In the TNM 8th edition staging of breast cancer, a patient has a 2.8 cm invasive ductal carcinoma with metastasis to 4 ipsilateral axillary lymph nodes, none fixed. What is the pathological N stage?
- A pN2a ✓
- B pN1
- C pN3a
- D pN2b
Correct answer: A. pN2a
Explanation
In AJCC 8th edition staging, pN2a denotes 4–9 ipsilateral axillary lymph node metastases (at least one >2 mm). With 4 involved axillary nodes that are not fixed, the correct classification is pN2a. pN1 covers 1–3 axillary nodes; pN3a covers 10 or more axillary nodes. pN2b pertains to internal mammary nodes detected clinically without axillary involvement.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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