Richtlijn: Mammacarcinoom (2.0) - Kwaliteitskoepel

Stage IIIA T 0-2 * N 2 M 0
T 3 N 1-2 M 0
Stage IIIB T 4 N 0-2 M 0
Stage IIIC Any T N 3 M 0
Stage IV Any T Any N M 1
*) T1 includes T1mi.
Richtlijn: Mammacarcinoom (2.0)
Summary
Tis In situ
T1 ≤ 2 cm
T1mi ≤ 0,1 cm
T1a > 0,1 cm to 0,5 cm
T1b > 0,5 cm to 1,0 cm
T1c > 1,0 cm to 2,0 cm
T2 > 2 cm to 5 cm
T3 > 5 cm
T4 Chest wall/skin ulceration, skin nodules, inflammatory
T4a Chest wall
T4b Skin ulceration, satellite skin nodules, skin oedema
T4c Both T4a and T4b T4d Inflammatory carcinoma
pN1mi Micrometastasis, > 0,2 mm to 2 mm
pN1a 1-3 axillary nodes
N1 Movable axillary pN1b Internal mammary nodes with microscopic/macroscopic
metastasis by sentinel node biopsy but not clinically detected
1-3 axillary nodes and internal mammary nodes and internal
pN1c mammary nodes with microscopic/macroscopic metastasis by
sentinel node biopsy but not clinically detected
N2a Fixed axillary
Internal
pN2a 4-9 axillary nodes
N2b mammary
clinically
apparent
pN2b Internal mammary nodes, clinically detected, without axillary
nodes
N3a Infra-clavicular pN3a ≥ 10 axillary nodes or infraclavicular
N3b Internal
mammary and
axillary
pN3b Internal mammary nodes, clinically detected, with axillary
node(s) or > 3 axillary nodes and internal axillary mammary
nodes with microscopic metastasis by sentinal node biopsy but
not clinically detected
N3c Supra-clavicular pN3c Supra-clavicular
1) Microinvasion is the extension of cancer cells beyond the basement membrane into the adjacent
tissues with no focus more than 0,1 cm in greatest dimension. When there are multiple foci of
microinvasion, the size of only the largest focus is used to classify the microinvasion. (Do not use the sum
of all individual foci.) The presence of multiple foci of microinvasion should be noted, as it is with multiple
larger invasive carcinomas.
2) Invasion of the dermis alone does not qualify as T 4 . Chest wall includes ribs, intercostals muscles, and
serratus anterior muscle but not perctoral muscle.
3) Inflammatory carcinoma of the breast is characterized by diffuse, brawny induration of the skin with
an erysipeloid edge, usually with no underlying mass. If the skin biopsy is negative and there is no localized
measurable primary cancer, the T category is pT X when pathologically staging a clinical inflammatory
carcinoma (T 4d ). Dimpling of the skin, nipple retraction, or other skin changes, except those in T 4b and T 4d ,
may occur in T 1 , T 2 , or T 3 without affecting the classification.
4) Clinically detected is defined as detected by clinical examination or by imaging studies (excluding
lymphoscintigraphy) and having characteristics highly suspicious for malignancy or a presumed
pathological macrometastasis based on fine-needle aspiration biopsy with cytological examination.
Confirmation of clinically detected metastatic disease by fine-needle aspiration without excision biopsy is
designated with an (f) suffix, e.g., cN 3a (f).
03/27/2012 Mammacarcinoom (2.0) 198