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AJCC TNM Clinical Staging System

Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
Tis (DCIS) Ductal carcinoma in situ
Tis (LCIS) Lobular carcinoma in situ
Tis Paget's disease Paget's disease of the nipple with no tumor
T1 Tumors < cm in greatest dimension
T1mic Microinvasion < 0.1 cm in greatest dimension
T1a Tumor > 0.5 cm but not more than 1 cm in greatest dimension
T1c Tumor > 1 cm and not more than 2 cm in greatest dimension
T2 Tumor > 2 cm and not more than 5 cm in greatest dimension
T3 Tumor > 5 cm in greatest dimension
T4 Tumor of any size with direct extension to (a) chest wall or (b) only as described below
T4a Extension to chest wall, not including pectoralis muscle
T4b Edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast
T4c Both TT4a and TT4ba
T4d Inflammatory carcinoma
REGIONAL LYMPH NODES (N)
Nx Regional lymph nodes cannot be assessed (e.g., previously removed)
N0 No regional lymph node metastasis
N1 Metastasis to movable axillary lymph node(s)
N2 Metastasis in ipsilateral axillary lymph nodes fixed or matted, or clinically apparent ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastasis
N2a Metastasis to ipsilateral axillary lymph nodes fixed to one another (matted) or to other structures
N2b Metastasis only in clinically apparent ipsilateral internal mammary nodes and in the absence of clinically evident axillary lymph node metastasis
N3 Metastasis in ipsilateral infraclavicular lymph node(s) or clinically apparent ipsilateral internal mammary node(s) and in the presence of clinically evident axillary lymph node metastasis; or metastasis in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement
N3a Metastasis in ipsilateral infraclavicular lymph node(s) and axillary lymph node(s)
N3b Metastasis in ipsilateral internal mammary node(s) and axillary lymph nodes(s)
N3c Metastasis in ipsilateral supraclavicular lymph node(s)
PATHOLOGICAL CLASSIFICATION (PN)
pNx Regional lymph nodes cannot be assessed (e.g., previously removed or not removed for pathologic studies)
pN0 No regional lymph node metastasis histologically, no additional examination for isolated tumor cells (ITC)
Note: ITC are defined as single tumor cells or small cell clusters not greater than 0.2mm, usually detected with immunohistochemistry (IHC) or molecular methods but that may be verified with H&E stains. ITCs do not usually show evidence of metastatic activity (e.g., proliferation or stromal reaction).
pN0(i-) No regional lymph node metastasis histologically, negative IHC
pN0(i+) No regional lymph node metastasis histologically, positive IHC, no IHC cluster > 0.2 mm
pN0(mol-) No regional lymph node metastasis histologically, negative molecular findings (RT-PCR)
pN0(mol+) No regional lymph node metastasis histologically, positive molecular findings (RT-PCR)
pN1mil Micrometastasis (>0.2 mm, none > 2 mm)
pN1 Metastasis in 1-3 axillary lymph nodes and/or internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent
pN1a Metastasis in 1-3 axillary lymph nodes
pN1b Metastasis in internal mammary lymph nodes with microscopic disease detected with sentinel lymph node dissection but not clinically apparent
pN1c Metastasis in 1-3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected with sentinel lymph node dissection but not clinically apparent (if associated with >3 positive axillary lymph nodes, the internal mammary nodes are classified as pN3b to reflect increased tumor burden)
pN2 Metastasis
pN2a Metastasis in 4-9 axillary lymph nodes in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis
pN2b Metastasis in clinically apparent internal mammary lymph nodes in the absence of axillary lymph node metastasis
pN3 Metastasis to > 10 axillary lymph nodes, in infraclavicular lymph nodes, or in clinically apparent ipsilateral internal mammary lymph nodes in the presence of > 1 positive axillary lymph nodes; or in > 3 axillary lymph nodes with clinically negative microscopic metastasis in internal mammary lymph nodes; or in ipsilateral supraclavicular lymph nodes
pN3a Metastasis in > 10 axillary lymph odes (at least 1 tumor deposit > 2.0 mm) or metastasis to the infraclavicular lymph nodes
pN3b Metastasis in clinically apparent ipsilateral internal mammary lymph nodes in the presence of > 1 positive axillary lymph nodes; or in > 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected with sentinel lymph node dissection but not clinically apparent
pN3c Metastasis in ipsilateral supraclavicular lymph nodes
DISTANT METASTASIS (M)
Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
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