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SEER Inquiry System - Report
Produced: 11/28/2024 11:35 AM
Question 20190032
Inquiry Details
References:
2018 Summary Stage. Respiratory Tract and Thorax section, Lung chapter, v1.1
Question:
Summary Stage 2018--Lung: Are ground-glass lung nodules coded as distant for Summary Stage? See Discussion.
Discussion:
Chest x-ray: Multifocal pneumonia in left lung; possibility of masses in left lung not excluded.
Chest CT: 4 large ground-glass masses in LUL (largest 46mm); beginning of Tree-In-Bud appearance in LUL; 2 small ground-glass nodules in right lung.
Lung LUL biopsy: Adenocarcinoma, Solid Predominant.
No further information as patient did not want to discuss treatment options.
Per the AJCC book and CAnswer Forum, multifocal classification should be applied equally whether the lesions are in the same lobe OR in different ipsilateral lobes OR contralateral lobes, cT2b(m), cN0, cM0.
Answer:
Do not assume that ground glass presentation is consistent with a neoplasm. There are numerous causes of a ground glass lung condition such as sarcoidosis or pulmonary fibrosis. A ground glass lung opacity may also be observed in conditions such as alveolar proteinosis, desquamative pneumonitis, hypersensitive pneumonitis, and drug-induced or radiation-induced lung disease. If an area of ground glass opacity persists in the lung, it is usually classified as an adenocarcinoma, a classification that ranges from premalignant lesions to invasive disease. This is in line with AJCC that states to stage based on the largest tumor determined to be positive for cancer.
To Summary Stage the case example provided, ignore the lesions in the contralateral lung (do not assume that they are malignant). There are multiple lesions in the left lung, but once again, do not assume that those not biopsied are malignant. This leaves us with the lesion confirmed to be malignant, making this a Localized (code 1) tumor.
