12.5. TNM-8 klassifisering for malignt mesoteliom

Tabell 21 TNM-8-klassifisering av malignt pleuralt mesoteliom
Gjengitt fra Brierley et al., 2017. Med tillatelse fra John Wiley and Sons i 2024.
Stadium	Forklaring
T1	Tumor limited to the ipsilateral parietal ± visceral ± mediastinal ± diaphragmatic pleura
T2	Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: •involvement of diaphragmatic muscle •extension of tumor from visceral pleura into the underlying pulmonary parenchyma
T3	Describes locally advanced but potentially resectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: involvement of the endothoracic fascia extension into the mediastinal fat solitary, completely resectable focus of tumor extending into the soft tissues of the chest wall nontransmural involvement of the pericardium
T4	Describes locally advanced technically unresectable tumor. Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction direct transdiaphragmatic extension of tumor to the peritoneum direct extension of tumor to the contralateral pleura direct extension of tumor to mediastinal organs direct extension of tumor into the spine tumor extending through to the internal surface of the pericardium with or without a pericardial effusion, or tumor involving the myocardium
N1	Metastases in the ipsilateral bronchopulmonary, hilar, or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal lymph nodes) lymph nodes
N2	Metastases in the contralateral mediastinal, ipsilateral, or contralateral supraclavicular lymph nodes
M1	Distant metastasis present

Tabell 22 Stadieinndeling av malignt pleuralt mesoteliom
Gjengitt fra Brierley et al., 2017. Med tillatelse fra John Wiley and Sons i 2024.
Stadium	N0	N1	N2
T1	IA	II	IIIB
T2	IB	II	IIIB
T3	IB	IIIA	IIIB
T4	IIIB	IIIB	IIIB
M1	IV	IV	IV

Anbefaling - Utredning av mesoteliom:

Malignt pleuralt mesoteliom mistenkes ved pleuraeffusjon, pleural fortykkelse og samtidig brystsmerter.
CT toraks med kontrast er basis for diagnostikk og staging.
For videre cyto-/histologisk diagnostikk gjøres aspirering for cytologi, og pleural biopsering (helst torakoskopisk).
Histologisk bekreftelse av diagnosen må etterstrebes. Siden negativ cytologi/pleural biopsi ikke utelukker mesoteliom bør videre utredning gjøres.
Ved vurdering for kurativ behandling skal PET/CT utføres. I en ikke-kurativ situasjon er det ikke indikasjon for PET/CT, med mindre dette er ønskelig før biopsi, for mer sannsynlig å få representativ prøve.

Siste faglige endring: 19. november 2024