- Email: [email protected]
The Tumor, Nodes, and Metastasis (TNM) Classification of Malignant Tumors of the Eye and Ocular Adnexa
AMERICAN JOURNAL OF OPHTHALMOLOGY® FRANK
W.
NEWELL,
Publisher and Editor-in-Chief
Tribune Tower, Suite 1415, 435 North Michigan Ave., Chicago, Illinois 60611
EDITORIAL BOARD Thomas M. Aaberg, Milwaukee Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Jules 1. Baum, Boston William M. Bourne, Rochester Ronald M. Burde, St. Louis Fred Ederer, Bethesda Frederick T. Fraunfelder, Portland Eugene Helveston, Indianapolis Frederick A. jakobiec, New York Michael A. Kass, St. Louis Herbert E. Kaufman, New Orleans
Kenneth R. Kenyon, Boston Steven G. Kramer, San Francisco Irving H. Leopold, Irvine Robert Machamer, Durham A. Edward Maumenee, Baltimore Irene H. Maumenee, Baltimore Nancy M. Newman, San Francisco Don H. Nicholson, Miami Edward W. D. Norton, Miami Arnall Patz, Baltimore Deborah Pavan-Langston, Boston
Thomas H. Pettit, Los Angeles Dennis Robertson, Rochester Stephen J. Ryan, Los Angeles Jerry A. Shields, Philadelphia David Shoch, Chicago Ronald E. Smith, Los Angeles Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles H. Stanley Thompson, Iowa City E. Michael Van Buskirk, Portland Gunter K. von Noorden, Houston George O. Waring, Atlanta
Published monthly by the OPHTHALMIC PuBLISHING COMPANY Tribune Tower, Suite 1415, 435 North Michigan Avenue, Chicago, Illinois 60611 Directors A. Edward Maumenee, President David Shoch, Vice President Frank W. Newell, Secretary and Treasurer
Edward W. D. Norton Bruce E. Spivey Bradley R. Straatsma
EDITORIALS The Tumor, Nodes, and
Metastasis (TNM) Classification Tumors of the Eye and Ocular Adnexa
of Malignant
A. Jean Campbell, Leslie Sobin, and Lorenz E. Zimmerman The anatomic extent of disease is generally the most important indicator of prognosis for the patient with cancer and at most sites provides the main guide for the selection of therapy. The assessment of the extent of disease is also important for controlled clinical trials because it provides a critical means of stratification of patients. Comparison of data and reproducibility in the care of patients necessitate uniformity and standardization in measurement of the extent of disease. Since the inception, in the late 1940s, of the TNM classification (tumor, nodes, and metastasis), it has become the most widely used system for this measurement. Its basic principles are applicable to all body sites. It has been formulated by a multidisciplinary group composed, over the years, of surgeons, radiotherapists, medical oncologists, pathologists, epidemiologists, and statisticians from many countries.
Currently, national TNM committees in the British Isles, Canada, France, German-speaking countries, Italy, Japan, and the United States help with the formulation, testing, and dissemination of information on TNM. The American Joint Committee on Cancer and the International Union Against Cancer have been responsible for the organization of TNM task forces and the publication of classifications. The current editions of the manuals on the TNM classiflcanon'" cover 25 tumor sites and several special tumor types. Malignant tumors of the eye and its adnexa are the latest lesions to be categorized in the TNM classification. Two groups worked jointly in this endeavor. The task force of the American Joint Committee on Cancer included R. J. Campbell, R. L. Font, C. E. Iliff, J. A. Shields, W. H. Spencer, and L. E. Zimmerman. The members of the task force of the Interna83
84
January, 1985
AMERICAN JOURNAL OF OPlITHALMOLOGY
tional Union Against Cancer were A. Brini of France, A. Kaneko of Japan, P. K. Lommatzsch of the German Democratic Republic, G. O. H. Naumann of the German Federal Republic, J. A. Oosterhuis of the Netherlands, and K. C. Wybar of Britain. A single classification of eye and adnexal tumors resulted.':" The sites are separately classified as eyelid, conjunctiva, uvea, orbit, and lacrimal gland, and subclassifications are included when appropriate. For histologic classification and diagnostic criteria, reference was made to the World Health Organization classification. 4 Uniform classification of the histology and extent of disease (staging) of eye and adnexal tumors is recommended so that there will be consistency in . gathering data. This assessment will foster determination of the most appropriate treatment for the patient, and the evaluation of results of management will be more uniform.
