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AJCC Cancer Staging Manual

Summary of Changes

Micrometastases are distinguished from isolated tumor cells on the basis of size and histologic evidence of malignant activity.

Identifiers have been added to indicate the use of sentinel lymph node dissection and immunohistochemical or molecular techniques.

Major classifications of lymph node status are designated according to the number of involved axillary lymph nodes as determined by routine hematoxylin and eosin staining (preferred method) or by immunohistochemical staining.

The classification of metastasis to the infraclavicular lymph nodes has been added as N3.

Metastasis to the internal mammary nodes, based on the method of detection and the presence or absence of axillary nodal involvement, has been reclassified. Microscopic involvement of the internal mammary nodes detected by sentinel lymph node dissection using lymphoscintigraphy but not by imaging studies or clinical examination is classified as N1. Macroscopic involvement of the internal mammary nodes as detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination is classified as N2 if it occurs in the absence of metastases to the axillary lymph nodes or as N3 if it occurs in the presence of metastases to the axillary lymph nodes.

Metastasis to the supraclavicular lymph nodes has been reclassified as N3 rather than M1.

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References

  1. Page DL, Kidd TE, Dupont WD, Simpson JF, Rogers LW: Lobular neoplasia of the breast: higher risk for subsequent invasive cancer predicted by more extensive disease. Hum Pathol; 22:1232–1239, 1991

    Article  PubMed  CAS  Google Scholar 

  2. Elston CW, Ellis IO: Pathological prognostic factors in breast cancer. I. The value of histologic grade in breast cancer: experience from a large study with long-term follow-up. His-topathology 19:403–410, 1991

    CAS  Google Scholar 

  3. Fitzgibbons PL, Page DL, Weaver D, et al: Prognostic factors in breast cancer. College of American pathologists consensus statement 1999. Arch Pathol Lab Med 124:966–978, 2000

    PubMed  CAS  Google Scholar 

  4. Hansemann von D: Uber assymetrische zelltheilung in epi-thelkrebsen und deren biologische bedeutung. Virchows Arch Pathol Anat 119:299–326, 1890

    Article  Google Scholar 

  5. Greenough RB: Varying degrees of malignancy in cancer of the breast. J Cancer Res 9:452–463, 1925

    Google Scholar 

  6. Bloom HJG, Richardson WW. Histologic grading and prognosis in breast cancer. Br J Cancer 9:359–377, 1957

    Article  Google Scholar 

  7. Le Doussal V, Tubiana-Hulin M, Friedman S, et al: Prognostic value of histologic grade nuclear components of Scarff-Bloom-Richardson (SBR): an improved score modification based on multivariate analysis of 1262 invasive ductal breast carcinomas. Cancer 64:1914–1921, 1989

    Article  PubMed  Google Scholar 

  8. Henson DE, Ries L, Freedman LS, Carriaga M: Relationship among outcome, stage of disease, and histologic grade for 22,616 cases of breast cancer. Cancer 68:2142–2149, 1991

    Article  PubMed  CAS  Google Scholar 

  9. Neville AM, Bettelheim R, Gelber RD, et al: Factors predicting treatment responsiveness and prognosis in node-negative breast cancer. J Clin Oncol 10:696–705, 1992

    PubMed  CAS  Google Scholar 

  10. Delides GS, Garas G, Georgouli G, et al: Intralaboratory variations in the grading of breast carcinoma. Arch Pathol Lab Med 106:126–128, 1982

    PubMed  CAS  Google Scholar 

  11. Stenkvist B, Bengtsson E, Eriksson O, et al: Histopathological systems of breast cancer classification: reproducibility and clinical significance. J Clin Pathol 36:392–398, 1983

    Article  PubMed  CAS  Google Scholar 

  12. Gilchrist KW, Kalish L, Gould VE, et al: Interobserver reproducibility of histopathological features in Stage II breast cancer: an ECOG study. Breast Cancer Res Treat 5:3–10, 1985

    Article  PubMed  CAS  Google Scholar 

  13. Harvey JM, de Klerk NH, Sterrett GH: Histologic grading in breast cancer: interobserver agreement, and relation to other prognostic factors including ploidy. Pathology 24:63–68, 1992

    Article  PubMed  CAS  Google Scholar 

  14. Lundin J, Lundin M, Holli K, et al: Omission of histologic grading from clinical decision making may result in overuse of adjuvant therapies in breast cancer: results from a nationwide study. J Clin Oncol 19:28–36, 2001

    PubMed  CAS  Google Scholar 

  15. Dalton LW, Page DL, Dupont WD: Histologic grading of breast carcinoma. A reproducibility study. Cancer 73:2765–2770, 1994

    Article  PubMed  CAS  Google Scholar 

  16. Frierson HF, Wolber RA, Berean KW, et al: Interobserver reproducibility of the Nottingham modification of the Bloom and Richardson histologic grading scheme for infiltrating ductal carcinoma. Am J Clin Pathol 103:195–198, 1995

    PubMed  Google Scholar 

  17. Robbins P, Pinder S, de Klerk N, et al: Histologic grading of breast carcinomas: a study of interobserver agreement. Hum Pathol 26:873–879, 1995

