Breast cancer staging refers to TNM classification of breast carcinomas. The system applies to epithelial malignancies and does not apply to breast sarcomas, phyllodes tumor, or breast lymphomas. The following article reflects the 8th edition manual published by the American Joint Committee on Cancer (AJCC), which has been used for staging since January 1, 2018 2.
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Primary tumor (T)
TX: primary tumor cannot be assessed
T0: no evidence of primary tumor
Tis (DCIS): ductal carcinoma in situ
Tis (Paget): Paget disease of the nipple not associated with invasive carcinoma or ductal carcinoma in situ
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T1: ≤20 mm in greatest dimension
T1mi: ≤1 mm
T1a: >1 mm but ≤5 mm
T1b: >5 mm but ≤10 mm
T1c: >10 mm but ≤20 mm
T2: >20 mm but ≤50 mm in greatest dimension
T3: >50 mm in greatest dimension
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T4: any size with direct extension to chest wall and/or skin (but not invasion of dermis alone)
T4a: chest wall extension (but not invasion of pectoralis muscle alone)
T4b: skin edema (including peau d'orange), ipsilateral macroscopic satellite nodules, and/or ulceration
T4c: both T4a and T4b
Regional lymph node (N)
Clinical (cN)
cNX: regional nodes cannot be assessed (e.g., previously removed)
cN0: no evidence of nodal metastasis (by imaging or clinical examination)
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cN1: metastasis to mobile ipsilateral level I/II axillary lymph nodes
cN1mi: micrometastases (larger than 0.2 mm but none larger than 2.0 mm)
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cN2: metastasis to fixed/matted ipsilateral level I/II axillary lymph nodes or to ipsilateral internal mammary artery lymph nodes alone
cN2a: metastasis to fixed/matted ipsilateral level I/II axillary lymph nodes
cN2b: metastasis to ipsilateral internal mammary lymph nodes alone without axillary lymph node metastases
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cN3: metastasis to ipsilateral infraclavicular (level III axillary) lymph nodes or to ipsilateral internal mammary lymph nodes and level I/II axillary lymph nodes or to ipsilateral supraclavicular lymph nodes
cN3a: metastasis to ipsilateral infraclavicular (level III axillary) lymph nodes
cN3b: metastasis to ipsilateral internal mammary lymph nodes and level I/II axillary lymph nodes
cN3c: metastasis to ipsilateral supraclavicular lymph nodes
Pathologic (pN)
pNX: regional nodes cannot be assessed (e.g. not removed or previously removed)
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pN0: no evidence of nodal metastasis or isolated tumor cells only
pN0(i+): isolated tumor cells only (malignant cell clusters no larger than 0.2 mm)
pN0(mol+): positive molecular findings by reverse transcriptase polymerase chain reaction (RT-PCR) but no isolated tumor cells detected
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pN1: micrometastases, metastasis to 1-3 axillary lymph nodes, or clinically negative internal mammary nodes with metastases by sentinel lymph node biopsy
pN1mi: micrometastases (larger than 0.2 mm but none larger than 2.0 mm)
pN1a: metastases in 1-3 axillary lymph nodes, with at least one metastasis larger than 2.0 mm
pN1b: metastases, excluding isolated tumor cells, in ipsilateral internal mammary sentinel nodes
pN1c: both pN1a and pN1b
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pN2: metastasis in 4-9 axillary lymph nodes, or clinically positive internal mammary nodes with absence of axillary lymph node metastases
pN2a: metastasis in 4-9 axillary lymph nodes, with at least one metastasis larger than 2.0 mm
pN2b: metastasis to ipsilateral internal mammary lymph nodes by imaging with or without microscopic confirmation, with pathologically negative axillary lymph nodes
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pN3: metastasis to 10 or more axillary lymph nodes; infraclavicular (level III axillary) lymph nodes; clinically positive ipsilateral internal mammary lymph nodes in presence of positive level I/II lymph nodes; more than 3 axillary lymph nodes and positive sentinel lymph node biopsy in clinically negative internal mammary lymph nodes; or in supraclavicular lymph nodes
pN3a: metastasis to 10 or more axillary lymph nodes, with at least one metastasis larger than 2.0 mm or metastasis to infraclavicular (level III axillary) lymph nodes
pN3b: pN1a or pN2a in the presence of cN2b (positive internal mammary lymph nodes by imaging) or pN2a in the presence of pN1b
pN3c: metastasis to ipsilateral supraclavicular lymph nodes
Distant metastases (M)
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M0: no clinical or radiographic evidence of distant metastases
cM0(i+): no clinical or radiographic evidence of distant metastases but positive tumor cells or <0.2 mm depositions detected microscopically or by molecular techniques in circulating blood, bone marrow, or other nonregional nodal tissue in a patient without signs or symptoms of metastasis
cM1: distant metastases present by clinical or radiographic detection
pM1: histologically proven metastasis in distant organs or deposits >0.2 mm in nonregional lymph nodes
NB: The MX category is no longer used, it was removed in the 6th edition of the TNM system, if presence of metastases is not known the cancer is assigned M0 5.
