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Nasal cavity and paranasal sinuses (ICD10 C30.0, C31.0, C31.1)

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Introduction

This is the data sheet for TNM 9th edition staging of the nasal cavity and paranasal sinuses (ICD10 C30.0, C31.0, C31.1)

For more detailed information regarding TNM staging, please see pages 39-42 of the UICC TNM 9 book.

Stage groupings

Stage Group	T stage	N stage	M stage
Stage 0	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage III	T3	N0	M0
	T1, T2, T3	N1	M0
Stage IVA	T1, T2, T3	N2	M0
	T4a	N0, N1, N2	M0
Stage IVB	T4b	Any N	M0
	Any T	N3	M0
Stage IVC	Any T	Any N	M1

TNM clinical classification

T - primary tumour

Maxillary Sinus

T value	Description
cTX	Primary tumour cannot be assessed
cT0	No evidence of primary tumour
cTis	Carcinoma in situ
cT1	Tumour limited to the mucosa with no erosion or destruction of bone
cT2	Tumour causing bone erosion or destruction, including into the hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates
cT3	Tumour invades any of the following: bone of posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa or ethmoid sinuses
cT4a	Tumour invades any of the following: anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate and sphenoid or frontal sinuses
cT4b	Tumour invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Nasal Cavity and Ethmoid Sinus

T value	Description
cTX	Primary tumour cannot be assessed
cT0	No evidence of primary tumour
cTis	Carcinoma in situ
cT1	Tumour restricted to one subsite of nasal cavity or ethmoid sinus, with or without bony invasion
cT2	Tumour involves two subsites in a single site or extends to involve an adjacent site within the nasoethmoidal complex, with or without bony invasion
cT3	Tumour extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate
cT4a	Tumour invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses
cT4b	Tumour invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than V2, nasopharynx, or clivus

N - regional lymph nodes

N value	Description
cN1	Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without clinical extranodal extension
cN2	Metastasis described as:
	cN2a - Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension without clinical extranodal extension cN2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, without clinical extranodal extension cN2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without clinical extranodal extension
cN3a	Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension
cN3b	Metastasis in a single or multiple lymph nodes with clinical extranodal extension*

Notes:

* Clinical extranodal extension is defined as the presence of skin involvement or soft tissue invasion with deep fixation to underlying muscle or adjacent anatomical structures or clinical signs of nerve involvement. Imaging is becoming a standard method of detecting unequivocal extranodal extension. Midline nodes are considered ipsilateral nodes.

M - distant metastasis

M value	Description
cM0	No distant metastasis
cM1	Distant Metastasis

TNM pathological classification

pT - primary tumour

The pT categories correspond to the T categories as per above.

The pN categories correspond to the cN categories. Extranodal extension however is defined pathologically, not clinically or radiologically.

Histological examination of a selective neck dissection specimen should ordinarily include six or more lymph nodes.

Histological examination of a radical or modified radical neck dissection specimen should ordinarily include 15 or more lymph nodes

pN - regional lymph nodes

pN value	Description
pNX	Regional lymph nodes cannot be assessed
pN0	No regional lymph node metastasis
pN1	Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without extranodal extension
pN2	Metastasis as described below:
	pN2a - Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension with pathological extranodal extension* OR metastasis in a single lymph node more than 3 cm but not more than 6 cm in greatest dimension without pathological extranodal extension pN2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, without pathological extranodal extension pN2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without pathological extranodal extension
pN3a	Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension
pN3b	Metastasis in a lymph node more than 3 cm in greatest dimension with pathological extranodal extension* OR metastasis in multiple ipsilateral, or any contralateral or bilateral node(s) with pathological extranodal extension

Note:

* Pathological extranodal extension (pENE) should only be diagnosed when tumour that is present within the confines of a lymph node definitively transgresses through the entire thickness of the lymph node capsule into the surrounding connective tissue, with or without stromal reaction. A soft tissue deposit should be considered as at least one lymph node with extranodal extension if it occurs at a site where a regional lymph node would be expected.