Radiation Oncology/Breast/Staging
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Front Page: Radiation Oncology | RTOG Trials |
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Breast: Main Page | Staging | Breast Overview | Prevention | Benign | DCIS | LCIS | Paget's | Phyllodes tumor | Early stage | Advanced stage | Post mastectomy | Inflammatory | Partial breast irradiation | Regional lymphatics | Hormonal therapy | Chemotherapy | RT technique | Recurrence | Toxicity of RT | Randomized | NSABP trials |
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[edit] Current staging
AJCC 7th Edition (2009)
Primary Tumor:
- T0 - no primary tumor found
- Tis - in situ (DCIS or LCIS or Paget's)
- T1 ≤ 2 cm
- T1mi ≤ 0.1 cm (microinvasive)
- T1a > 0.1 to 0.5 cm
- T1b > 0.5 to 1 cm
- T1c > 1 to 2 cm
- T2 > 2 to 5 cm
- T3 > 5 cm
- T4 Chest wall /skin
- T4a Chest wall (not including pectoralis muscle)
- T4b Skin edema (peau d'orange), ulceration, or satellite skin nodules
- T4c Both 4a and 4b
- T4d Inflammatory carcinoma
| Clinical staging | Pathologic staging | ||
|---|---|---|---|
| cN0 | No lymph node metastases | pN0 | No lymph node metastases |
| cN1 | Movable ipsilateral axillary lymph nodes | pN1mi | Micrometastases (> 0.2mm but <= 2.0 mm) |
| pN1a | 1-3 axillary lymph nodes (at least 1 > 2.0mm) | ||
| pN1b | Metastases in IM nodes (micrometastases, or macrometastases detected by SLN biopsy but not clinically detected) | ||
| pN1c | 1-3 axillary lymph nodes and metastases in IM nodes (micrometastases, or macromets detected by SLN but not clinically detected) | ||
| cN2a | Ipsilateral axillary lymph nodes fixed or matted | pN2a | 4-9 axillary lymph nodes (at least 1 > 2.0 mm) |
| cN2b | Clinically detected internal mammary nodes in the absence of axillary lymph node metastases | pN2b | Metastases in clinically detected IM nodes in the absence of axillary lymph nodes |
| cN3a | Infraclavicular lymph nodes (level III) | pN3a | 10 or more axillary lymph nodes (at least 1 > 2.0 mm); or infraclavicular (level III) lymph nodes |
| cN3b | Clinically apparent internal mammary nodes with axillary lymph node involvement | pN3b | Metastases in clinically detected IM nodes in the presence of positive axillary nodes; or microscopic IM nodes and more than 3 axillary lymph nodes |
| cN3c | Supraclavicular lymph nodes | pN3c | Supraclavicular lymph nodes |
Mnemonics: "A" Nodes are "A"xillary, "B" Nodes are internal "B"reast (eg IMNs), "C" Nodes are supra"C"lavicular - excludes N1 subgroups
Distant Metastases:
- M0 - none
- cM0(i+) - no clinical or radiographic evidence of distant metastases, but tumor cells detected in circulating blood, bone marrow, or other tissues (e.g. prophylactically removed ovaries), ≤ 0.2 mm, in a patient without symptoms or signs of metastases.
- M1 - distant detectable metastases; or histologically proven > 0.2 mm
Stage Grouping:
- 0: Tis
- IA: T1 N0
- IB: T0-T1 N1mi
- IIA: T0-1 N1 or T2 N0
- IIB: T2 N1 or T3 N0
- IIIA: T3 N1 or T0-3 N2
- IIIB: T4 N0-2
- IIIC: N3
- IV: M1
Changes from 6th edition:
- T1mic changed to T1mi to indicate microscopic disease
- Clarification of wording of "not clinically detected" and "clinically detected" internal mammary nodes. *Clarification of Isolated tumor cells (ITC).
