Malignant pleural mesothelioma (TNM staging)
Below is the eighth edition of the TNM staging system for malignant pleural mesothelioma, which was published in 2018.
T - Tumor
- Tx: primary tumor cannot be assessed
- T0: no evidence of primary tumor
- T1
- involving ipsilateral parietal pleura (inc. mediastinal and diaphragmatic pleura) +/- visceral pleura
- T2
- involving any of the ipsilateral pleural surfaces with at least one of the following features:
- confluent visceral pleural tumor (including the fissures)
- involvement of diaphragmatic muscle
- invasion of the lung parenchyma
- involving any of the ipsilateral pleural surfaces with at least one of the following features:
- T3
- involving all of the ipsilateral pleural surfaces with at least one of the following features:
- invasion of the endothoracic fascia
- extension into the mediastinal fat
- solitary, completely resectable focus invading soft tissues of the chest wall
- non-transmural involvement of the pericardium
- involving all of the ipsilateral pleural surfaces with at least one of the following features:
- T4
- involving all of the ipsilateral pleural surfaces with at least one of the following features:
- any rib involvement
- invasion of the peritoneum through the diaphragm
- invasion of any mediastinal organ (inc. myocardium)
- direct extension to the contralateral pleura
- invasion of the spine or brachial plexus
- transmural invasion of the pericardium (+/- pericardial effusion)
- involving all of the ipsilateral pleural surfaces with at least one of the following features:
N - Nodes
- Nx: nodes cannot be assessed
- N0: no evidence of nodal involvement
- N1: ipsilateral bronchopulmonary, hilar, or mediastinal nodal involvement (inc. internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal lymph nodes)
- N2: contralateral bronchopulmonary, hilar, or mediastinal lymph nodes or ipsilateral or contralateral supraclavicular lymph nodes
M - Metastases
- Mx: presence of metastases cannot be assessed
- M0: no evidence of distant metastases
- M1: distant metastases present
Stage groupings
- Stage IA: T1, N0, M0
- Stage IB: T2 or 3, N0, M0
- Stage II: T1 or 2, N1, M0
- Stage IIIA: T3, N1, M0
- Stage IIIB: T1-3, N2, M0 or T4, any N, M0
- Stage IV: any T, any N, M1
Most Stage I and II tumors are resectable. Some stage III tumors may be resectable.
Previous editions
The seventh edition had separate T1a and T1b categories but these were combined following a survival analysis showing no difference between these two groups . The seventh edition also had an extra category for nodal involvement . Intrapleural (previous N1) and extrapleural (previous N2) lymph nodes are now combined into one category (N1) and previous N3 nodes have been moved into the N2 category.
Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu malignant pleural mesothelioma staging: