medical decision support medical decision support
Sign In

Grading Criteria of Suzuki et al for Non-Small Cell Carcinomas of the Lung

Description

Suzuki et al used histologic criteria to classify non-small cell carcinomas of the lung in addition to the TNM classification. These features can help describe and compare different tumors. The authors are from the National Cancer Hospital in Tokyo and the National Cancer Hospital in Chiba, Japan.


 

Patient selection: adenocarcinoma, squamous cell carcinoma, other (large cell undifferentiated carcinoma, etc.)

 

Parameters scored:

(1) pleural involvement

(2) scar formation

(3) nuclear atypia (based on the most atypical area)

(4) mitotic activity (based on examination of several sections)

 

Additional criteria described:

(5) resection adequacy

(6) intrapulmonary metastasis

(7) lymphovascular invasion

Pleural Involvement

Code

does not extend beyond the elastic pleural layer

P0

invades the elastic layer of the visceral pleura but do not reach the pleural surface

P1

extends to the visceral pleural surface

P2

extends into the parietal pleura or into the chest wall

P3

 

 

Scar Formation

Grade

no or minimal fibroblastic tissue, with no collagen; may show foci of alveolar collapse with condensation of elastic fibers

1

fibroblastic tissue present with a small amount of collagen fibers

2

fibroblastic tissue with moderate or abundant amounts of collagen fibers

3

hyalinization

4

 

 

Nuclear Atypia

Grade

nuclei uniform in size, equal to or slightly larger than those of reactive type II alveolar pneumocytes

1

nuclei uniform in size, up to 2 times larger than those of reactive type II alveolar pneumocytes

2

presence of tumor giant cells

3

 

 

Mitotic Activity (based on 40x objective lens)

Grade

<= 5 per 10 high powered microscopic fields (HPF)

1

6-15 mitoses per 10 HPF

2

> 15 mitoses per 10 HPF

3

 

where:

• The text has Grade 2 mitotic activity as 6-10 and Grade 3 as > 15 per 10 HPF, leaving a gap in the range. 10 mitoses per 10 HPF does not seem to be a striking number.

 

Resection adequacy:

(1) Complete resection indicates a negative surgical margin and the highest mediastinal lymph node negative for tumor.

(2) Incomplete resection indicates a positive surgical margin and/or the highest mediastinal lymph node positive for tumor.

 

Intrapulmonary metastasis: An tumor mass separate from the primary tumor with identical histologic features.

 

Lymphovascular invasion: tumor cells in lymphatic or blood vessel lumen (endothelial lined space)

 


To read more or access our algorithms and calculators, please log in or register.

Specialty

ICD-10