Breast carcinoma TNM pathologic prognostic stage groups AJCC UICC 8th edition

When TNM is...	And grade is...	And HER2 status is...	And ER status is...	And PR status is...	Then the pathological prognostic stage group is...
Tis N0 M0	Any	Any	Any	Any	0
T1* N0 M0 T0 N1mi M0 T1* N1mi M0	G1	Positive	Positive	Positive	IA
				Negative	IA
			Negative	Positive	IA
				Negative	IA
		Negative	Positive	Positive	IA
				Negative	IA
			Negative	Positive	IA
				Negative	IA
T1* N0 M0 T0 N1mi M0 T1* N1mi M0	G2	Positive	Positive	Positive	IA
				Negative	IA
			Negative	Positive	IA
				Negative	IA
		Negative	Positive	Positive	IA
				Negative	IA
			Negative	Positive	IA
				Negative	IB
T1* N0 M0 T0 N1mi M0 T1* N1mi M0	G3	Positive	Positive	Positive	IA
				Negative	IA
			Negative	Positive	IA
				Negative	IA
		Negative	Positive	Positive	IA
				Negative	IA
			Negative	Positive	IA
				Negative	IB
T0 N1^¶ M0 T1* N1^¶ M0 T2 N0 M0	G1	Positive	Positive	Positive	IA
				Negative	IB
			Negative	Positive	IB
				Negative	IIA
		Negative	Positive	Positive	IA
				Negative	IB
			Negative	Positive	IB
				Negative	IIA
T0 N1^¶ M0 T1* N1^¶ M0 T2 N0 M0	G2	Positive	Positive	Positive	IA
				Negative	IB
			Negative	Positive	IB
				Negative	IIA
		Negative	Positive	Positive	IA
				Negative	IIA
			Negative	Positive	IIA
				Negative	IIA
T0 N1^¶ M0 T1* N1^¶ M0 T2 N0 M0	G3	Positive	Positive	Positive	IA
				Negative	IIA
			Negative	Positive	IIA
				Negative	IIA
		Negative	Positive	Positive	IB
				Negative	IIA
			Negative	Positive	IIA
				Negative	IIA
T2 N1^Δ M0 T3 N0 M0	G1	Positive	Positive	Positive	IA
				Negative	IIB
			Negative	Positive	IIB
				Negative	IIB
		Negative	Positive	Positive	IA
				Negative	IIB
			Negative	Positive	IIB
				Negative	IIB
T2 N1^Δ M0 T3 N0 M0	G2	Positive	Positive	Positive	IB
				Negative	IIB
			Negative	Positive	IIB
				Negative	IIB
		Negative	Positive	Positive	IB
				Negative	IIB
			Negative	Positive	IIB
				Negative	IIB
T2 N1^Δ M0 T3 N0 M0	G3	Positive	Positive	Positive	IB
				Negative	IIB
			Negative	Positive	IIB
				Negative	IIB
		Negative	Positive	Positive	IIA
				Negative	IIB
			Negative	Positive	IIB
				Negative	IIIA
T0 N2 M0 T1* N2 M0 T2 N2 M0 T3 N1^Δ M0 T3 N2 M0	G1	Positive	Positive	Positive	IB
				Negative	IIIA
			Negative	Positive	IIIA
				Negative	IIIA
		Negative	Positive	Positive	IB
				Negative	IIIA
			Negative	Positive	IIIA
				Negative	IIIA
T0 N2 M0 T1* N2 M0 T2 N2 M0 T3 N1^Δ M0 T3 N2 M0	G2	Positive	Positive	Positive	IB
				Negative	IIIA
			Negative	Positive	IIIA
				Negative	IIIA
		Negative	Positive	Positive	IB
				Negative	IIIA
			Negative	Positive	IIIA
				Negative	IIIB
T0 N2 M0 T1* N2 M0 T2 N2 M0 T3 N1^Δ M0 T3 N2 M0	G3	Positive	Positive	Positive	IIA
				Negative	IIIA
			Negative	Positive	IIIA
				Negative	IIIA
		Negative	Positive	Positive	IIB
				Negative	IIIA
			Negative	Positive	IIIA
				Negative	IIIC
T4 N0 M0 T4 N1^Δ M0 T4 N2 M0 Any T N3 M0	G1	Positive	Positive	Positive	IIIA
				Negative	IIIB
			Negative	Positive	IIIB
				Negative	IIIB
		Negative	Positive	Positive	IIIA
				Negative	IIIB
			Negative	Positive	IIIB
				Negative	IIIB
T4 N0 M0 T4 N1^Δ M0 T4 N2 M0 Any T N3 M0	G2	Positive	Positive	Positive	IIIA
				Negative	IIIB
			Negative	Positive	IIIB
				Negative	IIIB
		Negative	Positive	Positive	IIIA
				Negative	IIIB
			Negative	Positive	IIIB
				Negative	IIIC
T4 N0 M0 T4 N1^Δ M0 T4 N2 M0 Any T N3 M0	G3	Positive	Positive	Positive	IIIB
				Negative	IIIB
			Negative	Positive	IIIB
				Negative	IIIB
		Negative	Positive	Positive	IIIB
				Negative	IIIC
			Negative	Positive	IIIC
				Negative	IIIC
Any T Any N M1	Any	Any	Any	Any	IV
NOTES: For cases with lymph node involvement with no evidence of primary tumor (eg, T0 N1, etc) or with breast ductal carcinoma in situ (eg, Tis N1, etc), the grade, HER2, ER, and PR information from the tumor in the lymph node should be used for assigning stage group. For cases where HER2 is determined to be "equivocal" by ISH (FISH or CISH) testing under the 2013 ASCO/CAP HER2 testing guidelines, the HER2 "negative" category should be used for staging in the pathological prognostic stage group table. The prognostic value of these prognostic stage groups is based on populations of persons with breast cancer that have been offered and mostly treated with appropriate endocrine and/or systemic chemotherapy (including anti-HER2 therapy).

