Enneking Staging

  • Purpose
    • Allow prognosis
    • Guide surgical management
    • Guide adjunctive therapies
  • A compartment is an anatomically confining space which will resist tumour spread beyond its boundaries
    • Intracompartmental
    • Intraosseous
    • Intra fascial compartments
    • Superficial to deep fascia
    • Parosseous
    • Extracompartmental
    • Extension beyond above
      • Pelvis
      • Popliteal fossae
      • Cubital fossa
      • Axilla

Musculoskeletal Tumour Society

Graded by grade, site and metastasis

FactorCategoryDescription
GradeG0Benign, encapsulated or reactive bone. Stage I latent, II active, III aggressive
GILow grade malignant. Pseudocapsule, microsatellites in reactive zone
GIIHigh grade malignant. Microsatellites, skip mets beyond reactive zone, permeative margin, Codmans triangle
SiteT0Intracapsular
TIExtracapsular but intracompartmental
TIIExtracapsular & extracompartmental
MetastasisM0No mets
MISkip, regional or distant mets
  • Compartment = anatomic structure forming barrier to extension, bone, cartilage or capsule
  • Skip metastasis, nodules of tumour separated from primary lesion by an intervening zone of normal non-reactive tissue, are not the same as satellites found in the reactive zone

Benign

StageBehaviourGrade, site, metastasis
ILatentG0, T0, M0
IIActiveG0, T0, M0
IIIAggressive, e.g. giant cellG0, T1 or II, MI or II

Malignant

StageDescription
1ALow grade, intracompartmental
1BLow grade, extracompartmental
2AHigh grade, intracompartmental
2BHigh grade, extracompartmental
3Metastasis

Original publication Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980(153):106-20.

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.