Pleura > Mesothelioma

TNM Staging of Malignant Mesothelioma:

(From: AJR 1999; Heelan RT, et al. Staging of malignant pleural mesothelioma: Comparison of CT and MR imaging. 172: 1039-1047 and Radiographics 2004; Wang ZF, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. 24: 105-119)

Stage:

Stage I:

Ia: T1aN0M0
Ib: T1bN0Mo

Stage II:

T2N0M0

Stage III:

T3 Any N M0
N1 or N2 Any T M0

Stage IV:

Any T4
Any N3
Any M1

T Stage: Size/extent of primary tumor

T1:

T1a: Tumor limited to the ipsilateral parietal pleura, including mediastinal and diaphragmatic pleura, but no visceral pleural involvement
T1b: Tumor involving the ipsilateral parietal pleura, including mediastinal and diaphragmatic pleura, with scattered foci of tumor also involving the visceral pleura

T2:

Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral) with at least one of the following features:

- Involvement of diaphragmatic muscle
- Confluent visceral pleural tumor (including the fissures) or extension of tumor from the visceral pleura into the underlying pulmonary parenchyma

T3:

Locally advanced but potentially resectable tumor that involves all the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral) with at least one of the following features:

- Involvement of the endothoracic fascia
- Extension into the mediastinal fat
- Non-transmural involvement of the pericardium

- A solitary completely resectable focus of tumor that extends into the soft tissues of the chest wall

T4:

Locally advanced technically unresectable tumor that involves all the ipsilateral pleural surfaces with at least one of the following features:

- Diffuse extension or multifocal massess of tumor in the chest wall, with or without associated rib destruction
- Direct transdiaphragmatic extension of tumor to the peritoneum
- Direct extension of tumor to the contralateral pleura
- Direct extension of tumor to one or more mediastinal organs
- Direct extension of tumor into the spine
- Tumor extending through to the internal surface of the pericardium with or without pericardial effusion or involving the myocardium

N Stage: Presence of regional nodal disease

N0: No regional node metastases
N1: Mets to the ipsilateral bronchopulmonary or hilar lymph nodes
N2: Mets to the subcarinal or ipsilateral mediastinal nodes, including ipsilateral internal mammary nodes
N3: Mets to the contralateral mediastinal, contralateral internal mammary, or ipsilateral/contralateral supraclavicular nodes

M Stage: Presence of distant metastases

M0: No distant mets
M1: Distant mets present