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Brigham Staging System

In 1993, while working at the Brigham & Women’s Hospital, Dr. David Sugarbaker and several colleagues developed the Brigham/Dana-Farber Cancer Institute Staging System (often shortened to simply the Brigham Staging System). The system was developed based on clinical experience with 52 patients. Dr. Sugarbaker updated his Brigham system in 1998 based on subsequent experience.

The Brigham Staging System places a heavy emphasis on the viability of surgery as a treatment option for patients. Generally, Stage 1 and Stage 2 mesothelioma tumors are still viable candidates for removal; however, by the time the mesothelioma cancer reaches the lymph nodes (Stage 3) or metastasizes into other areas of the body (Stage 4), surgery is no longer a valid option, and other treatments will need to be sought out.

Stages of the Brigham System

As with other staging systems, the Brigham system is composed of four stages. However, rather than simply defining the location and assessing the nodal responses and metastasis, the Brigham System also assesses the possibility and effectiveness of surgical intervention at each stage.

Brigham Staging System
Stage Description
Stage 1 Disease completely resected within the capsule of the parietal pleura without adenopathy: ipsilateral pleura, lung, pericardium, diaphragm, or chest wall disease limited to previous biopsy sites. Surgery is a viable option.
Stage 2 All of stage I with positive resection margins and/or intrapleural adenopathy. At this stage, surgery is still a viable option.
Stage 3 Local extension of disease into the chest wall or mediastinum; heart, or through diaphragm, peritoneum; or with extrapleural lymph node involvement. Surgery is no longer a viable option.
Stage 4 Distant metastatic disease – surgery is not a viable option.


Flores RM, Rush VW. Staging of Mesothelioma. In: Pass HI, Vogelzang N, Carbone M, ed. Malignant Mesothelioma: Pathogenesis, Diagnosis, and Translational Therapies. New York, NY: Springer;2005:402-415.

Sugarbaker DJ, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg. 1999 Jan;117(1):54-63; discussion 63-5.

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