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Staging (Lung)
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Staging (Lung)
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Pathologic Stage Classification (pTNM, AJCC 8th Edition) CAP Approved Lung – Lung 4.0.0.0
TNM Descriptors (required only if applicable) (select all that apply)
___ m (multiple primary tumors)
___ r (recurrent)
___ y (posttreatment)
Primary Tumor (pT)
___ pTX: Primary tumor cannot be assessed, or tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
___ pT0: No evidence of primary tumor
___ pTis (SCIS): Squamous cell carcinoma in situ (SCIS)
___ pTis (AIS): Adenocarcinoma in situ (AIS): adenocarcinoma with pure lepidic pattern, =3 cm in greatest dimension
pT1: Tumor =3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (ie, not in the main bronchus)
___ pT1mi: Minimally invasive adenocarcinoma: adenocarcinoma (=3 cm in greatest dimension) with a predominantly lepidic pattern and =5 mm invasion in greatest dimension (See note C)
___ pT1a: Tumor =1 cm or less in greatest dimension; A superficial spreading tumor of any size with its invasive component limited to the bronchial wall and may extend proximal to the main bronchus also is classified as T1a, but these tumors are uncommon
___ pT1b: Tumor >1 cm, but =2 cm in greatest dimension ___ pT1c: Tumor >2 cm but =3 cm in greatest dimension pT2: Tumor >3 cm but =5 cm or having any of the following features:# • Involves the main bronchus regardless of distance to the carina, but without involvement of the carina; • Invades visceral pleura (PL1 or PL2); • 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 in greatest dimension
___ pT2b: Tumor >4 cm, but =5 cm in greatest dimension
___ pT3: Tumor >5 cm but =7 cm in greatest dimension; or directly invading any of the following: parietal pleura (PL3), chest wall (including superior sulcus tumors), phrenic nerve, parietal pericardium; or separate tumor nodule(s) in the same lobe as the primary
___ pT4: Tumor >7 cm in greatest dimension; or tumor of any size invading one or more of the following: diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body or carina; or separate tumor nodule(s) in an ipsilateral lobe different from that of the primary
Regional Lymph Nodes (pN)
___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN1: Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes, including involvement by direct extension
___ pN2: Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
___ pN3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
Distant Metastasis (pM) (required only if confirmed pathologically in this case) pM1: Distant metastasis
___ pM1a: Separate tumor nodule(s) in contralateral lobe; tumor with pleural or pericardial nodules or malignant pleural (or pericardial) effusion#
___ pM1b: Single extrathoracic metastasis in a single organ (including involvement of a single nonregional lymph node)
___ pM1c: Multiple extrathoracic metastases in single organ or in multiple organs Specify site(s) (if applicable): ____________________________
- Size of invasion determines pT (sizes for pT stages have all changed)
- Subtyping of adenocarcinoma pattern %s
- Formula for determining largest dimension of invasive component
- New reporting STAS - Removal of atelectasis for pT staging