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Staging of malignant pleural mesothelioma

A number of staging systems have been described for staging of malignant pleural mesothelioma. Below is the International Mesothelioma Interest Group TNM staging system.

TNM

T - Tumour
  • Tx: primary tumour cannot be assessed
  • T0: no evidence of primary tumour
  • T1a
    • potentially resectable
    • only parietal pleura
    • no mediastinal pleural involvement
  • T1b
    • potentially resectable
    • parietal pleura AND
    • scattered foci of mediastinal pleural involvement
  • T2
    • potentially resectable
    • parietal and visceral pleural involvement, and / or
    • pulmonary parenchymal involvement and/or
    • diaphragmatic muscle involvement
  • T3
    • potentially resectable
    • localised tumour extension into endothoracic fascia and / or
    • localised non-transmural involvement of pericardium and / or
    • localised extension into mediastinal fat
  • T4
    • unresectable
    • multiple foci of extension into chest wall +/- rib destruction and/or
    • extension through diaphragm into peritoneum and / or
    • extension into contralateral pleura and / or
    • extension into mediastinal organs and / or
    • extension through pericardium +/- direct extension into heart
N - Nodes
  • Nx: nodes cannot be assessed
  • N0: no evidence of nodal involvement
  • N1: ipsilateral bronchopulmonary or hilar nodal involvement
  • N2: subcarinal or ipsilateral mediastinal / internal mammary nodes
  • N3: contralateral mediastinal / internal mammary nodes
M - Metastases
  • Mx: presence of metastases cannot be assessed
  • M0: no evidence of metastases
  • M1: distant metastases present

Stage groupings

  • Stage IA: T1a, N0, M0
  • Stage IB:T1b, N0, M0
  • Stage II: T2, N0, M0
  • Stage III:
    • T1 or 2,  N1 or N2, M0 OR
    • T3, any N, M0
  • Stage IV: any T, any N, M1

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