clasificación clínica del cáncer de mama

1. Clinical Classification of breast
cancer
Cajas Montenegro Carlos Michaell

2. RULES FOR CLASSIFICATION
The anatomic TNM system is a method for coding extent of disease. This is done by assigning
a category of extent of disease for the tumor (T), regional lymph nodes (N), and distant
metastases (M). T, N, and M are assigned by clinical means and by adding surgical findings
and pathological information to the clinical information

3. CLINICAL CLASSIFICATION
Clinical categorization of a cancer is based on findings of history, physical examination, and any imaging studies that
are done. Imaging studies are not required to assign clinical categories o r stage. Cases with a biopsy o f lymph nodes
or metastatic sites may be staged clinically, including the biopsy information.
Physical Examination
Physical examination includes careful
inspection and palpation of the skin,
mammary gland, and lymph nodes
(axillary, supraclavicular, and cervical) ,
imaging, and pathological examination
of the breast or other tissues as
appropriate to establish the diagnosis of
breast carcinoma. The extent of tissue
examined pathologically for clinical
staging is not as great as that required
for pathological staging (see
“Pathological Classification”
Imaging
Imaging findings are considered elements of
staging if they are collected within 4 months
of diagnosis or through completion of
surgery, whichever is longer in the absence
of disease progression. Relevant imaging
findings include the size of the primary
invasive cáncer and of chest wall invasión
and the presence or absence of regional or
distant metastases. Imaging and clinical
findings obtained after a patient has been
treated with neoadjuvant chemotherapy,
hormonal therapy, immunotherapy, or
radiation therapy are not considered
elements of initial clinical staging. If recorded
in the medical record, these should be
denoted using the modifier prefix “ye.”
Clinical findings are usually integrated
with imaging to determine the size of
primary tumor and the presence or
absence of múltiple synchronous lesions
involving the same breast quadrant or
different breast quadrants (i.e., multifocal
or multicentric disease, respectively). The
imaging modalities most commonly used
to help determine T and N features are
mammography and ultrasound. The
routine use of breast magnetic resonance
(MR) imaging in newly diagnosed cáncer
patients has not been shown to have
significant benefit in obtaining clear
surgical margins

4. • Primary Tumor (T) - Clinical and Pathological
The T category of the primary tum or is defined by the same criteria regardless of whether it is based on clinical
or pathological criteria, or both. The T category is based primarily on the size of the invasive component of the
cáncer
TI se define como un tumor de 20 mm o menos en su
mayor dimensión.
• T1a es definido como tumor de más de 1 mm pero no
más de 5 mm en la mayor dimensión;
• T 1b se define como un tumor de más de 5 mm pero
no más de 10 mm de mayor dimensión
• T 1c se define como un tumor de más de 10 mm pero
no más de 20 mm en la mayor dimensión

5. T2 se define como un tumor de más de
20 mm pero no más de 50 mm en la
dimensión máxima, y
T3 es definido como tumor de más de
50 mm en su mayor dimensión

6. T4 se define como un tumor de cualquier tamaño con extensión directa a pared torácica y / o piel (ulceración o
nódulos cutáneos). (a) Extensión de T4a a la pared torácica. La adherencia / invasión al músculo pectoral NO es
extensión a la pared torácica y no se clasifica como T4.
(b) T4b, ilustrado aquí como nódulos de piel satélite, se define como edema (incluyendo peau d'orange) de la piel, o
ulceración de la piel de la mama, o satélite nódulos cutáneos confinados a la misma mama. Estos no cumplen los
criterios de carcinoma inflamatorio,
(c) T4b ilustrado aquí como edema (incluyendo peau d ’orange) de la piel. (d)
T4c se define como T4a y T4b. T4d (no ilustrado) es cáncer inflamatorio

7. Imaging Classification of Regional Lymph Nodes
Imaging is not necessary to assign the clinical node category. Routine use
of axillary ultrasound in breast cancer patients is controversial.
Metaanalyses suggest that among patients who prove to have positive
node , clinically occult axillary nodal metastases can be detected in about
half on preoperative ultrasound evaluation. In centers that routinely
implement regional nodal ultrasound, imaging should include at least
ipsilateral axillary levels I and II. Lymph node measurements are obtained
by both long and short axis lengths on ultrasound. However, ultrasound
measurements are operator and technique dependent.

8. • Fig.48.6
Categorías clínicas de los ganglios linfáticos:
• cN 1 se define como metástasis en ganglios
linfáticos axilares móviles ipsilaterales de nivel I. II.
• cN2a se define como metástasis en los ganglios
linfáticos axilares ipsolaterales de nivel I, II fijados
entre sí (enmarañados).
• cN2b se define como metástasis solo en los
ganglios mamarios internos psilaterales detectados
clínicamente y en ausencia de metástasis de los
ganglios linfáticos axilares de nivel I, II clínicamente
evidentes.
• cN3a se define como metástasis en ganglios
linfáticos infraclaviculares (axilares de nivel III)
ipsolaterales con o sin compromiso de los ganglios
linfáticos axilares de nivel I, II.
• cN3b se define como metástasis en ganglios
linfáticos mamarios internos ipsolaterales detectados
clínicamente y ganglios linfáticos axilares
clínicamente evidentes.
• cN3c se define como metástasis en ganglios
linfáticos supraclaviculares ipsolaterales con o sin
compromiso de los ganglios linfáticos mamarios
internos o axilares