- pTX: primary tumor cannot be assessed or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
- pT0: no evidence of primary tumor
- pTis: carcinoma in situ, squamous cell carcinoma in situ, adenocarcinoma in situ (pure lepidic pattern and ≤ 3 cm)
- pT1mi: minimally invasive adenocarcinoma (≤ 3 cm with a predominantly lepidic pattern and ≤ 5 mm of invasion)
- pT1a: tumor ≤ 1 cm or rarely a superficial, spreading tumor of any size with invasive component limited to the bronchial wall that may extend proximal to the main bronchus
- pT1b: tumor > 1 cm but ≤ 2 cm
- pT1c: tumor > 2 cm but ≤ 3 cm
- pT2: tumor > 3 cm but ≤ 5 cm or involves the main bronchus regardless of distance to the carina without involvement of the carina, invades visceral pleura (PL1 or PL2) or is associated with atelectasis or obstructive pneumonitis that extends to the hilar region involving part or all of the lung
- pT2a: tumor > 3 cm but ≤ 4 cm or has 1 of the above features and size cannot be determined
- pT2b: tumor > 4 cm but ≤ 5 cm
- pT3: tumor > 5 cm but ≤ 7 cm or directly invades parietal pleura (PL3), chest wall (including superior sulcus tumors), phrenic nerve or parietal pericardium or presence of a separate tumor nodule in the same lobe
- pT4: tumor > 7 cm or tumor of any size invading diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body or carina or presence of a separate tumor nodule in an ipsilateral different lobe
Notes:
- Tumor size has important prognostic relevance; each centimeter increase in size, from less than 1 cm to up to 5 cm, yields a significantly different prognosis
- Multiple separate nodules are classified into four disease patterns (J Thorac Oncol 2016;11:639):
- Multiple primary tumors
- Nodules of the same histopathological type
- Multiple tumors with predominant ground glass features on CT and a lepidic pattern on pathological examination
- Diffuse pneumonic type lung cancer
- Multiple primary tumors
- Considered separate primary tumors if different histologic types (e.g., squamous carcinoma and adenocarcinoma) or are squamous carcinomas that have arisen from carcinoma in situ
- Different biomarker pattern and absence of nodal or systemic metastases favor multiple primary tumors
- Single primary tumor
- Considered to have arisen from a single tumor if an exact match by comparative genomic hybridization
- Similar histologic appearance, matching biomarker patterns and significant nodal or systemic metastases favor a single primary tumor