- Subdivision of Stage I into IA and IB (IB includes T0-T1 with N1mi nodal micrometastases). Otherwise, no changes in TNM or Overall Stage
- New cM0(i+) category for circulating tumor cells or incidentally discovered metastatic cells in other tissue
- Clarification of assigning staging after neoadjuvant therapy (yc or ypTNM)
[edit] Older staging versions
AJCC 6th edition (2002)
Primary Tumor:
- T0 - no primary tumor found
- Tis - in situ (DCIS or LCIS or Paget's)
- T1 ≤ 2 cm
- T1mic ≤ 0.1 cm (microinvasive)
- T1a > 0.1 to 0.5 cm
- T1b > 0.5 to 1 cm
- T1c > 1 to 2 cm
- T2 > 2 to 5 cm
- T3 > 5 cm
- T4 Chest wall /skin
- T4a Chest wall (not including pectoralis muscle)
- T4b Skin edema (peau d'orange), ulceration, or satellite skin nodules
- T4c Both 4a and 4b
- T4d Inflammatory carcinoma
| Clinical staging | Pathologic staging | ||
|---|---|---|---|
| cN0 | No lymph node metastases | pN0 | No lymph node metastases |
| cN1 | Movable ipsilateral axillary lymph nodes | pN1mi | Micrometastases (> 0.2mm but <= 2.0 mm) |
| pN1a | 1-3 axillary lymph nodes | ||
| pN1b | Microscopic involvement of IM nodes (not clinically apparent) but no axillary nodes | ||
| pN1c | 1-3 axillary lymph nodes and microscopic involvement of IM nodes | ||
| cN2a | Ipsilateral axillary lymph nodes fixed or matted | pN2a | 4-9 axillary lymph nodes |
| cN2b | Clinically apparent internal mammary nodes in the absence of axillary lymph node metastases | pN2b | Clinically apparent IM nodes in the absence of axillary lymph nodes |
| cN3a | Infraclavicular lymph nodes | pN3a | 10 or more axillary lymph nodes; or infraclavicular lymph nodes |
| cN3b | Clinically apparent internal mammary nodes with axillary lymph node involvement | pN3b | Clinically apparent IM nodes in the presence of positive axillary nodes; or microscopic IM nodes and more than 3 axillary lymph nodes |
| cN3c | Supraclavicular lymph nodes | pN3c | Supraclavicular lymph nodes |
Mnemonics: "A" Nodes are "A"xillary, "B" Nodes are internal "B"reast (eg IMNs), "C" Nodes are supra"C"lavicular - excludes N1 subgroups
Nodes:
- Isolated tumor cells (ITC) - small clusters of cells <= 0.2 mm, usually with no histologic evidence of malignant activity (such as proliferation or stromal reaction). Designated pN0. If IHC or PCR is performed, may be designated pN0(i+),pN0(i-),pN0(mol+),or pN0(mol-).
- Micrometastases (pN1mi) - > 0.2mm but <= 2.0 mm. May also be designated pN1mi(i+) or pN1mi(i-) if IHC is performed.
Distant metastasis:
- M0 No
- M1 Yes
Stage grouping:
- Stage 0: Tis
- Stage I: T1,N0,M0
- Stage IIA: T0-1,N1,M0 or T2,N0,M0
- Stage IIB: T2,N1,M0 or T3,N0,M0
- Stage IIIA: T3,N1,M0 or T0-3,N2,M0
- Stage IIIB: T4,any N,M0
- Stage IIIC: any T,N3,M0
- Stage IV: any T,any N,M1
AJCC 5th Edition (1997)
- pN1a - micrometastases (<0.2 cm)
- pN1bi - 1-3 nodes, < 2 cm
- pN1bii - 4+ nodes, < 2 cm
- pN1biii - extracapsular extension, < 2 cm
- pN1biv - > 2 cm
Otherwise unchanged compared to 6th edition
[edit] New Classifications
- For additional information, see Tissue microarrays (Breast/Breast overview)
Gene expression profiling is the basis for additional classification schemes.
- Luminal A type - ER+ and/or PR+, HER2–. Usually low grade. These express genes similar to normal cells lining breast ducts and glands
- Luminal B type - ER+ and/or PR+, HER2+. These are similar to luminal A, but grow faster and have a slightly poorer prognosis.
- Basal type - ER–, PR–, HER2–, cytokeratin 5/6 positive, and/or HER1+. Also known as "triple negative". Higher prevalence in young African American women.
- HER2 type - ER-, PR-, HER2+. Usually high histological grade.
