lunes, 8 de abril de 2019

Breast Cancer Treatment (PDQ®) 2/5 —Health Professional Version - National Cancer Institute

Breast Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute

National Cancer Institute



Breast Cancer Treatment (PDQ®)–Health Professional Version

Histopathologic Classification of Breast Cancer

Table 1 describes the histologic classification of breast cancer based on tumor location.[1] Infiltrating or invasive ductal cancer is the most common breast cancer histologic type and comprises 70% to 80% of all cases.
Table 1. Tumor Location and Related Histologic Subtype
Tumor LocationHistologic Subtype
NOS = not otherwise specified.
Carcinoma, NOS 
DuctalIntraductal (in situ)
Invasive with predominant component
Invasive, NOS
Comedo
Inflammatory
Medullary with lymphocytic infiltrate
Mucinous (colloid)
Papillary
Scirrhous
Tubular
Other
LobularInvasive with predominant in situ component
Invasive [2]
NipplePaget disease, NOS
Paget disease with intraductal carcinoma
Paget disease with invasive ductal carcinoma
OtherUndifferentiated carcinoma
Metaplastic
The following tumor subtypes occur in the breast but are not considered typical breast cancers:
  • Phyllodes tumor.[3,4]
  • Angiosarcoma.
  • Primary lymphoma.
References
  1. Breast. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 347-76.
  2. Yeatman TJ, Cantor AB, Smith TJ, et al.: Tumor biology of infiltrating lobular carcinoma. Implications for management. Ann Surg 222 (4): 549-59; discussion 559-61, 1995. [PUBMED Abstract]
  3. Chaney AW, Pollack A, McNeese MD, et al.: Primary treatment of cystosarcoma phyllodes of the breast. Cancer 89 (7): 1502-11, 2000. [PUBMED Abstract]
  4. Carter BA, Page DL: Phyllodes tumor of the breast: local recurrence versus metastatic capacity. Hum Pathol 35 (9): 1051-2, 2004. [PUBMED Abstract]

Stage Information for Breast Cancer

The American Joint Committee on Cancer (AJCC) staging system provides a strategy for grouping patients with respect to prognosis. Therapeutic decisions are formulated in part according to staging categories but also according to other clinical factors such as the following, some of which are included in the determination of stage:
  • Tumor size.
  • Lymph node status.
  • Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
  • Human epidermal growth factor receptor 2 (HER2/neu) status in the tumor.
  • Tumor grade.
  • Menopausal status.
  • General health of the patient.
The standards used to define biomarker status are described as follows:
  • Estrogen receptor (ER) expression: ER expression is measured primarily by immunohistochemistry (IHC). Any staining of 1% of cells or more is considered positive for ER.[1]
  • Progesterone receptor (PR) expression: PR expression is measured primarily by IHC. Any staining of 1% of cells or more is considered positive for PR.
  • HER2 expression: HER2 is measured primarily by either IHC to assess expression of the HER2 protein or by in situ hybridization (ISH) to assess gene copy number. The American Society of Clinical Oncology/College of American Pathologists consensus panel has published guidelines for cases when either IHC or ISH testing is equivocal.[2]
    IHC:
    • Negative: 0 or 1+ staining
    • Equivocal: 2+ staining
    • Positive: 3+ staining
    ISH (dual probe):
    • Possible negative results:
      • HER2/chromosome enumeration probe (CEP17) ratio <2.0 AND HER2 copy number <4
    • Possible equivocal results: (requires performing alternative ISH test to confirm equivocal or IHC if not previously performed)
      • HER2/CEP17 ratio <2.0 AND HER2 copy number ≥4 but <6
    • Possible positive results:
      • HER2/CEP17 ratio ≥2.0 by ISH
      • HER2 copy number ≥6 regardless of ratio by ISH
    ISH (single probe):
    • Negative: <4 HER2 copies
    • Equivocal: ≥4 HER2 copies but <6 HER2 copies
    • Positive: ≥6 HER2 copies

