Pleura
Mesothelial tumors
Mesothelioma staging

Author: Vaidehi Avadhani, M.D. (see Authors page)

Revised: 23 March 2018, last major update January 2014

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Mesothelioma staging pleura[TIAB]

Cite this page: Avadhani, V. Mesothelioma staging. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/pleurastaging.html. Accessed July 21st, 2018.
Definition / general
  • Multiple staging systems have been used for malignant mesothelioma
    • Butchart scheme proposed in 1976
    • Brigham and Women's Hospital Thoracic Oncology Group system
    • International Mesothelioma Interest Group system
      • AJCC and the International Union Against Cancer have adopted this system
      • Recommended by College of American Pathologists
Pathological staging - primary tumor (pT)
  • pTX: Primary tumor cannot be assessed
  • pT0: No evidence of primary tumor
  • pT1a: Tumor limited to ipsilateral parietal pleura with or without mediastinal or diaphragmatic pleural involvement
    • No involvement of the visceral pleura
  • pT1b: Tumor involves ipsilateral parietal pleura with or without mediastinal or diaphragmatic pleural involvement
    • Tumor also involving the visceral pleura
  • pT2: Tumor involves each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic and visceral pleura) with at least 1 of the following features:
    • Involvement of diaphragmatic muscle
    • Extension of tumor from visceral pleura into the underlying pulmonary parenchyma
  • pT3: Locally advanced but potentially resectable tumor that involves all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic and visceral pleura), with at least 1 of the following features:
    • Involvement of the endothoracic fascia
    • Extension into mediastinal fat
    • Solitary completely resectable focus of tumor extending into the soft tissues of the chest wall
    • Nontransmural involvement of the pericardium
  • pT4: Locally advanced technically unresectable tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic and visceral pleura), with at least 1 of the following features:
    • Diffuse extension or multifocal masses of tumor in the chest wall with or without associated rib destruction
    • Direct transdiaphragmatic extension to the peritoneum
    • Direct extension to the contralateral pleura
    • Direct extension to mediastinal organs
    • Direct extension into the spine
    • Extension through the internal surface of the pericardium with or without a pericardial effusion
    • Tumor involving the myocardium
Regional lymph nodes (pN)
  • pNX: Regional lymph nodes cannot be assessed
  • pN0: No regional lymph node metastases
  • pN1: Metastases in the ipsilateral bronchopulmonary or hilar lymph nodes
  • pN2: Metastases in the subcarinal or the ipsilateral mediastinal lymph nodes, including the ipsilateral internal mammary and peridiaphragmatic nodes
  • pN3: Metastases in the contralateral mediastinal, contralateral internal mammary, ipsilateral or contralateral supraclavicular lymph nodes
Distant metastasis (pM)
  • pM1: Distant metastasis
Anatomic stage

Stage I T1 N0 M0
Stage IA T1a N0 M0
Stage IB T1b N0 M0
Stage II T2 N0 M0
Stage III T1, T2 N1 M0
T1, T2 N2 M0
T3 N0, N1, N2 M0
Stage IV T4 Any N M0
Any T N3 M0
Any T Any N M1

Additional references