Enneking surgical staging system

Last revised by Dr Yuranga Weerakkody on 02 Nov 2015

The Enneking surgical staging system (also known as the MSTS system) is based on tumor grade, local spread and metastatic disease of malignant musculoskeletal tumors.

It does not classify skull tumors or marrow-originating tumors (e.g. lymphoma, plasmacytoma / multiple myeloma, Ewing sarcoma) 1. It is widely accepted and used by orthopaediac surgeons given its compartment-based classification. 

Staging

  • stage Ia
    • low-grade (G1)
    • intracompartmental (T1)
    • no metastases (M0)
  • stage Ib
    • low-grade (G1)
    • extracompartmental (T2)
    • no metastases (M0)
  • stage IIa
    • high-grade (G2)
    • intracompartmental (T1)
    • no metastases (M0)
  • stage IIb
    • high-grade (G2)
    • extracompartmental (T2)
    • no metastases (M0)
  • ​stage III
    • low or high-grade (G1 or G2)
    • intra- or extra-compartmental (T1 or T2)
    • distant metastases (M1)
Grading

Low-grade corresponds to Broder grade 1 or 2 (<25% chance metastases) and high-grade corresponds to Broder grade 3 or 4 1

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