PNM classification of alveolar echinococcosis

P	Hepatic localization of the parasite
PX	Primary tumor cannot be assessed
P0	No detectable tumor in the liver
P1	Peripheral lesions without proximal vascular and/or biliar involvement
P2	Central lesions with proximal vascular and or biliar involvement of 1 lobe*
P3	Central lesions with hilar vascular of biliar involvement of both lobes and/or with involvement of 2 hepatic veins
P4	Any liver lesion with extension along the vessels and the biliary tree^¶
N	Extrahepatic involvement of neighboring organs (diaphragm, lung, pleura, pericardium, heart, gastric and duodenal wall, adrenal glands, peritoneum, retroperitoneum, parietal wall [muscles, skin, bone], pancreas, regional lymph nodes, liver ligaments, kidney)
NX	Not evaluable
N0	No regional involvement
N1	Regional involvement of contiguous organs or tissues
M	The absence or presence of distant metastasis (lung, distant lymph nodes, spleen, central nervous system, orbital, bone, skin, muscle, kidney, distant peritoneum, and retroperitoneum)
MX	Not completely evaluated
M0	No metastasis^Δ
M1	Metastasis

PNM classification denotes the extension of the parasitic mass in the liver (P), involvement of neighboring organs (N), and metastases (M).

* For classification, the plane projecting between the bed of the gall bladder and the inferior vena cava divides the liver in two lobes.
¶ Vessels mean inferior vena cava, portal vein and arteries.
Δ Chest X-ray and cerebral computed tomography negative.

Reproduced from: Brunetti E, Kern K, Vuitton DA, Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Tropica 2009; 114:1. Table used with the permission of Elsevier Inc. All rights reserved.

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PNM classification of alveolar echinococcosis