Malignant Pleural Mesothelioma Staging 

Updated: Nov 01, 2019
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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TNM Classification for Malignant Pleural Mesothelioma

The tumor-node-metastasis (TNM) classification and prognostic groups for malignant pleural mesothelioma staging is provided below. [1, 2]

Table. TNM Classification for Malignant Pleural Mesothelioma (Open Table in a new window)

Primary tumor (T)

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor limited to the ipsilateral parietal pleura with or without mediastinal pleura and with or without involvement of visceral, mediastinal, or diaphragmatic pleura

T2

Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:

  • Involvement of the diaphragmatic muscle

  • Extension of tumor from the visceral pleura into the underlying pulmonary parenchyma

T3

Locally advanced but potentially resectable tumor; tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:

  • Involvement of the endothoracic fascia

  • Extension into the mediastinal fat

  • Solitary, completely resectable focus of tumor extending into the soft tissue of the chest wall

  • Nontransmural involvement of the pericardium

T4

Locally advanced, technically unresectable tumor; tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following:

  • Diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction

  • Direct diaphragmatic extension of the tumor to the peritoneum

  • Direct extension of the tumor to the contralateral pleura

  • Direct extension of the tumor to a mediastinal organ

  • Direct extension of the tumor into the spine

  • Tumor extending through to the internal surface of the pericardium with or without a pericardial effusion or tumor involving the myocardium

Regional lymph nodes (N)

NX

Regional lymph node(s) cannot be assessed

N0

No regional lymph node metastases

N1

Metastases in the ipsilateral bronchopulmonary, hilar, or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal) lymph nodes

N2

Metastases in the contralateral mediastinal, ipsilateral, or contralateral supraclavicular lymph nodes

Distant metastases (M)

M0

No distant metastasis

M1

Distant metastasis

Table. Anatomic stage/prognostic groups (Open Table in a new window)

Stage

T

N

M

IA

T1

N0

M0

IB

T2-T3

N0

M0

II

T1-T2

N1

M0

IIIA

T3

N1

M0

IIIB

T1-T3

N2

M0

T4

Any N

M0

IV

Any T

Any N

M1