The New
References 1. American Joint Committee on Cancer, Beahrs, O. H., and Myers, M. H. (eds.): Manual for Staging of Cancer, 2nd ed. Philadelphia, J. B. Lippincott, 1983. 2. International Union Against Cancer, Harmer, M. H. (ed.): TNM classification of Malignant Tumors, 3rd ed. Geneva, 1978; rev. ed., 1982. 3. International Union Against Cancer: TNM Classification of Ophthalmic Tumors. Geneva. In press. 4. Zimmerman, L. E., Sobin, L. H., et al.: Histological typing of tumours of the eye and its adnexa. In International Histological Classification of Tumours. Geneva, World Health Organization, 1980.
Reprint requests to Lorenz E. Zimmerman, M.D., Armed Forces Institute of Pathology, Section on Ophthalmology, Washington, DC 20306.
JOURNAL
Size
Frank W. Newell With this issue THE JOURNAL'S dimensions expand from a page size of 6 3/4 x 9 7/8 inches to 8 1/8 x 10 7/8 inches. The second series of THE AMERICAN JOURNAL OF OPHTHALMOLOGY was published in this size from 1902 to 1917. With its merger into the third series, THE JOURNAL changed to the smaller size. The new size provides a major change in graphics supervised by a master of modern graphics techniques, Charles Todaro, of the Mack Printing Company. The new JOURNAL will publish larger and clearer figures (a boon to electron microscopy) and less crowded tables, and will appear in a more attractive format. THE JOURNAL will continue in its traditional twocolumn format with easily readable columns. Several new features will be added to the advertising section. The summary abstract of each of the original articles will be reprinted in the advertising section. Interested readers may clip these and, if they wish, paste them to a 3 x 5-inch index card for filing. This will permit easy access to pertinent articles. The Second Sight page by Janus will view ophthalmology from the perspectives of many publications.
Additionally, the advertising section will carry a New Products and Services section from which the interested reader can get a quick indication of new equipment available in the field. Many readers miss the ophthalmic miniatures that began in 1942. They were sacrificed to the reluctance of authors to have ophthalmic miniatures at the end of their articles. From time to time ophthalmic miniatures will reappear in the advertising section. With the popularity of the Letters section and the large amount of original material it contains, readers have easy access to the latest in ophthalmology. When this section is combined with the five-year index (last published in May 1983 for the five years between 1978 and 1982), the reader has a dynamic survey comparable to a recent textbook. As has been true of THEJOURNAL since its founding by Adoloph Alt in 1884, THE JOURNAL is responsive to the needs and wishes of its readers. Please tell us what you like and what you don't like about THE JOURNAL'S new format and features.
W.
NEWELL,
Publisher and Editor-in-Chief
Tribune Tower, Suite 1415, 435 North Michigan Ave., Chicago, Illinois 60611
EDITORIAL BOARD Thomas M. Aaberg, Milwaukee Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Jules 1. Baum, Boston William M. Bourne, Rochester Ronald M. Burde, St. Louis Fred Ederer, Bethesda Frederick T. Fraunfelder, Portland Eugene Helveston, Indianapolis Frederick A. jakobiec, New York Michael A. Kass, St. Louis Herbert E. Kaufman, New Orleans
Kenneth R. Kenyon, Boston Steven G. Kramer, San Francisco Irving H. Leopold, Irvine Robert Machamer, Durham A. Edward Maumenee, Baltimore Irene H. Maumenee, Baltimore Nancy M. Newman, San Francisco Don H. Nicholson, Miami Edward W. D. Norton, Miami Arnall Patz, Baltimore Deborah Pavan-Langston, Boston
Thomas H. Pettit, Los Angeles Dennis Robertson, Rochester Stephen J. Ryan, Los Angeles Jerry A. Shields, Philadelphia David Shoch, Chicago Ronald E. Smith, Los Angeles Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles H. Stanley Thompson, Iowa City E. Michael Van Buskirk, Portland Gunter K. von Noorden, Houston George O. Waring, Atlanta
Published monthly by the OPHTHALMIC PuBLISHING COMPANY Tribune Tower, Suite 1415, 435 North Michigan Avenue, Chicago, Illinois 60611 Directors A. Edward Maumenee, President David Shoch, Vice President Frank W. Newell, Secretary and Treasurer
Edward W. D. Norton Bruce E. Spivey Bradley R. Straatsma
EDITORIALS The Tumor, Nodes, and
Metastasis (TNM) Classification Tumors of the Eye and Ocular Adnexa
of Malignant
A. Jean Campbell, Leslie Sobin, and Lorenz E. Zimmerman The anatomic extent of disease is generally the most important indicator of prognosis for the patient with cancer and at most sites provides the main guide for the selection of therapy. The assessment of the extent of disease is also important for controlled clinical trials because it provides a critical means of stratification of patients. Comparison of data and reproducibility in the care of patients necessitate uniformity and standardization in measurement of the extent of disease. Since the inception, in the late 1940s, of the TNM classification (tumor, nodes, and metastasis), it has become the most widely used system for this measurement. Its basic principles are applicable to all body sites. It has been formulated by a multidisciplinary group composed, over the years, of surgeons, radiotherapists, medical oncologists, pathologists, epidemiologists, and statisticians from many countries.
