Essai de classification clinique tnm dans le cancer du sein

TNM classification in cancer of the breast The TNM classification for breast cancer has been used at the Institut Gustave Roussy (I.G.R.) since 1960 following the recommendations of the International Union Against Cancer. It has been possible to stage nearly all cases (93%) and on preliminary experience the classification has been satisfactory. It is essential that the staging be carried out when the patient is first seen and not made retrospectively. The groups obtained are quite homogeneous but vary in size. The signs which appear to have been most important in determining the stage of a tumor are size, adherence to skin or pectoral muscle. If patients presenting with distant metastases and those retrospectively staged are excluded, the number of T1 cases is small (2%) in comparison with T2 (33%) and T3 (37%). The 3‐year survival rate assessed on 199 patients staged according to the TNM classification underlines the advantages of the classification: T1, 100%, T2, 81%; T3, 68%; T4, 58%; N0 + N1, 78%; N2 + N3, 46%; M0, 70%; M1, 19%. Means of improving distribution between the various groups and homogeneity within each group are reviewed. Additional information is needed in certain cases, for example, the method of measuring the tumour, assessment of pectoral adherence, whether or not it was provoked by muscle contraction. The definition of adenopathy “fixed en bloc” and its eventual replacement by other criteria, the classification of multiple tumours in one breast or cases apparently bilateral at onset and finally details of extension “beyond the tumour” or “beyond the mammary region”. Thus in spite of its deficiences we have found the TNM classification of breast cancer to be a useful tool and will continue to use it. We feel however that it should be periodically reviewed and adjusted in the light of fresh experience.