Clinical stage of breast cancer
Stage 0: No lymph nodes in the ipsilateral axilla, tumor diameter less than 2cm
Stage I: active lymph nodes in the ipsilateral axilla, with or without metastasis, tumor diameter 2-5cm, Zhang Chenguang, Breast Surgery Department, Xinjiang Cancer Hospital
Stage II: ipsilateral axillary lymph nodes fused into a block and adhered to other tissues, tumor diameter greater than 5cm
Stage III: Metastasis in ipsilateral supraclavicular, infraclavicular or axillary lymph nodes or edema in upper limbs. The metastatic lymph nodes are fused and hard.
Stage IV: metastasis in other distant sites
Pathological classification (pTNM)
T primary tumor
TX primary tumor cannot be identified (e.g., resected)
T0 primary tumor not detected
Tis primary carcinoma in situ
Tis(DCIS) ductal carcinoma in situ
Tis(LCIS) lobular carcinoma in situ
Tis(Paget) papillary Paget’s disease without tumor
Note: Paget’s disease with masses is staged according to the size of the masses
T1 tumor maximum diameter ≤2cm
T1mic microinvasive carcinoma with maximum diameter ≤0.1cm
T1a maximal diameter >0.1cm, ≤0.5cm
T1b maximal diameter >0.5cm, ≤1.0cm
T1c maximal diameter >1.0cm, ≤2.0cm
T2 maximum diameter>2.0cm, ≤5.0cm
T3 maximum diameter >5.0cm
T4 direct invasion of chest wall or skin regardless of tumor size (chest wall includes ribs, intercostal muscles, and anterior serratus, but not pectoral muscles)
T4a Invasion of chest wall
T4b Skin edema (including orange peel-like changes), ulceration or satellite nodules on the affected breast
T4c coexistence of T4a and T4b
T4d inflammatory breast cancer
N-region lymph nodes
Nx-area lymph nodes cannot be analyzed (e.g., cleared)
N0 regional lymph nodes without metastasis
N1 ipsilateral axillary lymph nodes metastatic and mobile
N2 ipsilateral axillary lymph nodes fused to each other or fixed to other tissue; or clinically significant internal breast lymph node metastasis in the absence of clinical evidence of axillary lymph node metastasis
N2a ipsilateral axillary lymph nodes fused to each other or fixed to other tissues
N2b clinically significant internal mammary lymph node metastasis in the absence of clinical evidence of axillary lymph node metastasis
N3 ipsilateral subclavian lymph node metastasis; or clinically significant internal mammary lymph node metastasis in the presence of clinical evidence of axillary lymph node metastasis; or ipsilateral supraclavicular lymph node metastasis with or without axillary or internal mammary lymph node metastasis
N3a ipsilateral subclavian lymph node metastasis and axillary lymph node metastasis
N3b ipsilateral internal mammary lymph node and axillary lymph node metastasis
N3c ipsilateral supraclavicular lymph node metastasis
pN regional lymph nodes
pNx regional lymph nodes cannot be analyzed (surgery did not include this site or it was removed in the past)
pN0Histology without regional lymph node metastasis, no separate examination of isolated tumor cells
pN0(i-) histology without regional lymph node metastasis, immunohistochemically negative
pN0(i+) histology without regional lymph node metastasis, positive immunohistochemistry, tumor foci ≤0.2mm
pN0(mol-) no regional lymph node metastasis on histology, negative molecular assay (RT-PCR)
pN0(mol+) no regional lymph node metastasis on histology, positive molecular assay (RT-PCR)
pN1mi presence of micrometastases, maximum diameter >0.2mm, ≤2.0mm
pN1 ipsilateral 1 to 3 axillary lymph node metastases, or microscopic metastases in the anterior lymph nodes of the internal breast that are not clinically evident
pN1a ipsilateral 1 to 3 axillary lymph node metastases
pN1b microscopic metastasis of the internal breast sentinel lymph node that is not clinically significant
pN1c ipsilateral 1 to 3 axillary lymph node metastases, ipsilateral internal mammary sentinel lymph node microscopic metastases, and clinically insignificant
pN24 to 9 axillary lymph node metastases, or clinically significant internal breast lymph node metastases without axillary lymph node metastases
pN2a4 to 9 axillary lymph node metastases with at least one tumor focus >2.0mm
pN2b clinically significant internal breast lymph node metastasis without axillary lymph node metastasis
pN310 or more axillary lymph node metastases, or subclavian lymph node metastases, or clinically significant ipsilateral internal breast lymph node metastases in case of axillary lymph node metastases; or 3 or more axillary lymph node metastases with clinically negative microscopic internal breast lymph node metastases; or ipsilateral supraclavicular lymph node metastases
pN3a10 or more axillary lymph node metastases (at least one tumor focus >2.0mm), or subclavian lymph node metastases
pN3b 3 or more axillary lymph node metastases with clinically negative but microscopic internal breast lymph node metastases on biopsy of anterior lymph nodes
pN3c ipsilateral supraclavicular lymph node metastasis
M distant metastasis
Mx no distant metastases could not be assessed
M0 without distant metastasis
M1 with distant metastasis
Description.
Clinically evident: means detected by clinical physical examination or imaging (except lymph nuclei visualization).
pN classification is based on the results of axillary lymph node dissection with or without prior sentinel lymph node biopsy; if only sentinel lymph node biopsy is performed without subsequent axillary lymph node dissection, the sentinel lymph node is indicated by (sn), e.g., pN0(i+)(sn).
Isolated tumor cells refer to single cells or small cell clusters less than 0.2 mm, usually detected by immunohistochemical or molecular techniques and identified by conventional histology, isolated tumor cells do not necessarily show metastatic activity, such as proliferation or interstitial reaction.
Clinically inconspicuous: refers to a condition that cannot be detected by clinical physical examination or imaging (except lymph nuclein imaging).
Clinical staging
Stage O TisN0M0
Stage I T1N0M0
Stage IIA T0N1M0
T1N1M0
T2N0M0
Phase IIB T2N1M0
T3N0M0
Phase IIIA T0N2M0
T1N2M0
T2N2M0
T3N1~2M0
Phase IIIB T4N0M0
T4N1M0
T4N2M0
Phase IIIC any TN3M0
Stage IV any T any NM1
Histopathological grading (G)
Gx cannot determine the degree of differentiation.
G1 highly differentiated.
G2 moderately differentiated.
G3 hypodifferentiated.
Classification of the presence or absence of residual tumors after surgical treatment (R)
Rx cannot determine the presence or absence of residual tumors.
R0 no residual tumor.
R1 microscopically visible residual tumor.
R2 Visible to the naked eye.