Genomic profile for pathologic prognostic staging
When OncotypeDx score is less than 11...
When TNM is...	And grade is...	And HER2 status is...	And ER status is...	And PR status is...	Then the pathological prognostic stage group is...
T1 N0 M0 T2 N0 M0	Any	Negative	Positive	Any	IA
NOTES: Obtaining genomic profiles is NOT required for assigning pathological prognostic stage. However genomic profiles may be performed for use in determining appropriate treatment. If the OncotypeDx test is performed in cases with a T1N0M0 or T2N0M0 cancer that is HER2-negative and ER-positive, and the recurrence score is less than 11, the case should be assigned pathological prognostic stage group IA. If OncotypeDx is not performed, or if it is performed and the OncotypeDx score is not available, or is 11 or greater for patients with T1-2 N0 M0 HER2-negative, ER-positive cancer, then the prognostic stage group is assigned based on the anatomic and biomarker categories shown above. OncotypeDx is the only multigene panel included to classify pathologic prognostic stage because prospective level I data supports this use for patients with a score less than 11. Future updates to the staging system may include results from other multigene panels to assign cohorts of patients to prognostic stage groups based on the then available evidence. Inclusion or exclusion in this staging table of a genomic profile assay is not an endorsement of any specific assay and should not limit appropriate clinical use of any genomic profile assay based on evidence available at the time of treatment.

TNM: tumor, node, metastasis; AJCC: American Joint Committee on Cancer; UICC: Union for International Cancer Control.
* T1 includes T1mi.
¶ N1 does not include N1mi. T1 N1mi M0 and T0 N1mi M0 cancers are included for prognostic staging with T1 N0 M0 cancers of the same prognostic factor status.
Δ N1 includes N1mi. T2, T3, and T4 cancers and N1mi are included for prognostic staging with T2 N1, T3 N1, and T4 N1, respectively.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Corrected at 3rd printing, 2017.

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Breast carcinoma TNM pathologic prognostic stage groups AJCC UICC 8th edition