TNM Definitions

The AJCC has designated staging by TNM (tumor, node, metastasis) classification to define breast cancer.[3] The grade of the tumor is determined by its morphologic features, such as tubule formation, nuclear pleomorphism, and mitotic count.
Table 2. Definition of Primary Tumor (T) – Clinical and Pathologicala
T CategoryT Criteria
DCIS = ductal carcinoma in situ.
aReprinted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
bLobular carcinoma in situ is a benign entity and is removed from TNM staging in the AJCC Cancer Staging Manual, 8th ed.
cRules 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. The documented prognostic impact of postneoadjuvant extent of disease and response to therapy warrant clear definitions of the use of the yp prefix and response to therapy. The use of neoadjuvant therapy does not change the clinical (pretreatment) stage. As per TNM rules, the anatomic component of clinical stage is identified with the prefix c (e.g., cT). In addition, clinical staging can include the use of fine-needle aspiration (FNA) or core-needle biopsy and sentinel lymph node biopsy before neoadjuvant therapy. These are denoted with the postscripts and sn, respectively. Nodal metastases confirmed by FNA or core-needle biopsy are classified as macrometastases (cN1), regardless of the size of the tumor focus in the final pathological specimen. For example, if, prior to neoadjuvant systemic therapy, a patient with a 1 cm primary has no palpable nodes but has an ultrasound-guided FNA biopsy of an axillary lymph node that is positive, the patient will be categorized as cN1 (f) for clinical (pretreatment) staging and is assigned to Stage IIA. Likewise, if the patient has a positive axillary sentinel node identified before neoadjuvant systemic therapy, the tumor is categorized as cN1 (sn) (Stage IIA). As per TNM rules, in the absence of pathological T evaluation (removal of the primary tumor), which is identified with prefix p (e.g., pT), microscopic evaluation of nodes before neoadjuvant therapy, even by complete removal such as sentinel node biopsy, is still classified as clinical (cN).
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisbDCIS.
Tis (Paget)Paget disease of the nipple NOT associated with invasive carcinoma and/or DCIS in the underlying breast parenchyma. Carcinomas in the breast parenchyma associated with Paget disease are categorized based on the size and characteristics of the parenchymal disease, although the presence of Paget disease should still be noted.
T1Tumor ≤20 mm in greatest dimension.
–T1miTumor ≤1 mm in greatest dimension.
–T1aTumor >1 mm but ≤5 mm in greatest dimension (round any measurement >1.0–1.9 mm to 2 mm).
–T1bTumor >5 mm but ≤10 mm in greatest dimension.
–T1cTumor >10 mm but ≤20 mm in greatest dimension.
T2Tumor >20 mm but ≤50 mm in greatest dimension.
T3Tumor >50 mm in greatest dimension.
T4Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or macroscopic nodules); invasion of the dermis alone does not qualify as T4.
–T4aExtension to the chest wall; invasion or adherence to pectoralis muscle in the absence of invasion of chest wall structures does not qualify as T4.
–T4bUlceration and/or ipsilateral macroscopic satellite nodules and/or edema (including peau d'orange) of the skin that does not meet the criteria for inflammatory carcinoma.
–T4cBoth T4a and T4b are present.
–T4dInflammatory carcinoma (see Rules for Classificationc).
Table 3. Definition of Regional Lymph Nodes – Clinical (cN)a,b
cN CategorycN Criteria
aReprinted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
b(sn) and (f) suffixes should be added to the N category to denote confirmation of metastasis by sentinel node biopsy or fine-needle aspiration/core needle biopsy, respectively.
cThe cNX category is used sparingly in cases where regional lymph nodes have previously been surgically removed or where there is no documentation of physical examination of the axilla.
dcN1mi is rarely used but may be appropriate in cases where sentinel node biopsy is performed before tumor resection, most likely to occur in cases treated with neoadjuvant therapy.
cNXcRegional lymph nodes cannot be assessed (e.g., previously removed).
cN0No regional lymph node metastases (by imaging or clinical examination).
cN1Metastases to movable ipsilateral Level I, II axillary lymph nodes(s).
–cN1midMicrometastases (approximately 200 cells, >0.2 mm, but ≤2.0 mm).
cN2Metastases in ipsilateral Level I, II axillary lymph nodes that are clinically fixed or matted;
