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Staging (Invasive)
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Staging (Invasive)
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Pathologic Staging (pTNM)
CAP Approved Breast • Invasive Breast 4.0.0.0 AJCC 8th Edition
TNM Descriptors (required only if applicable) (select all that apply)
___ m (multiple foci of invasive carcinoma)
___ r (recurrent)
___ y (posttreatment)
Primary Tumor (Invasive Carcinoma) (pT)
___ pTX: Primary tumor cannot be assessed
___ pT0: No evidence of primary tumor#
___ pTis (DCIS): Ductal carcinoma in situ#
___ pTis (Paget): Paget disease of the nipple not associated with invasive carcinoma and/or DCIS in the underlying breast parenchyma##
___ pT1: Tumor ≤20 mm in greatest dimension
___ pT1mi: Tumor ≤1 mm in greatest dimension
___ pT1a: Tumor >1 mm but ≤5 mm in greatest dimension (round any measurement >1.0−1.9 mm to 2 mm)
___ pT1b: Tumor >5 mm but ≤10 mm in greatest dimension
___ pT1c: Tumor >10 mm but ≤20 mm in greatest dimension
___ pT2: Tumor >20 mm but ≤50 mm in greatest dimension
___ pT3: Tumor >50 mm in greatest dimension
___ pT4: Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules) ###
___ pT4a: Extension to the chest wall; invasion or adherence to pectoralis muscle in the absence of invasion of chest wall structures does not qualify as T4
___ pT4b: Ulceration and/or ipsilateral macroscopic satellite nodules and/or edema (including peau d’orange) of the skin that does not meet the criteria for inflammatory carcinoma
___ pT4c: Both T4a and T4b are present
___ pT4d: Inflammatory carcinoma
# For the purposes of this case summary, these categories should only be used in the setting of preoperative (neoadjuvant) therapy for which a previously diagnosed invasive carcinoma is no longer present after treatment. Patients with pathological complete response (absence of residual invasive carcinoma in both the breast and lymph nodes) should be categorized as ypT0N0 or ypTisN0, not ypTX.
## Carcinomas in the breast parenchyma associated with Paget disease are categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget disease should still be noted.
### Note: Invasion of the dermis alone does not qualify as pT4.
Regional Lymph Nodes (pN) (choose a category based on lymph nodes received with the specimen; immunohistochemistry and/or molecular studies are not required)
Modifier (required only if applicable)
___ (sn): Sentinel node(s) evaluated. If 6 or more nodes (sentinel or nonsentinel) are removed, this modifier should not be used.
___ (f): Nodal metastasis confirmed by fine needle aspiration or core needle biopsy.
Note: The (sn) modifier is added to the N category when a sentinel node biopsy is performed (using either dye or tracer) and fewer than six lymph nodes are removed (sentinel and nonsentinel). The (f) modifier is added to the N category to denote confirmation of metastasis by fine needle aspiration/core needle biopsy with NO further resection of nodes.
Category (pN)
___ pNX: Regional lymph nodes cannot be assessed (eg, not removed for pathological study or previously removed)
___ pN0: No regional lymph node metastasis identified or ITCs only#
___ pN0 (i+): ITCs only (malignant cell clusters no larger than 0.2 mm) in regional lymph node(s)
___ pN0 (mol+): Positive molecular findings by reverse transcriptase polymerase chain reaction (RTPCR); no ITCs detected
___ pN1mi: Micrometastases (approximately 200 cells, larger than 0.2 mm, but none larger than 2.0 mm)
___ pN1a: Metastases in 1 to 3 axillary lymph nodes, at least 1 metastasis larger than 2.0 mm##
___ pN1b: Metastases in ipsilateral internal mammary sentinel nodes, excluding ITCs
___ pN1c: pN1a and pN1b combined
___ pN2a: Metastases in 4 to 9 axillary lymph nodes (at least 1 tumor deposit larger than 2.0 mm)##
___ pN2b: Metastases in clinically detected internal mammary lymph nodes with or without microscopic confirmation; with pathologically negative axillary nodes
___ pN3a: Metastases in 10 or more axillary lymph nodes (at least 1 tumor deposit larger than 2.0 mm) or metastases to the infraclavicular (Level III axillary lymph) nodes##
___ pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary nodes by imaging); or pN2a in the presence of pN1b
___ pN3c: Metastases in ipsilateral supraclavicular lymph nodes
# Isolated tumor cells (ITCs) are defined as small clusters of cells not greater than 0.2 mm or single tumor cells, or a cluster of fewer than 200 cells in a single histologic cross-section. ITCs may be detected by routine histology or by immunohistochemical (IHC) methods. Nodes containing only ITCs are excluded from the total positive node count for purposes of N classification but should be included in the total number of nodes evaluated.
## Approximately 1000 tumor cells are contained in a 3-dimensional 0.2-mm cluster. Thus, if more than 200 individual tumor cells are identified as single dispersed tumor cells or as a nearly confluent elliptical or spherical focus in a single histologic section of a lymph node, there is a high probability that more than 1000 cells are present in the lymph node. In these situations, the node should be classified as containing a micrometastasis (pN1mi). Cells in different lymph node cross-sections or longitudinal sections or levels of the block are not added together; the 200 cells must be in a single node profile even if the node has been thinly sectioned into multiple slices. It is recognized that there is substantial overlap between the upper limit of the ITC and the lower limit of the micrometastasis categories due to inherent limitations in pathologic nodal evaluation and detection of minimal tumor burden in lymph nodes. Thus, the threshold of 200 cells in a single cross-section is a guideline to help pathologists distinguish between these 2 categories. The pathologist should use judgment regarding whether it is likely that the cluster of cells represents a true micrometastasis or is simply a small group of isolated tumor cells.
Distant Metastasis (pM) (required only if confirmed pathologically in this case)
___ pM1: Histologically proven metastases larger than 0.2 mm
Specify site, if known:____________________