Thymoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]

Overview

  • There is no universally accepted system; no AJCC staging exists.
  • Historically, a classifiaction system used both histological features and clinical behavior.
  • Masaoka staging is the clinically used staging system, although it may not be predictive for thymic carcinoma.
  • GETT staging is the surgical staging system, and may have better correlation with outcome.
  • A meta-analysis from UCLA suggests that evaluation of transcapsular extension (Stage I vs. Stage IIa) is of no clinical value, as they have same DFS and OS outcomes.

Historical Classification

  • Benign Thymoma (histologically and behaviorally benign)
  • Malignant Thymoma (invasive)
  • Type I - histologically benign, but behaving aggressively with local invasion
  • Type II ("thymic carcinoma") - histologically malignant, aggresive behavior

Masaoka TNM Staging (1999)

[1]

Original Masaoka Staging (1991)

  • Stage I - Macroscopically and microscopically completely encapsulated
  • Stage II - Macroscopic invasion into surrounding fatty tissues or mediastinal pleura or microscopic invasion into the capsule
  • Stage III - Macroscopic invasion into adjacent organs or intrathoracic metastases
  • Stage IVA - Pleural or pericardial implants/dissemination
  • Stage IVB - Nodal or hematogenous metastases

GETT Staging

  • Stage IA - Encapsulated, completely resected.
  • Stage IB - Macroscopically completely resected but suspicion of mediastinal adhesions or potential capsular invasion at surgery.
  • Stage II - Invasive tumor, completely resected.
  • Stage IIIA - Invasive tumor, subtotal resection.
  • Stage IIIB - Invasive tumor, biopsy alone.
  • Stage IVa - Supraclav or pleural met.
  • Stage IVb - Distant metastases.[1]

References

  1. 1.0 1.1 "Thymectomy and malignancy. [Eur J Cardiothorac Surg. 1994] - PubMed - NCBI".


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