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Stage Information for Breast Cancer

(continued)

continued...

Table 2. Regional Lymph Nodes (N)a

^a Reprinted with permission from AJCC: Breast. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 347-76.
^bClinically detected is defined as detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination and having characteristics highly suspicious for malignancy or a presumed pathologic macrometastasis based on fine needle aspiration biopsy with cytologic examination. Confirmation of clinically detected metastatic disease by fine needle aspiration without excision biopsy is designated with an (f) suffix, for example, cN3a(f). Excisional biopsy of a lymph node or biopsy of a sentinel node, in the absence of assignment of a pT, is classified as a clinical N, for example, cN1. Information regarding the confirmation of the nodal status will be designated in site-specific factors as clinical, fine needle aspiration, core biopsy, or sentinel lymph node biopsy. Pathologic classification (pN) is used for excision or sentinel lymph node biopsy only in conjunction with a pathologic T assignment.
Clinical
NX	Regional lymph nodes cannot be assessed (e.g., previously removed).
N0	No regional lymph node metastases.
N1	Metastases to movable ipsilateral level I, II axillary lymph node(s).
N2	Metastases in ipsilateral level I, II axillary lymph nodes that are clinically fixed or matted.
OR
Metastases in clinically detected^b ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastases.
N2a	Metastases in ipsilateral level I, II axillary lymph nodes fixed to one another (matted) or to other structures.
N2b	Metastases only in clinically detected^b ipsilateral internal mammary nodes and in the absence of clinically evident level I, II axillary lymph node metastases.
N3	Metastases in ipsilateral infraclavicular (level III axillary) lymph node(s) with or without level I, II axillary lymph node involvement.
OR
Metastases in clinically detected^b ipsilateral internal mammary lymph node(s) with clinically evident level I, II axillary lymph node metastases.
OR
Metastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement.
N3a	Metastases in ipsilateral infraclavicular lymph node(s).
N3b	Metastases in ipsilateral internal mammary lymph node(s) and axillary lymph node(s).
N3c	Metastases in ipsilateral supraclavicular lymph node(s).

Table 3. Pathologic (pN)a,b

AND = axillary node dissection; H&E = hematoxylin and eosin stain; IHC = immunohistochemical; ITC = isolated tumor cells; RT-PCR = reverse transcriptase/polymerase chain reaction.
^a Reprinted with permission from AJCC: Breast. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 347-76.
^b Classification is based on axillary lymph node dissection with or without sentinel lymph node biopsy. Classification based solely on sentinel lymph node biopsy without subsequent axillary lymph node dissection is designated (SN) for "sentinel node," for example, pN0(SN).
^c"Not clinically detected" is defined as not detected by imaging studies (excluding lymphoscintigraphy) or not detected by clinical examination.
^d"Clinically detected" is defined as detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination and having characteristics highly suspicious for malignancy or a presumed pathologic macrometastasis based on fine-needle aspiration biopsy with cytologic examination.
pNX	Regional lymph nodes cannot be assessed (e.g., previously removed or not removed for pathologic study).
pN0	No regional lymph node metastasis identified histologically.
Note: ITCs are defined as small clusters of cells ?0.2 mm, or single tumor cells, or a cluster of <200 cells in a single histologic cross-section. ITCs may be detected by routine histology or by 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.
pN0(i-)	No regional lymph node metastases histologically, negative IHC.
pN0(i+)	Malignant cells in regional lymph node(s) ?0.2 mm (detected by H&E or IHC including ITC).
pN0(mol-)	No regional lymph node metastases histologically, negative molecular findings (RT-PCR).
pN0(mol+)	Positive molecular findings (RT-PCR), but no regional lymph node metastases detected by histology or IHC.
pN1	Micrometastases.
OR
Metastases in 1-3 axillary lymph nodes.
AND/OR
Metastases in internal mammary nodes with metastases detected by sentinel lymph node biopsy but not clinically detected.^c
pN1mi	Micrometastases (>0.2 mm and/or >200 cells but none >2.0 mm).
pN1a	Metastases in 1-3 axillary lymph nodes, at least one metastasis >2.0 mm.
pN1b	Metastases in internal mammary nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected.^c
pN1c	Metastases in 1-3 axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected.
pN2	Metastases in 4-9 axillary lymph nodes.
OR
Metastases in clinically detected^d internal mammary lymph nodes in the absence of axillary lymph node metastases.
pN2a	Metastases in 4-9 axillary lymph nodes (at least 1 tumor deposit >2 mm).
pN2b	Metastases in clinically detected^d internal mammary lymph nodes in the absence of axillary lymph node metastases.
pN3	Metastases in ?10 axillary lymph nodes.
OR
Metastases in infraclavicular (level III axillary) lymph nodes.
OR
Metastases in clinically detected^c ipsilateral internal mammary lymph nodes in the presence of one or more positive level I, II axillary lymph nodes.
OR
Metastases in >3 axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected.^c
OR
Metastases in ipsilateral supraclavicular lymph nodes.
pN3a	Metastases in ?10 axillary lymph nodes (at least 1 tumor deposit >2.0 mm).
OR
Metastases to the infraclavicular (level III axillary lymph) nodes.
pN3b	Metastases in clinically detected^d ipsilateral internal mammary lymph nodes in the presence of one or more positive axillary lymph nodes;
OR
Metastases in >3 axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected.^c
pN3c	Metastases in ipsilateral supraclavicular lymph nodes.
Posttreatment ypN
-Posttreatment yp "N" should 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 that the axillary nodal evaluation was by AND.
-The X classification will be used (ypNX) if no yp posttreatment SN or AND was performed.
-N categories are the same as those used for pN.

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Last Updated: May 16, 2012

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