or in ipsilateral internal mammary nodes in the absence of axillary lymph node metastases.
–cN2aMetastases in ipsilateral Level I, II axillary lymph nodes fixed to one another (matted) or to other structures.
–cN2bMetastases only in ipsilateral internal mammary nodes in the absence of axillary lymph node metastases.
cN3Metastases in ipsilateral infraclavicular (Level Ill axillary) lymph node(s) with or without Level l, II axillary lymph node involvement; or in ipsilateral internal mammary lymph node(s) with Level l, II axillary lymph node metastases; ormetastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement.
–cN3aMetastases in ipsilateral infraclavicular lymph node(s).
–cN3bMetastases in ipsilateral internal mammary lymph node(s) and axillary lymph node(s).
–cN3cMetastases in ipsilateral supraclavicular lymph node(s).
Table 4. Definition of Regional Lymph Nodes – Pathological (pN)a,b
pN CategorypN Criteria
ITCs = isolated tumor cells; RT-PCR = reverse transcriptase-polymerase chain reaction.
aReprinted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
b(sn) and (f) suffixes should be added to the N category to denote confirmation of metastasis by sentinel node biopsy or fine-needle aspiration/core needle biopsy, respectively, with NO further resection of nodes.
pNXRegional lymph nodes cannot be assessed (e.g., not removed for pathological study or previously removed).
pN0No regional lymph node metastasis identified or ITCs only.
–pN0(i+)ITCs only (malignant cell clusters ≤0.2 mm) in regional lymph node(s).
–pN0(mol+)Positive molecular findings by RT-PCR; no ITCs detected.
pN1Micrometastases; or metastases in 1–3 axillary lymph nodes; and/or clinically negative internal mammary nodes with micrometastases or macrometastases by sentinel lymph node biopsy.
–pN1miMicrometastases (~200 cells, >0.2 mm, but ≤2.0 mm).
–pN1aMetastases in 1–3 axillary lymph nodes, at least one metastasis >2.0 mm.
–pN1bMetastases in ipsilateral internal mammary sentinel nodes, excluding ITCs.
–pN1cpN1a and pN1b combined.
pN2Metastases in 4–9 axillary lymph nodes; or positive ipsilateral internal mammary lymph nodes by imaging in the absence of axillary lymph node metastases.
–pN2aMetastases in 4–9 axillary lymph nodes (at least 1 tumor deposit >2.0 mm).
–pN2bMetastases in clinically detected internal mammary lymph nodes with or without microscopic confirmation; with pathologically negative axillary nodes.
pN3Metastases in ≥10 axillary lymph nodes; or in infraclavicular (Level Ill axillary) lymph nodes; or positive ipsilateral internal mammary lymph nodes by imaging in the presence of one or more positive Level l, II axillary lymph nodes; or in >3 axillary lymph nodes and micrometastases or macrometastases by sentinel lymph node biopsy in clinically negative ipsilateral internal mammary lymph nodes; or in ipsilateral supraclavicular lymph nodes.
–pN3aMetastases in ≥10 axillary lymph nodes (at least 1 tumor deposit >2.0 mm); ormetastases to the infraclavicular (Level III axillary lymph) nodes.
–pN3bpN1a or pN2a in the presence of cN2b (positive internal mammary nodes by imaging);
or pN2a in the presence of pN1b.
–pN3cMetastases in ipsilateral supraclavicular lymph nodes.
Table 5. Definition of Distant Metastasis (M)a
M CategoryM Criteria
aReprinted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
bNote that imaging studies are not required to assign the cM0 category.
M0No clinical or radiographic evidence of distant metastases.b
cM0(i+)No clinical or radiographic evidence of distant metastases in the presence of tumor cells or deposits ≤0.2 mm detected microscopically or by molecular techniques in circulating blood, bone marrow, or other nonregional nodal tissue in a patient without symptoms or signs of metastases.
cM1Distant metastases detected by clinical and radiographic means.
pM1Any histologically proven metastases in distant organs; or if in nonregional nodes, metastases >0.2 mm.
Table 6. Definition of Histologic Grade (G)a
GG Definition
SBR = Scarff-Bloom-Richardson grading system, Nottingham Modification.
aReprinted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
GXGrade cannot be assessed.
G1Low combined histologic grade (favorable), SBR score of 3–5 points.
G2Intermediate combined histologic grade (moderately favorable); SBR score of 6–7 points.
G3High combined histologic grade (unfavorable); SBR score of 8–9 points.
Table 7. Ductal Carcinoma in situ: Nuclear Gradea
GG Definition
aReprinted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
GXGrade cannot be assessed.
G1Low nuclear grade.
G2Intermediate nuclear grade.
G3High nuclear grade.

