The new TNM classification and micrometastases

The 6th Edition of the TNM classification is considered with particular reference to the evidence base for the analysis of lymph nodes. The justification for the definition of a micrometastasis is considered and in particular the problems related to describing a node deposit of less than 200 microm as NO. Such a classification in the absence of clear instructions on node examination is of limited value in terms of comparing different centres and even within the same centre. The classification does not embrace the rapid advances in the biology of breast cancer and some of these are considered as possible ways forward. TNM is meant to be pragmatic and evidence based leading to indications for treatment and a uniform approach between centres. In the former it succeeds, but some of the definitions would appear to be based on limited established data.