RadOnc Resident Wiki/Breast/Staging

Staging Discussion

Current staging

AJCC 7th Edition (2009)
Primary Tumor:

• T0 - no primary tumor found
• Tis
• T1                   20mm]
  • T1mi                 1]
  • T1a                   5]
  • T1b                 10]
  • T1c                 20]
• T2                         50]
• T3                        (50
• T4 Chest wall /skin
  • T4a Chest wall (X pecs)
  • T4b Edema | ulceration
  • T4c a+b
  • T4d Inflammatory

Abbreviations: Axillary = A, Internal Mammary = IM Infraclavicular nodes = ICN, Supraclavicular nodes = SCN

Regional Lymph Nodes

Clinical staging		Pathologic staging
cN1	"A"	pN1mi	200 cells
		pN1a	1-3 "A"
		pN1b	"IM"
		pN1c	a+b
cN2a	"A" matted	pN2a	4-9 "A"
cN2b	"IM"	pN2b	Same
cN3a	"ICN"	pN3a	Same
cN3b	"A" + "IM"	pN3b	Same
cN3c	"SCN"	pN3c	Same

Mnemonics:

"A" Nodes are "A"xillary, "B" Nodes are internal "B"reast (eg IMNs), "C" Nodes are supra"C"lavicular - excludes N1 subgroups

N2b and N3b are the same for p and c No clinically + nodes in pN1 cN3b is cN1 + cN2b (clinical pN1c "upgraded")

N2b-N3c is the same for both, except pN3a also includes ≥10

N1b and N3b are "A"+"IM"

Stage Grouping:

• 0: Tis
• 1A = T1
• 1B if N1mi
• 2A = Adds to 2
• 2b: Adds to 3               (N1/N0)
• 3A: N2 or adds to 4      (T3N1)
• 3B: T4
• 3C: N3
• 4: M1

New Classifications

For additional information, see Tissue microarrays (Breast/Breast overview)

Gene expression profiling is the basis for additional classification schemes.

• Luminal ER|PR (+)
  • A type low grade
  • B type more aggressive
• HER2
• Basal type - Trip (-) |cytokeratin 5/6 positive | HER1+