AJCC Anatomic and Prognostic Stage Groups

There are three stage group tables for invasive cancer:[3]
  • Anatomic Stage Group. The Anatomic Stage Group table is used in regions of the world where tumor grading and/or biomarker testing for ER, PR, and HER2 are not routinely available. (Refer to Table 8.)
  • Clinical Prognostic Stage Group. The Clinical Prognostic Stage Group table is used for all patients in the United States. Patients who have neoadjuvant therapy as their initial treatment should have the clinical prognostic stage and the observed degree of response to treatment recorded, but these patients are not assigned a pathological prognostic stage. (Refer to Table 9.)
  • Pathological Prognostic Stage Group. The Pathological Prognostic Stage Group table is used for all patients in the United States who have surgery as initial treatment and have pathological T and N information reported. (Refer to Table 10.)
In the United States, cancer registries and clinicians must use the Clinical and Pathological Prognostic Stage Group tables for reporting. It is expected that testing is performed for grade, HER2, ER, and PR status and that results are reported for all cases of invasive cancer in the United States.
AJCC Anatomic Stage Groups
Table 8. Definition of Anatomic Stage Groupsa
StageTNM
T = primary tumor; N = regional lymph node; M = distant metastasis.
aAdapted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
Notes:
1. T1 includes T1mi.
2. T0 and T1 tumors with nodal micrometastases (N1mi) are staged as Stage IB.
3. T2, T3, and T4 tumors with nodal micrometastases (N1mi) are staged using the N1 category.
4. M0 includes M0(i+).
5. The designation pM0 is not valid; any M0 is clinical.
6. If a patient presents with M1 disease before receiving neoadjuvant systemic therapy, the stage is Stage IV and remains Stage IV regardless of response to neoadjuvant therapy.
7. Stage designation may be changed if postsurgical imaging studies reveal the presence of distant metastases, provided the studies are performed within 4 months of diagnosis in the absence of disease progression, and provided the patient has not received neoadjuvant therapy.
8. Staging following neoadjuvant therapy is denoted with a yc or ypn prefix to the T and N classification. There is no anatomic stage group assigned if there is a complete pathological response (pCR) to neoadjuvant therapy, for example, ypT0, ypN0, cM0.
0Tis, N0, M0
IAT1, N0, M0
IBT0, N1mi, M0
T1, N1mi, M0
IIAT0, N1, M0
T1, N1, M0
T2, N0, M0
IIBT2, N1, M0
T3, N0, M0
IIIAT0, N2, M0
T1, N2, M0
T2, N2, M0
T3, N1, M0
T3, N2, M0
IIIBT4, N0, M0
T4, N1, M0
T4, N2, M0
IIICAny T (Tis, T1, T0, T2, T3, T4; N3, M0)
IVAny T (Tis, T1, T0, T2, T3, T4; Any N = N0, N1mi, N1, N2, N3, M1)
AJCC Prognostic Stage Groups
The Clinical Prognostic Stage is used for clinical classification and staging of patients in the United States with invasive breast cancer. It uses TNM information based on the patient’s history, physical examination, imaging results (not required for clinical staging), and biopsies.
Table 9. Definition of Clinical Prognostic Stage Groupsa
TNMGradeHER2 StatusER StatusPR StatusStage Group
T = primary tumor; N = regional lymph node; M = distant metastasis.
aAdapted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
bT1 includes T1mi.
cN1 does not include N1mi. T1, N1mi, M0, and T0, N1mi, M0 cancers are included for prognostic staging with T1, N0, M0 cancers of the same prognostic factor status.
dN1 includes N1mi. T2, T3, and T4 cancers and N1mi are included for prognostic staging with T2, N1; T3, N1; and T4, N1, respectively.
Notes:
