Review articleStaging system for breast cancer: revisions for the 6th edition of the AJCC Cancer Staging Manual
Section snippets
The revised AJCC staging system for breast cancer
The revised AJCC staging system for breast cancer is shown in Table 1, and the stage groupings are shown in Table 2. The major changes in this revision fall into two major categories: (1) changes related to the detection and description of microscopic metastatic lesions, and (2) changes related to the location and number of lymph node metastases. The inclusion of histologic tumor grade in the TNM system was considered but ultimately rejected.
Changes related to the detection and description of microscopic metastastic lesions
Major changes related to the detection and description of microscopic metastastic lesions are as follows:
- 1.
Micrometastases are distinguished from isolated tumor cells on the basis of size. They are more likely to show histologic evidence of malignant activity, but this is not an absolute requirement.
- 2.
Identifiers have been added to indicate the use of sentinel lymph node dissection and immunohistochemical or molecular techniques.
Summary
Since its inception, the AJCC staging system for breast cancer has been in an almost constant state of evolution, striving with each revision to reflect the most up-to-date clinical research as well as the widespread consensus among physicians about appropriate diagnostic and treatment standards. To date, these revisions have essentially represented a “fine-tuning” of the initial judgment that tumor size, lymph node status, and presence of distant metastases are the most significant prognostic
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