tnm classification veronesi et al
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The Breast (2006) 15, 580
THE BREAST
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TNM Classification Veronesi et al
Professor Veronesi and colleagues have proposedmodifications to the TNM classification of breastcancers1 that, by recording the complete metricdescription of all parameters and including biolo-gical criteria predictive of response, could finallybreak the paralysing effect of a classification thathas long outlived its usefulness. The accompanyingeditorial2 is surprisingly unenthusiastic. The mosttelling criticism is that ‘the authors fail to provideany evidence that they have identified subgroupswhich are more appropriate than those currentlydefined by TNM’. The problem is that TNM preventsthe identification of such subgroups. It is forinstance impossible for the work of this Centre tobe compared with any other, since TNM recordsneither individual measurements of diameter norhistological grade, that proved to be the essentialelements in the analysis of our data.3 When otherworkers fail to present their data precisely,no comparisons can be made. We have demon-strated that the arbitrary subgroupings of ‘T’ areunrelated to tumour growth patterns4; further-more, it has long been known that the histologicalgrade is a vital prognostic factor upon which thesuccess of the Nottingham Prognostic Index largelydepends.5
The defence that TNM is useful for those withoutmodern resources is surely too defeatist and some-what condescending? Not every centre will be ableto return advanced immunohistochemistry but all
ee front matter & 2006 Elsevier Ltd. All rights reservereast.2006.06.002
nal article: 10.1016/j.breast.2005.11.011
can strive for accurate measurements of diameterand agreement amongst pathologists. TNM allowslarge quantities of relatively poor data to beprocessed with high statistical precision, whereasthe interest of the patient lies in the identificationof similar groups whose management may then becompared and refined. Professor Veronesi andcolleagues should be wholeheartedly congratu-lated.
References
1. Veronesi U, Viale G, Rotmensz N, Goldhirsch A. RethinkingTNM: Breast cancer TNM classification for treatment decision-making and research. The Breast 2006;15:3–8.
2. Morrow M. What is the purpose of cancer staging? Editorial.The Breast 2006;15:1–2.
3. Johnson AE, Bennett MH, Cheung CWD, Cox S, Sales JEL. Themanagement of individual breast cancers. The Breast1995;4:100–11.
4. Johnson AE, Shekhdar J. Prognostic indices and screen-detected cancers: the size factor. The Breast 2002;11:206–7.
5. Elston CW, Ellis IO. Pathological prognostic factors in breastcancer. I. The value of histological grade in breast cancer:experience from a large study with long-term follow-up.Histopathology 1991;9:403–10.
Ann JohnsonMount Vernon Hospital,
Mount Vernon Postgraduate Medical Centre,Rickmansworth Road, Northwood HA6 2RN, UK
E-mail address: [email protected]
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