Lung

Pathologic TNM staging of carcinomas of the lung, AJCC 8th edition

• T, N and M categories code the anatomic extent of lung cancer and predict overall survival of patients with non small cell and small cell carcinomas
• The 8th edition AJCC / TNM classification has provided a more comprehensive stratification of tumors based on subdivision of T, N and M categories and also adopted the newly introduced histological entities of lung carcinoma

Images hosted on other servers:

• 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

• pNX: regional lymph nodes cannot be assessed
• pN0: no regional lymph nodes metastasis
• pN1: metastasis in ipsilateral peribronchial, ipsilateral hilar or intrapulmonary lymph node, including involvement by direct extension
• pN2: metastasis in ipsilateral mediastinal or subcarinal lymph node
• pN3: metastasis in contralateral mediastinal, contralateral hilar, ipsilateral / contralateral scalene or supraclavicular lymph node

Notes:

• In addition to anatomic extent of nodal disease, quantification based on the number of involved lymph node stations has prognostic impact

• pM0: no distant metastasis
• pM1a: separate tumor nodule in a contralateral lobe, pleural nodules, pericardial nodules, malignant pleural effusion or malignant pericardial effusion
• pM1b: single extrathoracic metastasis in a single organ (including a single non regional node)
• pM1c: multiple extrathoracic metastases in a single organ or in multiple organs

Notes:

• Most pleural and pericardial effusions are a result of the tumor
• Rarely, fluids are negative for tumor, non bloody and not an exudate; clinical judgment is required in these cases
  • Number of distant metastases has more prognostic relevance than organ location

A CT detected a ground glass nodule in the upper lung. Surgical resection revealed a 2 cm adenocarcinoma with pure lepidic pattern and no stromal invasion. What is the pT category?


1. pT0
2. pT1a
3. pT1b
4. pT1mi
5. pTis

E. pTis. The pTis category for adenocarcinoma in situ was added in the AJCC / TNM 8th edition staging scheme. By definition, this is a localized, small (≤ 3 cm) adenocarcinoma with growth restricted to neoplastic cells along pre-existing alveolar structures (lepidic growth) and lacking stromal, vascular, alveolar space or pleural invasion. Radiologic equivalent is a pure ground glass nodule on CT. In contrast, minimally invasive adenocarcinoma (pT1mi) is defined as a lepidic predominant adenocarcinoma measuring up to 3 cm with an invasive component measuring up to 0.5 cm.

Comment Here

Reference: Lung - Staging

What is the correct pM category for a lung carcinoma with an ipsilateral malignant pleural effusion?


1. pM0
2. pM1a
3. pM1b
4. pM1c

B. pM1a. A lung carcinoma with pleural or pericardial nodules or with a proven malignant pleural or pericardial effusion is defined as pM1a.

Comment Here

Reference: Lung - Staging