J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 6, Number 6, December 2014, pages 409-413

Relationship of Clinical and Pathologic Nodal Staging in Locally Advanced Breast Cancer: Current Controversies in Daily Practice?/b>

**Table 1.** Regional Lymph Nodes (N)
Clinical
Nx	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastases to movable ipsilateral level I, II axillary lymph node(s)
N2	Metastases in ipsilateral level I, II axillary lymph nodes that are clinically fixed or matted; or in clinically detected ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastases
N2a	Metastases in ipsilateral level I, II axillary lymph nodes fixed to one another (matted) or to other structures
N2b	Metastases only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident level I, II axillary lymph node metastases
N3	Metastases in ipsilateral infraclavicular (level III axillary) lymph node(s) with or without level I, II axillary lymph node involvement; or in clinically detected ipsilateral internal mammary lymph node(s) with clinically evident level I, II axillary lymph node metastases; or metastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement
N3a	Metastasis in ipsilateral infraclavicular lymph node(s)
N3b	Metastasis in ipsilateral internal mammary lymph node(s) and axillary lymph node(s)
N3c	Metastasis in ipsilateral supraclavicular lymph node(s)
Pathologic
Nx	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis histologically
N1	Micrometastases; or metastases in 1 - 3 axillary lymph nodes; and/or in internal mammary nodes with metastases detected by sentinel lymph node biopsy but not clinically detected
N1 mic	Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm)
N1a	Metastases in 1 - 3 axillary lymph nodes, at least one metastasis greater than 2.0 mm
N1b	Metastases in internal mammary nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected
N1c	Metastases in 1 - 3 axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected
N2	Metastases in 4 - 9 axillary lymph nodes; or in clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases
N2a	Metastases in 4 - 9 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm)
N2b	Metastases in clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases
N3	Metastases in 10 or more axillary lymph nodes; or in infraclavicular (level III axillary) lymph nodes; or in clinically detected ipsilateral internal mammary lymph nodes in the presence of one or more positive level I, II axillary lymph nodes; or in more than three axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected; or in ipsilateral supraclavicular lymph nodes
N3a	Metastases in 10 or more axillary lymph nodes (at least one tumor deposit greater than 2.0 mm); or metastases to the infraclavicular (level III axillary lymph) nodes
N3b	Metastases in clinically detected ipsilateral internal mammary lymph nodes in the presence of one or more positive axillary lymph nodes; or in more than three axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected
N3c	Metastasis in ipsilateral supraclavicular lymph nodes

Table 1. Regional Lymph Nodes (N)

Clinical

Regional lymph nodes cannot be assessed

No regional lymph node metastasis

Metastases to movable ipsilateral level I, II axillary lymph node(s)

Metastases in ipsilateral level I, II axillary lymph nodes that are clinically fixed or matted; or in clinically detected ipsilateral internal mammary nodes in the absence of clinically evident axillary lymph node metastases

N2a

Metastases in ipsilateral level I, II axillary lymph nodes fixed to one another (matted) or to other structures

N2b

Metastases only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident level I, II axillary lymph node metastases

Metastases in ipsilateral infraclavicular (level III axillary) lymph node(s) with or without level I, II axillary lymph node involvement; or in clinically detected ipsilateral internal mammary lymph node(s) with clinically evident level I, II axillary lymph node metastases; or metastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement

N3a

Metastasis in ipsilateral infraclavicular lymph node(s)

N3b

Metastasis in ipsilateral internal mammary lymph node(s) and axillary lymph node(s)

N3c

Metastasis in ipsilateral supraclavicular lymph node(s)

Pathologic

Regional lymph nodes cannot be assessed

No regional lymph node metastasis histologically

Micrometastases; or metastases in 1 - 3 axillary lymph nodes; and/or in internal mammary nodes with metastases detected by sentinel lymph node biopsy but not clinically detected

N1 mic

Micrometastases (greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm)

N1a

Metastases in 1 - 3 axillary lymph nodes, at least one metastasis greater than 2.0 mm

N1b

Metastases in internal mammary nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected

N1c

Metastases in 1 - 3 axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected

Metastases in 4 - 9 axillary lymph nodes; or in clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases

N2a

Metastases in 4 - 9 axillary lymph nodes (at least one tumor deposit greater than 2.0 mm)

N2b

Metastases in clinically detected internal mammary lymph nodes in the absence of axillary lymph node metastases

Metastases in 10 or more axillary lymph nodes; or in infraclavicular (level III axillary) lymph nodes; or in clinically detected ipsilateral internal mammary lymph nodes in the presence of one or more positive level I, II axillary lymph nodes; or in more than three axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected; or in ipsilateral supraclavicular lymph nodes

N3a

Metastases in 10 or more axillary lymph nodes (at least one tumor deposit greater than 2.0 mm); or metastases to the infraclavicular (level III axillary lymph) nodes

N3b

Metastases in clinically detected ipsilateral internal mammary lymph nodes in the presence of one or more positive axillary lymph nodes; or in more than three axillary lymph nodes and in internal mammary lymph nodes with micrometastases or macrometastases detected by sentinel lymph node biopsy but not clinically detected

N3c

Metastasis in ipsilateral supraclavicular lymph nodes

**Table 2.** Clinical Outcomes According to Use of Radiation Therapy
Author	10-year local recurrence	10-year overall survival
*Data refer to 5-year local recurrence.
Huang et al [4]	59	16	< 0.0001	47	54	0.063
Buchholz et al [10]*	53	23	< 0.001	-	-
McGuire et al [11]	33.3	7.3	0.04	77.3	33.3	0.0016

Table 2. Clinical Outcomes According to Use of Radiation Therapy

Author

10-year local recurrence

10-year overall survival

No RT (%)

RT (%)

P value

No RT (%)

RT (%)

P value

*Data refer to 5-year local recurrence.

Huang et al [4]

< 0.0001

0.063

Buchholz et al [10]*

< 0.001

McGuire et al [11]

33.3

7.3

0.04

77.3

33.3

0.0016