Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030.
AJR Am J Roentgenol. 2021 Aug;217(2):278-290. doi: 10.2214/AJR.20.25223. Epub 2021 Feb 17.
The standardization of the AJCC TNM staging system for breast cancer allows physicians to evaluate patients with breast cancer using standard language and criteria, assess treatment response, and compare patient outcomes. Previous editions of the relied on the anatomic TNM method of staging that incorporates imaging and uses population-level survival data to predict patient outcomes. Recent advances in therapy based on biomarker status and multigene panels have improved treatment strategies. In the newest edition of the (8th edition, adopted on January 1, 2018), breast cancer staging integrates anatomic staging with tumor grade, biomarker data regarding hormone receptor status, oncogene expression, and gene expression profiling to assign a prognostic stage. This article reviews the 8th edition of the AJCC breast cancer staging system with a focus on anatomic staging and the challenges that anatomic staging poses for radiologists. We highlight key imaging findings that impact patient treatment and discuss the role of imaging in evaluating response to neoadjuvant therapy. Finally, we discuss biomarkers and multigene panels and how these impact prognostic stage. The review will help radiologists identify critical findings that affect breast cancer staging and understand ongoing limitations of imaging in staging.
美国癌症联合委员会（AJCC）乳腺癌 TNM 分期系统的标准化
使医生能够使用标准语言和标准对乳腺癌患者进行评估，判断治疗效果，并比较患者的预后。以往的 AJCC 分期系统依赖于解剖学 TNM 分期方法，该方法结合了影像学检查，并使用人群水平的生存数据来预测患者的预后。基于生物标志物状态和多基因检测的治疗进展改善了治疗策略。在最新版 AJCC 分期系统（第 8 版，于 2018 年 1 月 1 日采用）中，乳腺癌分期将解剖学分期与肿瘤分级、激素受体状态的生物标志物数据、致癌基因表达和基因表达谱相结合，以确定预后分期。本文重点介绍了 AJCC 第 8 版乳腺癌分期系统的解剖学分期以及其对放射科医生的挑战，强调了影响患者治疗的关键影像学表现，并讨论了影像学在评估新辅助治疗效果中的作用。最后，我们还讨论了生物标志物和多基因检测，以及它们如何影响预后分期。本文综述将有助于放射科医生识别影响乳腺癌分期的关键影像学表现，并了解分期中影像学的局限性。
