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1、AJCCStagingMomentsAJCCTNMStaging7thEditionBreastCase#2Contributors:StephenB.Edge,MDRoswellParkCancerInstitute,Buffalo,NewYorkDavidR.Byrd,MDUniversityofWashingtonMedicalCenter,Seattle,WashingtonDavidJ.Winchester,MDNorthShoreUniversityEvanstonHospital,Evanston,IllinoisDavidP.Win
2、chester,MDNorthShoreUniversityEvanstonHospital,Evanston,IllinoisBreastCase#2 PresentationofNewCaseNewlydiagnosedbreastcancerpatientPresentationatCancerConferencefortreatmentrecommendationsandclinicalstagingBreastCase#2 History&Physical62yroldwomannoticedanon-tendermassintheupp
3、erouterquadrant(UOQ)oftheleftbreastFamilyhx-breastcainmaternalauntatage70Physicalexaminationrevealsafirm,mobile,4cmmassintheUOQwithnooverlyingskinchangesandnopalpableadenopathyBreastCase#2 ImagingResultsMammogram-3.9cmdensityUOQ leftbreast,rightbreastnegativeUltrasoundbreast-3
4、.8cmhypoechoicareaUOQleft breast,leftaxillarynodes negative,rightbreast negativeUsedwithpermissionBreastCase#2 DiagnosticProcedureProcedureUltrasound-guidedcoreneedlebiopsyUOQleftbreastPathologyReportInfiltratingductcarcinomaBloom-Scarff-Richardson(BSR)Grade3Estrogenreceptorpo
5、sitiveProgesteronereceptorpositiveHER2negativebyIHCBreastCase#2 ClinicalStagingClinicalstagingUsesinformationfromthephysicalexam,imaging,anddiagnosticbiopsyPurposeSelectappropriatetreatmentEstimateprognosisBreastCase#2 ClinicalStagingSynopsis-patientwith3.9cmmass,infiltratingd
6、uctca,axillaisnegativeonexamandimagingWhatistheclinicalstage?T____N____M____StageGroup______BreastCase#2 ClinicalStagingClinicalStagecorrectanswerT2N0M0StageGroupIIABasedonstage,treatmentisselectedReviewNCCNtreatmentguidelinesforthisstageBreastCase#2 ClinicalStagingRationalefo
7、rstagingchoicesT2for3.9cmprimarytumorN0becausenodeswereclinicallynegativeonphysicalexamandimagingM0becausetherewasnothingtosuggestdistantmetastases;iftherewas,appropriatetestswouldbeperformedbeforedevelopingatreatmentplanPrognosticFactors ClinicallySignificantApplicabletothisc
8、asePaget’sdisease:noBSR:Grade3Estrogenreceptor:positiveProges
