Pleural
Pleural
International Mesothelioma Interest Group (IMIG) Staging System for Diffuse Malignant Pleural Mesothelioma
T = tumour
T1a Tumour limited to the ipsilateral pleura including mediastinal and diaphragmatic pleura. No involvement of the visceral pleura.
T1b Tumour involving the ipsilateral parietal pleura, including mediastinal and diaphragmatic pleura. Scattered foci of tumour also involving the visceral pleura.
T2 Tumour involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features:
· involvement of diaphragmatic muscle
· confluent visceral pleural tumour (including the fissures) or
· extension of tumour from visceral pleura into underlying pulmonary parenchyma
T3 Describes locally advanced but potentially resectable tumour. Tumour involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features:
· involvement of the endothoracic fascia
· extension into the mediastinal fat
· soltary, completely resectable focus of tumour extending into the soft tissues of the chest wall
· non-transmural involvement of the pericardium
T4 Describes locally advanced technically unresectable tumour. Tumour involving all of the ipsilateral pleural surfaces surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features:
· diffuse extension or multifocal masses of tumour in the chest wall, with or without associated rib destruction
· direct transdiaphragmatic extension of tumour to the peritoneum
· direct extension of tumour to the contralateral pleura
· direct extension of tumour to one of more mediastinal organs
· direct extension of tumour into the spine
· tumour extending through to the internal surface of the pericardium with or without a pericardial effusion, or tumour involving the myocardium
N = Lymph nodes
Nx Regional lymph nodes cannot be assessed
N0 No regional node metastases
N1 Metastases in the ipsilateral bronchopulmonary or hilar lymph nodes
N2 Metastases in the subcarinal or ipsilateral mediastinal lymph nodes, including the ipsilateral mammary nodes
N3 Metastases in the contralateral mediastinal, contralateral internal mammary, ipsilateral or contralateral supraclavicular lymph nodes
M = Metastases
MX Presence of distant metastases cannot be assessed
M0 No distant metastasis
M1 Distant metastasis present
Stage summary
Stage Description
Stage Ia T1a N0 M0
Stage Ib T1b N0 M0
Stage II T2 N0 M0
Stage III Any T3 M0
Any N1 M0
Any N2 M0
Stage IV AnyT4
Any N3
Any M1
From Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. Chest 108(4): 1122-1128, 1995
•Stage I: Disease confined within the capsule of the parietal pleura: ipsilateral pleura, lung, pericardium, and diaphragm
•Stage II: All of stage I with positive intrathoracic (N1 or N2) lymph nodes
•Stage III: Local extension of disease into the following: chest wall or mediastinum; heart or through the diaphragm, peritoneum; with or without extrathoracic or contralateral (N3) lymph node involvement
•Stage IV: Distant metastatic disease