Currently, national TNM committees in the British Isles, Canada, France, German-speaking countries, Italy, Japan, and the United States help with the formulation, testing, and dissemination of information on TNM. The American Joint Committee on Cancer and the International Union Against Cancer have been responsible for the organization of TNM task forces and the publication of classifications. The current editions of the manuals on the TNM classiflcanon'" cover 25 tumor sites and several special tumor types. Malignant tumors of the eye and its adnexa are the latest lesions to be categorized in the TNM classification. Two groups worked jointly in this endeavor. The task force of the American Joint Committee on Cancer included R. J. Campbell, R. L. Font, C. E. Iliff, J. A. Shields, W. H. Spencer, and L. E. Zimmerman. The members of the task force of the Interna83
84
January, 1985
AMERICAN JOURNAL OF OPlITHALMOLOGY
tional Union Against Cancer were A. Brini of France, A. Kaneko of Japan, P. K. Lommatzsch of the German Democratic Republic, G. O. H. Naumann of the German Federal Republic, J. A. Oosterhuis of the Netherlands, and K. C. Wybar of Britain. A single classification of eye and adnexal tumors resulted.':" The sites are separately classified as eyelid, conjunctiva, uvea, orbit, and lacrimal gland, and subclassifications are included when appropriate. For histologic classification and diagnostic criteria, reference was made to the World Health Organization classification. 4 Uniform classification of the histology and extent of disease (staging) of eye and adnexal tumors is recommended so that there will be consistency in . gathering data. This assessment will foster determination of the most appropriate treatment for the patient, and the evaluation of results of management will be more uniform.
The New
References 1. American Joint Committee on Cancer, Beahrs, O. H., and Myers, M. H. (eds.): Manual for Staging of Cancer, 2nd ed. Philadelphia, J. B. Lippincott, 1983. 2. International Union Against Cancer, Harmer, M. H. (ed.): TNM classification of Malignant Tumors, 3rd ed. Geneva, 1978; rev. ed., 1982. 3. International Union Against Cancer: TNM Classification of Ophthalmic Tumors. Geneva. In press. 4. Zimmerman, L. E., Sobin, L. H., et al.: Histological typing of tumours of the eye and its adnexa. In International Histological Classification of Tumours. Geneva, World Health Organization, 1980.
Reprint requests to Lorenz E. Zimmerman, M.D., Armed Forces Institute of Pathology, Section on Ophthalmology, Washington, DC 20306.
JOURNAL
Size
Frank W. Newell With this issue THE JOURNAL'S dimensions expand from a page size of 6 3/4 x 9 7/8 inches to 8 1/8 x 10 7/8 inches. The second series of THE AMERICAN JOURNAL OF OPHTHALMOLOGY was published in this size from 1902 to 1917. With its merger into the third series, THE JOURNAL changed to the smaller size. The new size provides a major change in graphics supervised by a master of modern graphics techniques, Charles Todaro, of the Mack Printing Company. The new JOURNAL will publish larger and clearer figures (a boon to electron microscopy) and less crowded tables, and will appear in a more attractive format. THE JOURNAL will continue in its traditional twocolumn format with easily readable columns. Several new features will be added to the advertising section. The summary abstract of each of the original articles will be reprinted in the advertising section. Interested readers may clip these and, if they wish, paste them to a 3 x 5-inch index card for filing. This will permit easy access to pertinent articles. The Second Sight page by Janus will view ophthalmology from the perspectives of many publications.
Additionally, the advertising section will carry a New Products and Services section from which the interested reader can get a quick indication of new equipment available in the field. Many readers miss the ophthalmic miniatures that began in 1942. They were sacrificed to the reluctance of authors to have ophthalmic miniatures at the end of their articles. From time to time ophthalmic miniatures will reappear in the advertising section. With the popularity of the Letters section and the large amount of original material it contains, readers have easy access to the latest in ophthalmology. When this section is combined with the five-year index (last published in May 1983 for the five years between 1978 and 1982), the reader has a dynamic survey comparable to a recent textbook. As has been true of THEJOURNAL since its founding by Adoloph Alt in 1884, THE JOURNAL is responsive to the needs and wishes of its readers. Please tell us what you like and what you don't like about THE JOURNAL'S new format and features.