Lung cancer (IASLC 7th edition staging)

The International Association for the Study of Lung cancer (IASLC) 7th edition for lung cancer staging is as follows. This has now been updated with an 8th edition in 2016

The parameter assessed on the T stage include size, endobronchial location, local invasion, atelectasis, and separate tumour nodules.

  • T1: no invasion of proximal lobar bronchus. Tumour is surrounded by lung or visceral pleural:
    • T1a ≤ 2 cm
    • T1b > 2 cm but ≤ 3 cm
  • T2: local invasion of visceral pleura. Atelectasis/obstructive penumonitis that extends to the hilum but do not involve the entire lung:
    • T2a > 3 cm and ≤ 5 cm
    • T2b > 5 cm but ≤ 7 cm
  • T3:
    • >7 cm.
    • endobronchial location/involvement <2 cm distal to the carina. 
    • atelectasis and/or obstructive pneumonitis of the entire lung.
    • separate tumour nodule in the ipsilateral primary tumour lobe. 
    • involvement of the chest wall, including Pancoast tumour, diaphragm, phrenic nerve, mediastinal pleura or parietal pericardium
  • T4:
    • any size tumour with mediastinal, tracheal, oesophageal and/or vertebral body invasion.
    • separate tumour nodule in the ipsilateral lung but a different lobe. 
  • N1: ipsilateral hilar, interlobar, segmental and subsegmental node.
  • N2: ipsilateral mediastinal node. 
  • N3:
    • contralateral mediastinal or pulmonary nodes
    • ipsilateral or contralateral supraclavicular or scalene nodes
  • M1a: separate tumour deposit in the contralateral lung, pleural surface or malignant pleural and/or pericardial effusion
  • M1b: distant metastases

For prognostic purposes, thoracic lymph nodes can be divided into prognostic zones which is easier to remember than individual thoracic lymph node stations/levels 4:

  • supraclavicular zone: nodal station 1
  • upper zone: nodal stations 2-4
  • aortopulmonary zone: nodal stations 5-6
  • subcarinal and lower zones: nodal stations 7-9
  • hilar/interlobar and peripheral zones: nodal stations 10-14
Nodal numbering system
  • 1  =  low cervical, supraclavicular and sternal notch nodes
  • 2 = upper paratracheal nodes 
    • 2R = right upper paratracheal nodes
    • 2L  =  left upper paratracheal nodes
  • 3  =  pre-vascular and retrotracheal nodes
  • 4 = lower paratracheal nodes
    • 4R = right lower paratracheal nodes
    • 4L =  left lower paratracheal nodes
  • 5  =  subaortic/ aortopulmonary nodes 
  • 6 =  para-aortic nodes
  • 7  =  subcarinal nodes
  • 8 =  para-oesophageal nodes
  • 9  =  pulmonary ligament nodes
  • 10 = hilar nodes
    • 10R = right hilar nodes
    • 10L =  left hilar nodes
  • 11 = inter lobar nodes
    • 11R = right interlobar nodes
    • 11L = left interlobar nodes
  • 12 = lobar nodes
    • 12R = right lobar nodes
    • 12L  =  left lobar nodes
  • 13 = segmental nodes
    • 13R = right segmental nodes
    • 13L  =  left segmental nodes
  • 14 = sub segmental nodes
    • 14R = rightubsegmental nodes 
    • 14L =  left subsegmental nodes

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Article Information

rID: 25080
System: Chest
Section: Staging
Synonyms or Alternate Spellings:
  • 1996 AJCC-UICC regional lymph node classification system for lung cancer staging

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