1. Because N1mi categorization requires evaluation of the entire node, and cannot be assigned on the basis of an fine-needle aspiration or core biopsy, N1mi can only be used with Clinical Prognostic Staging when clinical staging is based on a resected lymph node in the absence of resection of the primary cancer, such as in the situation where sentinel node biopsy is performed before receiving neoadjuvant chemotherapy or endocrine therapy.
2. For cases with lymph node involvement with no evidence of primary tumor (e.g., T0, N1, etc.) or with breast ductal carcinoma in situ (e.g.,Tis, N1, etc.), the grade, human epidermal growth factor receptor 2 (HER2), estrogen receptor, and progesterone receptor information from the tumor in the lymph node should be used for assigning stage group.
3. For cases where HER2 is determined to be equivocal by in situ hybridization (fluorescence in situ hybridization or chromogenic in situ hybridization) testing under the 2013 American Society of Clinical Oncologists/College of American Pathologists HER2 testing guidelines, the HER2-negative category should be used for staging in the Pathological Prognostic Stage Group table.[4,5]
4. The prognostic value of these Prognostic Stage Groups is based on populations of persons with breast cancer that have been offered and mostly treated with appropriate endocrine and/or systemic chemotherapy (including anti–HER2 therapy).
Tis, N0, M0Any (refer to Table 6 and Table 7)AnyAnyAny0
T1b, N0, M0G1PositivePositivePositiveIA
NegativeIA
T0, N1mi, M0NegativePositiveIA
NegativeIA
T1b, N1mi, M0NegativePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIB
G2PositivePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIA
NegativePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIB
G3PositivePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIA
NegativePositivePositiveIA
NegativeIB
NegativePositiveIB
NegativeIB
T0, N1c, M0; T1b, N1c, M0; T2, N0, M0G1PositivePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIA
NegativePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIA
G2PositivePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIA
NegativePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIB
G3PositivePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIA
NegativePositivePositiveIIA
NegativeIIB
NegativePositiveIIB
NegativeIIB
T2, N1d, M0; T3, N0, M0G1PositivePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIB
NegativePositivePositiveIIA
NegativeIIB
NegativePositiveIIB
NegativeIIB
G2PositivePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIB
NegativePositivePositiveIIA
NegativeIIB
NegativePositiveIIB
NegativeIIIB
G3PositivePositivePositiveIB
NegativeIIB
NegativePositiveIIB
NegativeIIB
NegativePositivePositiveIIB
NegativeIIIA
NegativePositiveIIIA
NegativeIIIB
T0, N2, M0; T1b, N2, M0; T2, N2, M0; T3, N1d, M0; T3, N2, M0G1PositivePositivePositiveIIA
NegativeIIIA
NegativePositiveIIIA
NegativeIIIA
NegativePositivePositiveIIA
NegativeIIIA
NegativePositiveIIIA
NegativeIIIB
G2PositivePositivePositiveIIA
NegativeIIIA
NegativePositiveIIIA
NegativeIIIA
NegativePositivePositiveIIA
NegativeIIIA
NegativePositiveIIIA
NegativeIIIB
G3PositivePositivePositiveIIB
NegativeIIIA
NegativePositiveIIIA
NegativeIIIA
NegativePositivePositiveIIIA
NegativeIIIB
NegativePositiveIIIB
NegativeIIIC
T4, N0, M0; T4, N1d, M0; T4, N2, M0; Any T, N3, M0G1PositivePositivePositiveIIIA
NegativeIIIB
NegativePositiveIIIB
NegativeIIIB
NegativePositivePositiveIIIB
NegativeIIIB
NegativePositiveIIIB
NegativeIIIC
G2PositivePositivePositiveIIIA
NegativeIIIB
NegativePositiveIIIB
NegativeIIIB
NegativePositivePositiveIIIB
NegativeIIIB
NegativePositiveIIIB
NegativeIIIC
G3PositivePositivePositiveIIIB
NegativeIIIB
NegativePositiveIIIB
NegativeIIIB
NegativePositivePositiveIIIB
NegativeIIIC
NegativePositiveIIIC
NegativeIIIC
Any T, Any N, M1Any (refer to Table 6 and Table 7)AnyAnyAnyIV

