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pN1aMetastasis in 1 to 3 axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm)

pN1bMetastasis in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent###

pN1c Metastasis in 1 to 3 axillary lymph nodes and in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent. (If associated with more than 3 positive axillary lymph nodes, the internal mammary nodes are classified as pN3b to reflect increased tumor burden)

pN2Metastasis in 4 to 9 axillary lymph nodes or in clinically apparent### internal mammary nodes in the absence of axillary lymph node metastasis

pN2aMetastasis in 4 to 9 axillary lymph nodes (at least 1 tumor deposit larger than 2.0 mm)

pN2bMetastasis in clinically apparent### internal mammary nodes in the absence of axillary lymph node metastasis

pN3Metastasis in 10 or more axillary lymph nodes, or in infraclavicular lymph nodes, or in clinically apparent### ipsilateral internal mammary nodes in the presence of 1 or more positive axillary lymph nodes; or in more than 3 axillary lymph nodes with clinically negative microscopic metastasis in internal mammary nodes or in ipsilateral supraclavicular lymph nodes

pN3aMetastasis in 10 or more axillary lymph nodes (at least 1 tumor deposit greater than 2.0 mm), or metastasis to the infraclavicular lymph nodes

pN3bMetastasis in clinically apparent### ipsilateral internal mammary lymph nodes in the presence of 1 or more positive axillary lymph nodes; or in more than 3 axillary lymph nodes and in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent.

pN3cMetastasis in ipsilateral supraclavicular lymph nodes

There are instances when the pathologist cannot make this determination because the complete staging procedure, such as a lymph node dissection, has not been performed or because information about a prior procedure is unavailable. In such situations an “X” is used rather than a number in the TNM designation.

# Classification is based on axillary lymph node dissection with or without sentinel lymph node dissection. Classification based solely on sentinel lymph node dissection without subsequent axillary dissection is designated (sn) for “sentinel node,” eg, pN0(i+)(sn).

## Isolated tumor cells (ITC) are defined as single tumor cells or small cell clusters not greater than 0.2 mm. They may be detected by routine histologic examination or by immunohistochemical (IHC) or molecular methods. ITCs do not usually show evidence of malignant activity (eg, proliferation or stromal reaction).

### Clinically apparent is defined as detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination. Not clinically apparent is defined as not detected by imaging studies (excluding lymphoscintigraphy) or by clinical examination.

^ Micrometastases may show histologic evidence of malignant activity (eg, proliferation or stromal reaction).

Distant Metastasis (M)

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