Malignant pleural mesothelioma (staging)

A.Prof Frank Gaillard et al.

A number of staging systems have been described for staging of malignant pleural mesothelioma. Below is the International Mesothelioma Interest Group TNM staging system.


T - Tumor
  • Tx: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • T1a
    • potentially resectable
    • only parietal pleura
    • no mediastinal pleural involvement
  • T1b
    • potentially resectable
    • parietal pleura AND
    • scattered foci of mediastinal pleural involvement
  • T2
    • potentially resectable
    • parietal and visceral pleural involvement, and / or
    • pulmonary parenchymal involvement and/or
    • diaphragmatic muscle involvement
  • T3
    • potentially resectable
    • localized tumor extension into endothoracic fascia and / or
    • localized non-transmural involvement of pericardium and / or
    • localized extension into mediastinal fat
  • T4
    • unresectable
    • multiple foci of extension into chest wall +/- rib destruction and/or
    • extension through diaphragm into peritoneum and / or
    • extension into contralateral pleura and / or
    • extension into mediastinal organs and / or
    • extension through pericardium +/- direct extension into heart
N - Nodes
  • Nx: nodes cannot be assessed
  • N0: no evidence of nodal involvement
  • N1: ipsilateral bronchopulmonary or hilar nodal involvement
  • N2: subcarinal or ipsilateral mediastinal / internal mammary nodes
  • N3: contralateral mediastinal / internal mammary nodes,or ipsilateral / contralateral supraclavicular nodes
M - Metastases
  • Mx: presence of metastases cannot be assessed
  • M0: no evidence of metastases
  • M1: distant metastases present

Stage groupings

  • Stage IA: T1a, N0, M0
  • Stage IB:T1b, N0, M0
  • Stage II: T2, N0, M0
  • Stage III:
    • T1 or 2,  N1 or N2, M0 OR
    • T3, any N, M0
  • Stage IV: any T, any N, M1
Share article

Article information

rID: 8721
System: Chest, Oncology
Section: Staging
Synonyms or Alternate Spellings:
  • Malignant pleural mesothelioma staging
  • Staging of malignant pleural mesothelioma

Support Radiopaedia and see fewer ads

Cases and figures

  • Figure 1: mesothelioma - gross pathology
    Drag here to reorder.
  • Case 1: contralateral nodes
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3: T4 with rib erosion
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.