Richtlijn: Mammacarcinoom (2.0) - Kwaliteitskoepel

pN 1c Metastasis in 1-3 axillary lymph nodes and internal mammary lymph nodes with microscopic or
macroscopic metastasis detected by sentinel lymph node biopsy but not clinically detected 8
pN 2 Metastasis in 4-9 ipsilateral axillary lymph nodes, or in clinically detected1 ipsilateral internal
mammary lymph node(s) in the absence of axillary lymph node metastasis
pN 2a Metastasis in 4-9 axillary lymph nodes, including at least one that is larger than 2 mm
pN 2b Metastasis in clinically detected internal mammary lymph node(s), in the absence of axillary
lymph node metastasis.
pN 3 Metastasis as described below:
pN 3a Metastasis in 10 or more axillary lymph nodes (at least one larger than 2 mm) or metastasis in
infraclavicular lymph nodes.
pN 3b Metastasis in clinically detected internal ipsilateral mammary lymph node(s) in the presence of
positive axillary lymph node(s); or metastasis in more than 3 axillary lymph nodes and in internal mammary
lymph nodes with microscopic or macroscopic metastasis detected by sentinel lymph node biopsy but not
clinically detected
pN 3c Metastasis in ipsilateral supraclavicular lymph node(s)
Post-treatment ypN:
• Post-treatment ypN shoud be evaluated as for clinical (pretreatment) N methods above. The
modifier sn is used only if a sentinel node evaluation was performed after treatment. If no subscript
is attached, it is assumed the axillary nodal evaluation was by axillary node dissection.
• The X classification will be used (ypNX ) if no yp post-treatment SN or axillary dissection was
performed
• N categories are the same as those used for pN.
pM - Distant Metastasis
pM 0 No distant metastasis
pM1 Distant metastasis microscopically confirmed 9
G Histopathological Grading
For histopathological grading of invasive carcinoma see: Elston CW, Ellis IO. Pathological prognostic
factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study
with long-term follow-up. Histopathology 1991;19:403-410.
R Classification
The absence or presence of residual tumour after treatment is described by the symbol 10 . More details can
be found in the TNM Supplement (International Union Against Cancer (UICC). TNM Supplement. A
Commentary on Uniform Use, 3 rd edition. Wittekind Ch, Henson DE, Hutter RVP, et al., eds. New York;
Wiley: 2003).
TNM and pTNM describe the anatomical extent of cancer in general without considering treatment. They
can be supplemented by the R classification, which deals with tumour status after treatment. It reflects the
effects of therapy, influences further therapeutic procedures and is a strong predictor of prognosis.
The definitions of the R categories are:
R X Presence of residual tumour cannot be assessed
R 0 No residual tumour
R 1 Microscopic residual tumour
R 2 Macroscopic residual tumor
Stage Grouping
Stage 0 T is N 0 M 0
Stage IA T 1 * N 0 M 0
Stage IB T 0-1 * N 1mi M 0
Stage IIA T 0-1 * N 1 M 0
T 2 N 0 M 0
Stage IIB T 2 N 1 M 0
T 3 N 0 M 0
Richtlijn: Mammacarcinoom (2.0)
03/27/2012 Mammacarcinoom (2.0) 197