    Article  PubMed  CAS  Google Scholar 

  18. Genestie C, Zafrani B, Asselain B, et al: Comparison of the prognostic value of Scarff-Bloom-Richardson and Nottingham histologic grades in a series of 825 cases of breast cancer: major importance of the mitotic count as a component of both grading systems. Anticancer Res 18:571–576, 1998

    PubMed  CAS  Google Scholar 

  19. Donhuijsen K, Schmidt U, Hirche H, et al: Changes in mitotic rate and cell cycle fractions caused by delayed fixation. Hum Pathol 21:709–714, 1990

    Article  PubMed  CAS  Google Scholar 

  20. Cross SS, Start RD, Smith JHF: Does delay in fixation affect the number of mitotic figures in processed tissue? J Clin Pathol 43:597–599, 1990

    Article  PubMed  CAS  Google Scholar 

  21. Start RD, Flynn MS, Cross SS, et al: Is the grading of breast carcinomas affected by a delay in fixation? Virch Arch A Pathol Anat 419:475–477, 1991

    Article  CAS  Google Scholar 

  22. Rosen PP, Groshen S, Saigo PE, et al: Pathological prognostic factors in Stage I (T1N0M0) and Stage II (T1N1M0) breast carcinoma: a study of 644 patients with median follow-up of 18 years. J Clin Oncol 7:1239–1251, 1989

    PubMed  CAS  Google Scholar 

  23. Rosner D, Lane WW: Should all patients with node-negative breast cancer receive adjuvant therapy? Cancer 68:1482–1494, 1991

    Article  PubMed  CAS  Google Scholar 

  24. Kollias J, Murphy CA, Elston CW, et al: The prognosis of small primary breast cancers. Eur J Cancer 35:908–912, 1999

    Article  PubMed  CAS  Google Scholar 

  25. Leitner SP, Swern AS, Weinberger D, et al: Predictors of recurrence for patients with small (one centimeter or less) localized breast cancer (T1a,bN0M0). Cancer 76:2266–2274, 1995

    Article  PubMed  CAS  Google Scholar 

  26. Reed W, Hannisdal E, Boehler PJ, et al: The prognostic value of p53 and c-erb B-2 immunostaining is overrated for patients with lymph node negative breast cancer. Cancer 88:804–813, 2000

    Article  PubMed  CAS  Google Scholar 

  27. Czerniecki BH, Scheff AM, Callans LS, et al: Immunohis-tochemistry with pancytokeratins improves the sensitivity of sentinel lymph node biopsy in patients with breast carcinoma. Cancer 1089–1103, 1999

    Google Scholar 

  28. Trojani M, de Mascarel I, Bonichon F, et al: Micrometastases to axillary lymph nodes from carcinoma of breast: detection by immunohistochemistry and prognostic significance. Br J Cancer 55:303–306, 1987

    Article  PubMed  CAS  Google Scholar 

  29. Senmak DD, Meineke TA, Knechtges DS, Anderson J. Prognostic significance of cytokeratin-positive breast cancer metastases. Mod Pathol 2:516–520, 1989

    Google Scholar 

  30. Chen ZL, Wen DR, Coulson WF, et al: Occult metastases in the axillary lymph nodes of patients with breast cancer node negative by clinical and histologic examination and conventional histology. Dis Markers 9:238–248, 1991

    Google Scholar 

  31. de Mascarel I, Bonichon F, Coindre JM, et al: Prognostic significance of breast cancer axillary lymph node micrometastases assessed by two special techniques: re-evaluation with longer follow-up. Br J Cancer 66:523–527, 1992

    Article  PubMed  Google Scholar 

  32. Hainsworth PI, Tjandra JJ, Stillwell RG, et al: Detection and significance of occult metastases in node-negative breast cancer. Br J Surg 80:459–463, 1993

    Article  PubMed  CAS  Google Scholar 

  33. Clare SE, Sener SF, Wilkens W, et al: Prognostic significance of occult lymph node metastases in node-negative breast cancer. Ann Surg Oncol 4:447–451, 1997

    Article  PubMed  CAS  Google Scholar 

  34. Hermanek P, Hutter RVP, Sobin LH, Wittekind C: Classification of isolated tumor cells and micrometastasis. Cancer 86:2668–2673, 1999

    Article  PubMed  CAS  Google Scholar 

  35. Huvos AG, Hutter RVP, Berg JW: Significance of axillary macrometastases and micrometastases in mammary cancer. Ann Surg 173:44–46, 1971.

