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Lung Cancer Synoptic Report — CAP + AJCC 9 Detailed Stage Group Guidance
Lung Cancer Synoptic Report — CAP fields with AJCC 9 Detailed Stage Group Criteria
Case / Specimen
Primary Tumor / Pathologic Findings
- pTis: carcinoma in situ.
- pT1: tumor ≤3.0 cm; subcategories per size (pT1a/pT1b/pT1c) — use AJCC 9 numeric breaks.
- pT2: >3.0–≤5.0 cm OR tumor with main bronchus involvement ≥2 cm distal to carina OR visceral pleural invasion OR atelectasis/obstructive pneumonitis to the hilum (not entire lung). Subcategories (pT2a/pT2b) use size splits.
- pT3: >5.0–≤7.0 cm OR direct invasion of chest wall, phrenic nerve, parietal pleura OR separate tumor nodule(s) in same lobe.
- pT4: >7.0 cm OR invasion of mediastinum/heart/great vessels/trachea/recurrent laryngeal nerve/esophagus/vertebrae/carina OR separate tumor nodule(s) in different ipsilateral lobe.
- Separate ipsilateral lobe nodules = pT4; contralateral nodules = M1a/b depending on context.
- Document measurement method, pleural invasion (PL0/1/2/3), STAS, and microscopic confirmation of invasion sites.
Lymph Nodes
Biomarkers / Molecular
Record assay method and specimen source. Molecular results may influence therapy and prognostic staging adjustments per AJCC 9 where applicable.
AJCC 9 Stage Group Guidance — Detailed Criteria
Use AJCC 9th edition manual for official tables. The following gives explicit mapping logic and representative T/N/M permutations used to determine stage groups and subgroups.
Show/hide: Overview & mapping logic
- Core principle: Stage group = combination of pT, pN, and pM (apply yp prefix for post‑therapy).
- Determine pT using detailed pT rules (size, invasion, separate nodules).
- Determine pN by nodal station location: N0 (no regional nodes), N1 (ipsilateral peribronchial/hilar/intrapulmonary), N2 (ipsilateral mediastinal/subcarinal), N3 (contralateral mediastinal/hilar or supraclavicular).
- pM1 subdivided by distribution of metastases (M1a, M1b, M1c) — map to Stage IV subgroups per AJCC 9.
- Stage group is then selected from AJCC 9 tables: e.g., Stage IA (small pT1 tumors, N0), Stage IIA (higher pT with N0 or selected T with limited N1), Stage III subdivisions determined by specific T & N combinations, Stage IV when any M1 present.
- Record staging rationale and all contributing elements in the report.
Show/hide: Detailed representative Stage Group table (explicit T/N combos)
Stage Group
Representative pT / pN (AJCC 9 examples)
Interpretation / Notes
0
pTis, N0, M0
In situ
IA1
pT1a (≤1 cm), pN0, M0
Very small peripheral tumor, no nodes
IA2
pT1b (>1–2 cm), pN0, M0
Small tumor, no nodes
IA3
pT1c (>2–3 cm), pN0, M0
Small tumor, no nodes
IB
pT2a (>3–4 cm), pN0, M0
Visceral pleural invasion or size within pT2a
IIA
pT2b (>4–5 cm) or pT3 (≤5 cm with qualifying features), pN0, M0
Higher T with no nodes
IIB
pT3 (>5–≤7 cm) pN0 OR pT1–2 with pN1
Large tumor or limited ipsilateral nodal involvement
IIIA
pT1–2 with pN2 OR pT3 with pN1
Ipsilateral mediastinal nodes or mixed combos
IIIB
pT3–T4 with pN2 (edition mapped) or selected T with N3
More extensive local disease and/or mediastinal nodal spread
IIIC
Any T with pN3, M0
Contralateral mediastinal/hilar or supraclavicular nodes
IVA
Any T, Any N, M1a (e.g., separate tumor nodule in contralateral lung; pleural/pericardial nodules; malignant pleural effusion)
Limited intrathoracic metastasis
IVB
Any T, Any N, M1b (single extrathoracic metastasis)
Single distant metastasis
IVC
Any T, Any N, M1c (multiple extrathoracic metastases)
Widespread metastatic disease
These representative mappings show common permutations. AJCC 9 specifies exact size boundaries for T subcategories and precise definitions for M1a/b/c. Always confirm with the official AJCC 9 tables.
Show/hide: Worked examples of stage assignment
Example 1 — Small peripheral adenocarcinoma 1.8 cm, no nodes, no metastasis:
- pT1b (1.8 cm) pN0 pM0 → Stage IA2 (representative).
Example 2 — 4.7 cm tumor invading visceral pleura, ipsilateral hilar node positive (station 10):
- Size 4.7 cm → pT2b (if AJCC 9 uses >4–5 cm split) + visceral pleura may also contribute → pN1 (hilar) → Combined → Stage IIB/IIIA depending on exact T subcategory mapping; consult table and record rationale.
Example 3 — 6.5 cm tumor invading chest wall with ipsilateral mediastinal node (station 4R) positive:
- Size 6.5 cm → pT3; mediastinal node → pN2 → Combined → Stage IIIA/IIIB based on table mapping; follow AJCC 9 exact permutation mapping.
Example 4 — Primary with separate contralateral pulmonary nodule:
- Contralateral nodule = M1a → Stage IVA (any T/N with M1a).
Practical checklist for assigning stage group (include in report):
1) Measured greatest tumor dimension and method.
2) Pleural invasion status (PL0/1/2/3) and method (elastic stain if used).
3) Separate tumor nodules (same lobe / ipsilateral different lobe / contralateral).
4) Node stations positive with counts and laterality (station: positive/total).
5) Presence of malignant pleural/pericardial effusion or pleural nodules (M1a features).
6) Any distant metastases (sites, number) to subcategorize M1b/M1c.
7) yp prefix and treatment response if neoadjuvant therapy administered.
8) Rationale line: list pT, pN, pM and AJCC table reference used.