Nasal cavity, paranasal sinuses, nasopharynx
Miscellaneous
TNM staging - nasal cavity and paranasal sinuses

Author: Nat Pernick, M.D. (see Authors page)

Revised: 25 May 2018, last major update November 2004

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: TNM staging nasal cavity and paranasal sinuses

Cite this page: Pernick, N. TNM staging - nasal cavity and paranasal sinuses. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/nasalTNM.html. Accessed October 17th, 2018.
Definition / general
  • Excludes nonepithelial tumors (lymphoma, soft tissue, bone, cartilage)
  • Pathologic staging is required for nodal (pN) assessment; for T assessment, pT supplements but does not replace clinical assessment
  • Ohngren line: connects medial canthus of eye to angle of mandible; used to divide maxillary sinus into anteroinferior portion (infrastructure), associated with good prognosis for carcinomas and superoposterior portion (suprastructure), with a poor prognosis
Primary tumor (T) - nasal cavity and paranasal sinuses
  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
Primary tumor (T) - maxillary sinus
  • T1: Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone
  • T2: Tumor causing bone erosion or destruction including extension into the hard palate or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates
  • T3: Tumor invades any of the following: bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses
  • T4a: Moderately advanced local disease; tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses
  • T4b: Very advanced local disease; tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx or clivus
Primary tumor (T) - nasal cavity and ethmoid sinus
  • T1: Tumor restricted to any one subsite (see below), with or without bony invasion
  • T2: Tumor invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion
  • T3: Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate or cribriform plate
  • T4a: Moderately advanced local disease; tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses
  • T4b: Very advanced local disease; tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx or clivus

  • Notes: Subsites are left and right maxillary sinus; septum, floor, lateral wall and vestibule (edge of naris to mucocutaneous junction) of nasal cavity; left and right ethmoid sinus
Regional lymph nodes (N) - nasal cavity and paranasal sinuses
  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
  • N2: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N2a: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
  • N2b: Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
  • N2c: Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N3: Metastasis in a lymph node, more than 6 cm in greatest dimension

  • Notes:
    • Selective neck dissection ordinarily includes 6 or more lymph nodes
    • Radical or modified radical neck dissection ordinarily includes 10 or more lymph nodes
    • Negative pathologic examination of fewer than the 6 - 10 nodes above still mandates a pN0 designation
    • Survival is significantly worse when metastases involve lymph nodes beyond the first echelon of lymphatic drainage, particularly lymph nodes in levels IV and V; thus, the region of nodal involvement should also be reported
    • Midline nodes are considered ipsilateral

  • Level I: Submental, submandibular; contains the submental and submandibular triangles bounded by the anterior and posterior bellies of the digastric muscle and by the hyoid bone inferiorly and the body of the mandible superiorly
  • Level II: Upper jugular; contains the upper jugular lymph nodes and extends from the level of the skull base superiorly to the hyoid bone inferiorly
  • Level III: Midjugular; contains the middle jugular lymph nodes from the hyoid bone superiorly to the level of the lower border of the cricoid cartilage inferiorly
  • Level IV: Lower jugular; contains the lower jugular lymph nodes from the level of the cricoid cartilage superiorly to the clavicle inferiorly
  • Level V: Posterior triangle; contains the lymph nodes in the posterior triangle bounded by the anterior border of the trapezius muscle posteriorly, the posterior border of the sternocleidomastoid muscle anteriorly and the clavicle inferiorly; for description purposes, level V may be further subdivided into upper, middle and lower levels corresponding to the superior and inferior planes that define levels II, III and IV
  • Level VI: Prelaryngeal, pretracheal, paratracheal; contains the lymph nodes of the anterior central compartment from the hyoid bone superiorly to the suprasternal notch inferiorly; on each side, the lateral boundary is formed by the medial border of the carotid sheath
  • Level VII: Upper mediastinal; contains the lymph nodes inferior to the suprasternal notch in the superior mediastinum
Distant metastasis (M) - nasal cavity and paranasal sinuses
  • M0: No distant metastasis
  • M1: Distant metastasis
Anatomic stage / prognostic groups - nasal cavity and paranasal sinuses
  • 0: Tis N0 M0
  • I: T1 N0 M0
  • II: T2 N0 M0
  • III: T3 N0 M0 or T1 - 3 N1 M0
  • IVA: T4a N0 - 1 M0 or T1 - 4a N2 M0
  • IVB: T4b any N M0 or any T N3 M0
  • IVC: Any T any N M1