Changes and Problematic Areas in Interpretation of the AJCC Cancer Staging Manual, 6th Edition, for Breast Cancer

Abstract

Abstract Context.—Tumor stage is an important prognostic factor and guides therapy for patients with breast cancer. The American Joint Committee on Cancer (AJCC) periodically updates the staging standards. This article describes changes and problematic areas in interpretation of the AJCC Cancer Staging Manual, 6th edition, for breast cancer and provides practical advice. Objectives.—This article reviews the variety of practical problems that can arise during assessment of the pathologic stage and other prognostic/predictive factors included in the College of American Pathologists Checklist for Evaluation of Resected Breast Cancers. Potential practical difficulties that can arise include the classification of lymph nodes, for example, isolated tumor cells, micrometastases, metastases, and the combination of locations. Another difficult area is assignment of a correct size. The use of clinical and imaging studies for optimal pathologic staging is discussed. Finally, the proper use of the TNM descriptors is described. Conclusions.—The various practical problems that can arise during the assessment of important prognostic and predictive features included in the College of American Pathologists Checklist for Evaluation of Resected Breast Cancers are discussed, and specific recommendations are given.