Breast Staging

Question 1

How to handle micrometastases in sentinel lymph nodes

Answer 1

1. The cutoff is 2mm
2. If there was neoadjuvant therapy, there are no micrometastases – all must be counted towards N staging
3. If there is a single macrometastasis, all micrometastases count towards N staging
4. If there are only micrometastases, no matter how many there are, and the patient did not receive neoadjuvant therapy, the N stage is N1mic

Question 2

T staging

Answer 2

pTis: Ductal carcinoma in situ
pT1mi: Microinvasive carcinoma (all foci less than or equal to 0.1 cm)
pT1: A carcinoma greater than 0.1 to 2.0 cm in greatest dimension
pT2: A carcinoma greater than 2.0 to 5.0 cm in greatest dimension
pT3: A carcinoma greater than 5.0 cm in greatest dimension
pT4: A carcinoma of any size with direct extension to the chest wall or skin (ulceration or skin nodules)

Question 3

In the presence of two or more nodules, . . .

Answer 3

In the presence of two or more nodules, use the largest dimension of the largest nodule to determine the T-stage.

Question 4

How to handle scattered single cells (like lobular) in a sentinel lymph node

Answer 4

Isolated tumor cells: Foci less than 0.2 mm in greatest dimension and/or fewer than 200 carcinoma cells in one tissue section

Micrometastasis: Deposits between 0.2 mm and 0.2 cm in greatest dimension and/or greater than 200 carcinoma cells in one tissue section