Separate Tumor Nodules
Description
“Separate tumor nodules” refers to what is conceptually a single tumor with intrapulmonary metastasis in the ipsilateral (same) lung. Their presence in the same or different lobes of lung from the primary tumor affects the T and M categories. Separate tumor nodules are defined as intrapulmonary metastasis identified in the same lobe or same lung (ipsilateral) originating from a single lung primary at the time of diagnosis. Biopsy of tumors may or may not be performed. So long as there is a strong suspicion the multiple lesions are of the same histological type by imaging, physician judgement, or microscopically, this meets the criteria of separate tumor nodules representing intrapulmonary metastases. The presence of metastases to extrathoracic sites does not change this distinction.Notes
**Note 1:** **Physician Statement** * Physician statement of Separate Tumor Nodules in the ipsilateral (same) lung can be used to code this data item when no other information is available. See discussion of terminology in Note 3. * Separate tumor nodules in the contralateral lung are not coded in this data item. **Note 2:** **Intrapulmonary Metastasis** * Code the presence and location of separate tumor nodules with the same histologic type, also known as intrapulmonary metastasis, at the time of diagnosis in this item. * Separate tumor nodules can be defined clinically (by imaging) and/or pathologically. * They can be in the same or different lobes of the same lung as the primary tumor. * In the case of multiple tumor nodules determined to be the same primary, if not all nodules are biopsies, assume they are the same histology **Note 3:** **Situations NOT coded in this data item** * Other situations that display multiple lesions are NOT coded in this item. Assign code 0 if the multiple lesions belong to one of these other situations. Refer to the AJCC Staging System Lung for standardized and precise definitions of the situations which aren’t separate tumor nodules. They are * Second primary tumors, also called synchronous primary tumors (not the same histology as the primary tumor) * Multifocal lung adenocarcinoma with ground glass/lepidic features * Diffuse pneumonic adenocarcinoma **Note 4:** **Definition of Synchronous** * "Synchronous" describes the appearance in time compared to the primary tumor * Do not code this item based solely on the word "synchronous". * If separate nodules are described as "metachronous," the nodules may be evidence of progression of disease in which case they would not be coded here.| Code | Description |
|---|---|
| 0 | No separate tumor nodules; single tumor only Separate tumor nodules of same histologic type not identified/not present Intrapulmonary metastasis not identified/not present Multiple nodules described as multiple foci of adenocarcinoma in situ or minimally invasive adenocarcinoma Non-invasive neoplasm (behavior /2) |
| 1 | Separate tumor nodules of same histologic type in ipsilateral lung, same lobe |
| 2 | Separate tumor nodules of same histologic type in ipsilateral lung, different lobe |
| 3 | Separate tumor nodules of same histologic type in ipsilateral lung, same AND different lobes |
| 4 | Separate tumor nodules of same histologic type in ipsilateral lung, unknown if same or different lobe(s) |
| 7 | Multiple nodules or foci of tumor present, not classifiable based on Notes 2 and 3 |
| 8 | Not applicable: Information not collected for this case (If this item is required by your standard setter, use of code 8 will result in an edit error.) |
| 9 | Not documented in medical record Separate Tumor Nodules not assessed or unknown if assessed |