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 NodesClinical stagingPathologic stagingcN1"A"pN1mi 200 cells  pN1a1-3 "A"  pN1b"IM"  pN1c a+bcN2a"A" mattedpN2a4-9 "A"cN2b"IM"pN2bSamecN3a"ICN"pN3a SamecN3b"A" + "IM"pN3bSamecN3c"SCN"pN3cSame 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+