occur in T1-3 tumors without changing the classification. • Classification is based upon axillary lymph node dissection (ALND) with or without sentinel lymph node dissection (SLND). Classification based solely on SLND without ALND should be designated (sn) [eg, pN0(i+)(sn)]. AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, Inc. Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois.