As of January 2025, the 9 Ed. TNM classification is recommended for assessing the stage (advancement) of thymic epithelial tumors.
| 9 Ed. AJCC/UICC TNM (2025) for Thymomas, Thymic Carcinomas and Thymic Neuroendocrine Neoplasms. | |||
|---|---|---|---|
| DESCRIPTION | 9th Ed. TNM CATEGORY | PATHOLOGY COMMENT | |
| PRIMARY TUMOR | |||
| Primary tumor cannot be assessed | TX | ||
| No evidence of primary tumor | T0 | ||
| Tumor thoroughly encapsulated | T1 | ||
| Direct invasion of the adjacent mediastinal fat or the mediastinal pleura | Histologic descriptor | ||
| ≤ 5 cm in greatest dimension | T1a | ||
| > 5 cm in greatest dimension | T1b | ||
| Tumor with direct involvement of the PERICARDIUM (partial or full thickness) | T2 | Microscopic involvement of the pericardium, either partial in the fibrous layer or penetrating through the serosal layer | |
| Tumor with direct involvement of the LUNG | Microscopic invasion into pulmonary parenchyma, or, into visceral pleura (microscopially confirmed direct penetration through the outer elastic layer of the visceral pleura without invasion into the lung parenchyma) |
||
| Tumor with direct involvement of the PHRENIC NERVE | Tumor cells being present within the nerve or perineurium, however, any type of entrapment of the nerve should be recorded | ||
| Tumor with direct invasion into any of the following: - BRACHIOCEPHALIC VEIN - SUPERIOR VENA CAVA - CHEST WALL - EXTRAPERICARDIAL PULMONARY ARTERIES OR VEINS | T3 | Tumor cells present at least within the media of great vessels | |
| Tumor with direct invasion into any of the following: - AORTA (ascending, arch or descending) - ARCH VESSELS - INTRAPERICARDIAL PULMONARY ARTERIES OR VEINS - MYOCARDIUM - TRACHEA - OESOPHAGUS | T4 | ||
| LYMPH NODES | |||
| Regional lymph nodes cannot be assessed | NX | ||
| No regional lymph node metastasis | N0 | ||
| Metastasis in ANTERIOR (PERITHYMIC/PREVASCULAR) lymph nodes Node groups: - Low anterior cervical: peritracheal, perithyroid (IASLC level 1) - Peri-thymic - Prevascular (IASLC level 3a) - Para-aortic, ascending aorta, superior phrenic (IASLC level 6) - Supradiaphragmatic/inferior phrenic/pericardial | N1 | Invasion by direct extension is counted as nodal involvement |
|
| Metastasis in deep intrathoracic or cervical lymph nodes Node groups: - Peri jugular - Supraclavicular - Internal mammary - Upper paratracheal (IASLC level 2) - Lower paratracheal (IASLC level 4) - Subaortic/aortopulmonary window (IASLC level 5) - Subcarinal (IASLC level 7) - Hilar (IASLC level 10) | N2 | ||
| DISTANT METASTASES | |||
| No pleural, pericardial or distant metastasis | M0 | ||
| Separate pleural or pericardial nodule(s) | M1a | ||
| Distant metastasis beyond the pleura or pericardium (includes: pulmonary intraparenchymal nodule) | M1b | ||
| STAGE GROUPS, 9 Ed. AJCC/UICC TNM | |||
|---|---|---|---|
| T1 (a+b) | N0 | M0 | Stage I |
| T2 | N0 | M0 | Stage II |
| T3 | N0 | M0 | Stage IIIA |
| T4 | N0 | M0 | Stage IIIB |
| Any T | N1 | M0 | IVA |
| Any T | N0, N1 | M1a | |
| Any T | N2 | M0, M1a | IVB |
| Any T | Any N | M1b | |
References:
- Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C: The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol 2011, 6:S1710-1716.
- Detterbeck FC, Stratton K, Giroux D, Asamura H, Crowley J, Falkson C, Filosso PL, Frazier AA, Giaccone G, Huang J, et al: The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposal for an Evidence-Based Stage Classification System for the Forthcoming (8th) Edition of the TNM Classification of Malignant Tumors. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2014, 9:S65-S72.
- Kondo K, Van Schil P, Detterbeck FC, Okumura M, Stratton K, Giroux D, Asamura H, Crowley J, Falkson C, Filosso PL, et al: The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2014, 9:S81-87.
- Nicholson AG, Detterbeck FC, Marino M, Kim J, Stratton K, Giroux D, Asamura H, Crowley J, Falkson C, Filosso PL, et al: The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the T Component for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2014, 9:S73-80.
- Ruffini E, Huang J, Cilento V, Goren E, Detterbeck F, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cangir AK, Falkson C, Fang W, Filosso PL, Giaccone G, Girard N, Guerrera F, Infante M, Kim DK, Lucchi M, Marino M, Marom EM, Nicholson AG, Okumura M, Rami-Porta R, Rimner A, Simone CB 2nd, Asamura H; Members of the IASLC Staging and Prognostic Factors Committee and of the Advisory Boards, and Participating Institutions. The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: Proposal for a Stage Classification for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol. 2023 Dec;18(12):1655-1671.
- Okumura M, Marino M, Cilento V, Goren E, Ruffini E, Dibaba D, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cangir AK, Detterbeck F, Falkson C, Fang W, Filosso PL, Giaccone G, Girard N, Guerrera F, Huang J, Infante M, Kim DK, Lucchi M, Marom EM, Nicholson AG, Rami-Porta R, Rimner A, Simone CB 2nd, Asamura H; Members of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee and of the Advisory Boards and Participating Institutions. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: Proposal for the T Component for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol. 2023 Dec;18(12):1638-1654.
- Fang W, Girard N, Cilento V, Goren E, Dibaba D, Ruffini E, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cangir AK, Detterbeck F, Falkson C, Filosso PL, Giaccone G, Guerrera F, Huang J, Infante M, Kim DK, Lucchi M, Marino M, Marom EM, Nicholson AG, Okumura M, Rami-Porta R, Rimner A, Simone CB 2nd, Asamura H; Members of the Staging and Prognostic Factors Committee, Members of the Advisory Boards and Participating Institutions of the Thymic Domain. The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: Proposals for the N and the M Components for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol. 2024 Jan;19(1):52-70.
- Marom EM, Fang W, Ruffini E, Detterbeck F, Ahmad U, Appel S, Bille A, Boubia S, Brambilla C, Cilento V, Cangir AK, Falkson C, Filosso PL, Giaccone G, Girard N, Goren E, Guerrera F, Huang J, Infante M, Kim DK, Lucchi M, Marino M, Nicholson AG, Okumura M, Rami-Porta R, Rimner A, Simone CB 2nd, Asamura H; Members of the IASLC Staging and Prognostic Factors Committee and of the Advisory Boards and Participating Institutions. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: A Re-Assessment of the International Thymic Malignancy Interest Group/International Association for the Study of Lung Cancer Lymph Node Map for Thymic Epithelial Tumors for the Forthcoming Ninth Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol. 2023 Dec;18(12):1672-1688.
- Molina TJ, Roden AC, Szolkowska M, Shimizu S, Moreira AL, Chalabreysse L, Besse B, de Montpréville V, Marom EM, Detterbeck F, Girard N, Nicholson AG, Marx A. International reproducibility study of thymic epithelial tumors staging: pT stage is an issue. proposals for improvement. A RYTHMIC/ITMIG study. Lung Cancer. 2024 Mar;189:107479.
- Roden AC, Judge M, den Bakker MA, Fang W, Jain D, Marx A, Moreira AL, Rajan A, Stroebel P, Szolkowska M, Cooper WA. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology. 2023 Dec;83(6):967-980.
