Staging of breast carcinoma is useful to determine a patient's prognosis and to assist in planning therapeutic intervention.
Staging elements:
(1) primary tumor
(2) lymph node involvement
(3) distant metastases
Anatomic subsites of the female breast:
(1) nipple
(2) central subareolar region
(3) lower inner quadrant
(4) lower outer quadrant
(5) upper inner quadrant
(6) upper outer quadrant
(7) axillary tail
Regional lymph nodes to the breast:
(1) axillary
(1a) Level I (low axilla): lymph nodes lateral to the lateral border of the pectoralis minor muscle; includes also intra-mammary lymph nodes
(1b) Level II (mid-axilla): lymph nodes between the medial and lateral borders of the pectoralis minor muscle and the interpectoral lymph nodes
(1c) Level III (apical axilla): lymph nodes medial to the medial margin of the pectoralis minor muscle, including those designated subclavicular, infraclavicular or apical
(2) internal mammary, ipsilateral
Lymph nodes coded as distant metastasis:
(1) ipsilateral supraclavicular
(2) ipsilateral cervical
(3) contralateral internal mammary
(4) other lymph node involvement
TNM Clinical Classification
TNM |
Code |
Description |
T |
TX |
primary tumor cannot be assessed |
|
T0 |
no evidence of primary tumor |
|
Tis |
carcinoma in situ |
|
T1 |
tumor <= 2 cm in maximum dimension |
|
T1a |
tumor <= 0.5 cm in maximum dimension |
|
T1b |
tumor > 0.5 and <= 1 cm |
|
T1c |
tumor > 1 cm and <= 2 cm |
|
T2 |
tumor > 2 cm and <= 5 cm in maximum dimension |
|
T3 |
tumor > 5 cm in maximum dimension |
|
T4 |
tumor of any size with direct extension to chest wall or skin |
|
T4a |
extension to the chest wall |
|
T4b |
edema (including peau d'orange) ulceration of the skin satellite skin nodules confined to same breast |
|
T4c |
both T4a and T4b findings |
|
T4d |
inflammatory carcinoma |
N |
NX |
regional lymph nodes cannot be assessed, including previous removal |
|
N0 |
no regional lymph node metastasis |
|
N1 |
metastasis to ipsilateral lymph nodes, movable |
|
N2 |
metastasis to ipsilateral lymph nodes, fixed to one another or to other structures |
|
N3 |
metastasis to ipsilateral internal mammary lymph nodes |
M |
MX |
presence of distant metastasis cannot be assessed |
|
M0 |
no distant metastasis |
|
M1 |
distant metastasis |
where:
• multiple simultaneous ipsilateral tumors are assigned the T designation for the largest focus, but annotated as "multiple simultaneous ipsilateral carcinomas"
• inflammatory carcinoma is a condition due to dermal lymphatic invasion, resulting in a diffuse, brawny induration of the skin with an erysipeloid edge.
• simple skin dimpling or nipple retraction does not change the classification
AJCC Stage |
T |
N |
M |
approximate 5 year survival |
0 |
is |
0 |
0 |
100% |
I |
1 |
0 |
0 |
95% |
IIA |
0 1 2 |
1 1 0 |
0 0 0 |
85% |
IIB |
2 3 |
1 0 |
0 0 |
70% |
IIIA |
0 1 2 3 |
2 2 2 1-2 |
0 0 0 0 |
50% |
IIIB |
4 |
1-3 |
0 |
48% |
IV |
1-4 |
1-3 |
1 |
18% |
5 year survival estimated from Figure 25-1, page 165, AJCC (1993).
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
ICD-10: ,