Stage groups
AJCC Anatomic Stage Groups
Anatomic stage groups are used alone only if biomarker tests are not available:
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stage 0
Tis, N0, M0
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stage IA
T1, N0, M0
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stage IB
[T0, T1], N1mi, M0
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stage IIA
[T0, T1], N1, M0
T2, N0, M0
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stage IIB
T2, N1, M0
T3, N0, M0
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stage IIIA
[T0, T1, T2], N2, M0
T3, [N1, N2], M0
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stage IIIB
T4, [N0, N1, N2], M0
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stage IIIC
[Any T], N3, M0
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stage IV
[Any T], [Any N], M1
Clinical prognostic stage
Clinical prognostic stage applies to all patients who have the requisite information, which includes histologic grade for invasive cancers (Nottingham modification of the Scarff-Bloom-Richardson system) and expression status of the human epidermal growth factor receptor 2 (HER2/neu), estrogen receptor (ER), and progesterone receptor (PR):
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stage 0
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anatomic stage 0
any grade, any HER2/ER/PR status
-
-
stage IA
-
anatomic stage IA or IB
-
G1 or G2
HER2+, ER±, PR±
HER2-, ER+, PR±
HER2-, ER-, PR+
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G3
HER2+, ER±, PR±
HER2-, ER+, PR+
-
-
-
stage IB
-
anatomic stage IA or IB
-
G1, G2, or G3
HER2-, ER-, PR-
-
G3
HER2-, ER+, PR-
HER2-, ER-, PR+
-
-
anatomic stage IIA
-
G1 or G2
HER2±, ER+, PR+
-
G3
HER2+, ER+, PR+
-
-
anatomic stage IIB
-
G1, G2, or G3
HER2+, ER+, PR+
-
-
-
stage IIA
-
anatomic stage IIA
-
G1
HER2±, ER+, PR-
HER2±, ER-, PR±
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G2
HER2±, ER+, PR-
HER2+, ER-, PR+
HER2+, ER-, PR-
-
G3
HER2+, ER+, PR-
HER2+, ER-, PR±
HER2-, ER+, PR+
-
-
anatomic stage IIB
-
G1
HER2+, ER+, PR-
HER2+, ER-, PR+
HER2-, ER+, PR+
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G2
HER2+, ER+, PR-
HER2+, ER-, PR+
HER2-, ER+, PR+
-
-
anatomic stage IIIA
-
G1 or G2
HER2±, ER+, PR+
-
-
-
stage IIB
-
anatomic stage IIA
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G2
HER2-, ER-, PR-
-
G3
HER2-, ER+, PR-
HER2-, ER-, PR±
-
-
anatomic stage IIB
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G1
HER2+, ER-, PR-
HER2-, ER+, PR-
HER2-, ER-, PR±
-
G2
HER2+, ER-, PR-
HER2-, ER+, PR-
HER2-, ER-, PR+
-
G3
HER2+, ER+, PR-
HER2+, ER-, PR±
HER2-, ER+, PR+
-
-
anatomic stage IIIA
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G3
HER2+, ER+, PR+
-
-
-
stage IIIA
-
anatomic stage IIB
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G3
HER2-, ER+, PR-
HER2-, ER-, PR+
-
-
anatomic stage IIIA
-
G1 or G2
HER2±, ER+, PR-
HER2±, ER-, PR+
HER2+, ER-, PR-
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G3
HER2+, ER+, PR-
HER2+, ER-, PR±
HER2-, ER+, PR+
-
-
anatomic stage IIIB or IIIC
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G1 or G2
HER2+, ER+, PR+
-
-
-
stage IIIB
-
anatomic stage IIB
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G2 or G3
HER2-, ER-, PR-
-
-
anatomic stage IIIA
-
G1 or G2
HER2-, ER-, PR-
-
G3
HER2-, ER+, PR-
HER2-, ER-, PR+
-
-
anatomic stage IIIB or IIIC
-
G1 or G2
HER2+, ER+, PR-
HER2+, ER-, PR±
HER2-, ER+, PR±
HER2-, ER-, PR+
-
G3
HER2+, ER±, PR±
HER2-, ER+, PR+
-
-
-
stage IIIC
-
anatomic stage IIIA
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G3
HER2-, ER-, PR-
-
-
anatomic stage IIIB or IIIC
-
G1 or G2
HER2-, ER-, PR-
-
G3
HER2-, ER+, PR-
HER2, ER-, PR±
-
-
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stage IV
-
anatomic stage IV
any grade, any HER2/ER/PR status
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Pathological prognostic stage
Pathological prognostic stage applies to patients who are treated initially with surgery but not with neoadjuvant therapy.
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stage 0
-
anatomic stage 0
any grade, any HER2/ER/PR status
-
-
stage IA
-
anatomic stage IA or IB
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G1
any HER2/ER/PR status
-
G2 or G3
any HER2/ER/PR status except HER2-, ER-, PR-
-
-
anatomic stage IIA
-
G1 or G2
HER2±, ER+, PR+
-
G3
HER2+, ER+, PR+
-
-
anatomic stage IIB
-
G1
HER2±, ER+, PR+
-
-
[T1 or T2], N0, M0
any grade, HER2-, ER+, PR±, OnctoypeDx genomic profile score less than 11
-
-
stage IB
-
anatomic stage IA or IB
-
G2 or G3
HER2-, ER-, PR-
-
-
anatomic stage IIA
-
G1
HER2±, ER+, PR-
HER2±, ER-, PR+
-
G2
HER2+, ER+, PR-
HER2+, ER-, PR+
-
G3
HER2-, ER+, PR+
-
-
anatomic stage IIB
-
G2
HER2±, ER+, PR+
-
G3
HER2+, ER+, PR+
-
-
anatomic stage IIIA
-
G1 or G2
HER2±, ER+, PR+
-
-
-
stage IIA
-
anatomic stage IIA
-
G1
HER2±, ER-, PR-
-
G2
HER2±, ER-, PR-
HER2-, ER+, PR-
HER2-, ER-, PR+
-
G3
HER2±, ER+, PR-
HER2±, ER-, PR±
-
-
anatomic stage IIB or IIIA
-
G3
HER2-, ER+, PR+
-
-
-
stage IIB
-
anatomic stage IIB
-
G1 or G2
HER2±, ER+, PR-
HER2±, ER-, PR±
-
G3
HER2+, ER+, PR-
HER2±, ER-, PR+
HER2-, ER+, PR-
-
-
anatomic stage IIIA
-
G3
HER2-, ER+, PR+
-
-
-
stage IIIA
-
anatomic stage IIB
-
G3
HER2-, ER-, PR-
-
-
anatomic stage IIIA
-
G1
HER2±, ER+, PR-
HER2±, ER-, PR±
-
G2
HER2±, ER+, PR-
HER2±, ER-, PR+
HER2+, ER-, PR-
-
G3
HER2±, ER+, PR-
HER2±, ER-, PR+
HER2+, ER-, PR-
-
-
anatomic stage IIIB or IIIC
-
G1 or G2
HER2±, ER+, PR+
-
-
-
stage IIIB
-
anatomic stage IIIA
-
G2
HER2-, ER-, PR-
-
-
anatomic stage IIIB or IIIC
-
G1
HER2±, ER+, PR-
HER2±, ER-, PR±
-
G2
HER2±, ER+, PR-
HER2±, ER-, PR+
HER2+, ER-, PR-
-
G3
HER2+, ER±, PR±
HER2-, ER+, PR+
-
-
-
stage IIIC
-
anatomic stage IIIA
-
G3
HER2-, ER-, PR-
-
-
anatomic stage IIIB or IIIC
-
G2
HER2-, ER-, PR-
-
G3
HER2-, ER+, PR-
HER2-, ER-, PR±
-
-
-
stage IV
-
anatomic stage IV
any grade, any HER2/ER/PR status
-
Treatment and prognosis:
Estimated five year survival rates:
stage I: ~87%
stage II: ~75%
stage III: ~46%
stage IV: ~13%