AJCC Pathological Prognostic Stage Groups

The Pathological Prognostic Stage applies to patients with invasive breast cancer initially treated with surgery. It includes all information used for clinical staging, surgical findings, and pathological findings following surgery to remove the tumor. Pathological Prognostic Stage is not used for patients treated with neoadjuvant therapy before surgery to remove the tumor.[3]
Table 10. Definition of Pathological Prognostic Stage Groupsa
TNMGradeHER2 StatusER StatusPR StatusStage Group
T = primary tumor; N = regional lymph node; M = distant metastasis.
aAdapted with permission from AJCC: Breast, revised version. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 4–96.
bT1 includes T1mi.
cN1 does not include N1mi. T1, N1mi, M0 and T0, N1mi, M0 cancers are included for prognostic staging with T1, N0, M0 cancers of the same prognostic factor status.
dN1 includes N1mi. T2, T3, and T4 cancers and N1mi are included for prognostic staging with T2, N1; T3, N1; and T4, N1, respectively.
Notes:
1. For cases with lymph node involvement with no evidence of primary tumor (e.g., T0, N1, etc.) or with breast ductal carcinoma in situ (e.g.,Tis, N1, etc.), the grade, human epidermal growth factor receptor 2 (HER2), estrogen receptor, and progesterone receptor information from the tumor in the lymph node should be used for assigning stage group.
2. For cases where HER2 is determined to be equivocal by in situ hybridization (fluorescence in situ hybridization or chromogenic in situ hybridization) testing under the 2013 American Society of Clinical Oncologists/College of American Pathologists HER2 testing guidelines, the HER2-negative category should be used for staging in the Pathological Prognostic Stage Group table.[4,5]
3. The prognostic value of these Prognostic Stage Groups is based on populations of persons with breast cancer that have been offered and mostly treated with appropriate endocrine and/or systemic chemotherapy (including anti–HER2 therapy).
Tis, N0, M0Any (refer to Table 6 and Table 7)AnyAnyAny0
T1b, N0, M0; T0, N1mi, M0; T1b, N1mi, M0G1PositivePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIA
NegativePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIA
G2PositivePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIA
NegativePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIB
G3PositivePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIA
NegativePositivePositiveIA
NegativeIA
NegativePositiveIA
NegativeIB
T0, N1, M0; T1b, N1c, M0; T2, N0, M0G1PositivePositivePositiveIA
NegativeIB
NegativePositiveIB
NegativeIIA
NegativePositivePositiveIA
NegativeIB
NegativePositiveIB
NegativeIIA
G2PositivePositivePositiveIA
NegativeIB
NegativePositiveIB
NegativeIIA
NegativePositivePositiveIA
NegativeIIA
NegativePositiveIIA
NegativeIIA
G3PositivePositivePositiveIA
NegativeIIA
NegativePositiveIIA
NegativeIIA
NegativePositivePositiveIB
NegativeIIA
NegativePositiveIIA
NegativeIIA
T2, N1c, M0; T3, N0, M0G1PositivePositivePositiveIA
NegativeIIB
NegativePositiveIIB
NegativeIIB
NegativePositivePositiveIA
NegativeIIB
NegativePositiveIIB
NegativeIIB
G2PositivePositivePositiveIB
NegativeIIB
NegativePositiveIIB
NegativeIIB
NegativePositivePositiveIB
NegativeIIB
NegativePositiveIIB
NegativeIIB
G3PositivePositivePositiveIB
NegativeIIB
NegativePositiveIIB
NegativeIIB
NegativePositivePositiveIIA
NegativeIIB
NegativePositiveIIB
NegativeIIIA
T0, N2, M0; T1b, N2, M0; T2, N2, M0, T3, N1d, M0; T3, N2, M0G1PositivePositivePositiveIB
NegativeIIIA
NegativePositiveIIIA
NegativeIIIA
NegativePositivePositiveIB
NegativeIIIA
NegativePositiveIIIA
NegativeIIIA
G2PositivePositivePositiveIB
NegativeIIIA
NegativePositiveIIIA
NegativeIIIA
NegativePositivePositiveIB
NegativeIIIA
NegativePositiveIIIA
NegativeIIIB
G3PositivePositivePositiveIIA
NegativeIIIA
NegativePositiveIIIA
NegativeIIIA
NegativePositivePositiveIIB
NegativeIIIA
NegativePositiveIIIA
NegativeIIIC
T4, N0, M0; T4, N1d, M0; T4, N2, M0; Any T, N3, M0G1PositivePositivePositiveIIIA
NegativeIIIB
NegativePositiveIIIB
NegativeIIIB
NegativePositivePositiveIIIA
NegativeIIIB
NegativePositiveIIIB
NegativeIIIB
G2PositivePositivePositiveIIIA
NegativeIIIB
NegativePositiveIIIB
NegativeIIIB
NegativePositivePositiveIIIA
NegativeIIIB
NegativePositiveIIIB
NegativeIIIC
G3PositivePositivePositiveIIIB
NegativeIIIB
NegativePositiveIIIB
NegativeIIIB
NegativePositivePositiveIIIB
NegativeIIIC
NegativePositiveIIIC
NegativeIIIC
Any T, Any N, M1Any (refer to Table 6 and Table 7)AnyAnyAnyIV
References
  1. Barnes DM, Harris WH, Smith P, et al.: Immunohistochemical determination of oestrogen receptor: comparison of different methods of assessment of staining and correlation with clinical outcome of breast cancer patients. Br J Cancer 74 (9): 1445-51, 1996. [PUBMED Abstract]
  2. Wolff AC, Hammond MEH, Allison KH, et al.: Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol 36 (20): 2105-2122, 2018. [PUBMED Abstract]
  3. Breast. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 589–628.
  4. Wolff AC, Hammond ME, Hicks DG, et al.: Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 31 (31): 3997-4013, 2013. [PUBMED Abstract]
  5. Wolff AC, Hammond ME, Hicks DG, et al.: Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. Arch Pathol Lab Med 138 (2): 241-56, 2014. [PUBMED Abstract]

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