Stadieinddeling af lungecancer

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Stadiegruppering i henhold til 9. TNM-klassifikationsudgave (198)

8th Edition TNM Classification of Lung Nonmucinous AIS, MIA, and Lepidic Predominant Adenocarcinoma

cT*	CT image on HRCT
	Solid part	0 cm	0 cm	< 0.5 cm†	0.6–1.0 cm†	1.1–2.0 cm†	2.1–3.0 cm†
	Total tumor size including GG	≤ 0.5 cm	0.6–3.0 cm‡‡	≤ 3.0 cm‡‡	0.6–3.0 cm††	1.1–3.0 cm††	2.1–3.0 cm††
	Pathologic Differential Diagnosis	AAH‡, AIS, MIA	AIS, MIA, LPA	MIA, LPA, AIS	LPA, Invasive AD, MIA	LPA, Invasive AD	Invasive AD
	Clinical Stage*		cTis‡‡	cT1mi‡‡	cT1a	cT1b	cT1c
pT	Invasive part	0 cm	0 cm	< 0.5 cm‡‡	0.6–1.0 cm†	1.1–2.0 cm†	2.1–3.0 cm†
	Total tumor size including lepidic growth part	Usually ≤ 0.5 cm‡	≤ 3.0 cm‡‡	≤ 3.0 cm‡‡	0.6–3.0 cm††	1.1–3.0 cm††	2.1–3.0 cm††
	Pathology	AAH	AIS	MIA	Lepidic predominant AD or invasive AD with lepidic component	Invasive AD with lepidic component or lepidic predominant AD	Invasive AD with lepidic component
	Pathologic Stage		pTis‡‡	pT1mi‡‡	pT1a	pT1b	pT1c

Proposed eighth edition of the clinical (cT) and pathologic T (pT) descriptor classification of small ( <3 cm) lung adenocarcinomas (ADs) with a ground glass (GG) and lepidic component by computed tomography (CT) and pathologic diagnosis.* The CT images on high-resolution CT (HRCT) scans can be suggestive of pathologic diagnoses, but they are not specific as GG opacities do not always correspond to lepidic patterns and solid components do not always correlate with invasive components. However, there is a general correlation between GG on CT scans and lepidic pattern microscopically, as well as between solid patterns on CT scans and invasive patterns histologically. A pathologic differential diagnosis is listed for each of the proposed possibilities on CT scans. Final pT staging of these tumors requires complete pathologic examination in resected specimens.

(Tis [AIS]) cT: These lesions typically show pure GG nodules (GGNs) measuring 3 cm or less; however, pure GGNs can also be minimally invasive AD (MIA) or invasive AD.^‡‡ pT: These tumors show pure lepidic growth without invasion, measuring 3 cm or less.^‡‡ If the pure GGN or lepidic predominant nodule is larger than 3.0 cm, it is classified as lepidic predominant AD (LPA) and should be staged as T1a (see text for explanation).

(T1mi) cT: MIA usually shows a GG predominant nodule 3 cm or smaller with a solid component that should appear 0.5 cm or smaller.^†,^‡‡ Although some MIAs have a larger solid component on CT scans because of other benign components such as a scar or organizing pneumonia, these cases can only be diagnosed by pathologic examination. pT: MIA histologically shows an LPA nodule measuring 3 cm or less with an invasive component measuring 0.5 cm or less.^†,^‡‡

(T1a) cT: GG predominant nodules measuring 3.0 cm or less with a solid component measuring 0.6 to 1.0 cm.^† pT: When an LPA measuring 3.0 cm or less has an invasive component measuring 0.6 to 1.0 cm, it is classified as pT1a.^†

(T1b) cT: GG predominant nodules measuring 3.0 cm or less with a solid component measuring 1.1 to 2.0 cm.^† pT: When an LPA measuring 3.0 cm or less has an invasive component measuring 1.1 to 2.0 cm, it is classified as pT1b.^†

(T1c) cT: GG predominant nodules measuring 3.0 cm or less with a solid component measuring 2.1 to 3.0 cm are classified as T1c. pT: When an invasive AD with a lepidic component measuring 3.0 cm or less has an invasive component measuring 2.1 to 3.0 cm, it is classified as T1c.^†

Source: Travis et al, J Thorac Oncol. 2016;11:1204-1223.

*All of the cT categories are presumptive, assuming the GG versus solid components correspond to lepidic versus invasive components, respectively, on pathologic examination of a resected specimen. cT category applying rule 4 of the TNM classification (when in doubt, opt for the lesser category).
^†In cases with multiple foci of solid or invasive components, see text for estimation of invasive size.
^‡Size is not the only distinguishing feature between atypical adenomatous hyperplasia (AAH) and AD in situ (AIS).
^‡‡If a pure GGN by CT or pure lepidic AD by pathologic pattern is larger than 3 cm, it should be classified as T1a. Similarly, if a GG predominant part-solid nodule has a solid component 0.5 cm or less, or if a tumor meets pathologic criteria for MIA but the total size is larger than 3 cm, it should be staged as cT1a or pT1a, respectively.
^††If the total tumor size is larger than 3.0 cm, depending on the invasive size these categories can be classified as T1a, T1b or T1c.

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