    Article  PubMed  CAS  Google Scholar 

  36. Verbanac KM, Fleming TP, Min CH, et al: RT-PCR increases detection of breast cancer sentinel lymph node micrometastases. [Abstract 125]. 22nd Annual San Antonio Breast Cancer Symposium, 1999

    Google Scholar 

  37. Carter CL, Allen C, Henson DE: Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 63:181–187, 1989

    Article  PubMed  CAS  Google Scholar 

  38. Nemoto T, Vana J, Bedwani RN, et al: Management and survival of female breast cancer: results of a national survey by the American College of Surgeons. Cancer 45:2917–2924, 1980

    Article  PubMed  CAS  Google Scholar 

  39. Paik S, Bryant J, Park C, et al: erbB-2 and response to doxorubicin in patients with axillary lymph node-positive, hormone receptor-negative breast cancer. J Natl Cancer Inst 90:1361–1370, 1998

    Article  PubMed  CAS  Google Scholar 

  40. Crump M, Goss PE, Prince M, Girouard C: Outcome of extensive evaluation before adjuvant therapy in women with breast cancer and 10 or more positive axillary lymph nodes. J Clin Oncol 14:66–69, 1996

    PubMed  CAS  Google Scholar 

  41. Diab SG, Hilsenbeck SG, de Moor C, et al: Radiation therapy and survival in breast cancer patients with 10 or more positive axillary lymph nodes treated with mastectomy. J Clin Oncol 16:1655–1660, 1998

    PubMed  CAS  Google Scholar 

  42. Fountzilas G, Nicolaides C, Aravantinos G, et al: Dose-dense adjuvant chemotherapy with epirubicin monotherapy in patients with operable breast cancer and > 10 positive axillary lymph nodes: a feasibility study. Oncology 55:508–12, 1998

    Article  PubMed  CAS  Google Scholar 

  43. Veronesi U, Marubini E, Mariani L, et al: The dissection of internal mammary nodes does not improve the survival of breast cancer patients: 30-year results of a randomized trial. Eur J Cancer 35:1320–1325, 1999

    Article  PubMed  CAS  Google Scholar 

  44. Bucalossi P, Veronesi U, Zingo L, Cantu C: Enlarged mastectomy for breast cancer: review of 1,213 cases. Am J Roentgenol Radium Ther Nucl Med 111:119–122, 1971

    Article  PubMed  CAS  Google Scholar 

  45. Caceres E: An evaluation of radical mastectomy and extended radical mastectomy for cancer of the breast. Surg Gynecol Obstetrics 123:337–241, 1967

    Google Scholar 

  46. Li KYY, Shen Z-Z: An analysis of 1,242 cases of extended radical mastectomy. Breast, Diseases of the Breast 10:10–19, 1984

    Google Scholar 

  47. Urban JA, Marjani MA: Significance of internal mammary lymph node metastases in breast cancer. Am J Roentgenol Radium Ther Nucl Med 111:130–136, 1971

    Article  PubMed  CAS  Google Scholar 

  48. Veronesi U, Cascinelli N, Bufalino R, et al: Risk of internal mammary lymph node metastases and its relevance on prognosis of breast cancer patients. Ann Surg 198:681–684, 1983

    Article  PubMed  CAS  Google Scholar 

  49. Halsted WS: The results of radical operations for the cure of cancer of the breast. Ann Surg 46:1–5, 1907

    Article  PubMed  CAS  Google Scholar 

  50. Debois JM: The significance of a supraclavicular node metastasis in patients with breast cancer: a literature review. Strahlenther Onkol 173:1–12, 1997

    Article  PubMed  CAS  Google Scholar 

  51. AJCC cancer staging manual, 5th ed. Philadelphia: Lippin-cott-Raven, 1997

    Google Scholar 

  52. Brito RA, Valero W, Buzdar AU, et al: Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases: The University of Texas M. D. Anderson Cancer Center experience. J Clin Oncol 19:628–633, 2001

    PubMed  CAS  Google Scholar 

  53. American Society of Clinical Oncology: Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. J Clin Oncol 14:2843–2877, 1996

    Google Scholar 

  54. American Society of Clinical Oncology: 1997 Update of recommendations for the use of tumor markers in breast and colorectal cancer. J Clin Oncol 16:793–795, 1998

    Google Scholar 

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Authors and Affiliations

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    American Joint Committee on Cancer

    Editor information

    Editors and Affiliations

    1. Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA

      Frederick L. Greene M.D. (Chair) (Chair)

    2. Vanderbilt University Medical Center, Nashville, Tennessee, USA

      David L. Page M.D. (Professor of Pathology and Epidemiology) (Professor of Pathology and Epidemiology)

    3. Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA

      Irvin D. Fleming M.D. (Professor) (Professor)

    4. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA

      April G. Fritz C.T.R., R.H.I.T.

    5. The Johns Hopkins School of Medicine, Baltimore, Maryland, USA

      Charles M. Balch M.D. (Professor of Surgery and Oncology) (Professor of Surgery and Oncology)

    6. University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA

      Daniel G. Haller M.D. (Professor of Medicine, Associate Chief for Clinical Affairs) (Professor of Medicine, Associate Chief for Clinical Affairs)

    7. Lynn Sage Breast Center, School of Medicine, Northwestern University, Chicago, Illinois, USA

      Monica Morrow M.D. (Professor of Surgery and Director) (Professor of Surgery and Director)

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    American Joint Committee on Cancer. (2002). Breast. In: Greene, F.L., et al. AJCC Cancer Staging Manual. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3656-4_25

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    • DOI: https://doi.org/10.1007/978-1-4757-3656-4_25

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