Lung Cancer Reporting (Resection Specimens)

Measure Specification

The TNM staging revisions (AJCC 7th edition) became effective for all new cases diagnosed after January 1, 2010. The new staging system is applicable to both NSCLC and, for the first time, small cell lung cancer (SCLC). There are significant changes in staging, particularly in T3 for NSCLC. These updates were maintained in the AJCC 8th edition. Recent evidence suggests that significant variability still exists among clinicians with respect to staging practices

The TNM staging system of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) is recommended for non-small cell lung cancer. Small cell lung cancer has been more commonly classified according to a separate staging system as either “limited” or “extensive” disease, but based on analysis of the International Association for the Study of Lung Cancer (IASLC) database, TNM staging is also recommended for small cell lung cancer.

The purpose of pathologic evaluation is to precisely classify the histologic type of lung cancer and to determine all staging parameters as recommended by the AJCC including tumor size, the extent of invasion (pleural and bronchial), adequacy of surgical margins, and presence or absence of lymph node metastasis. Pathologic evaluation is performed to classify the histologic type of the lung cancer, determine the extent of invasion, determine whether it is primary lung cancer or metastatic cancer, establish the cancer involvement status of the surgical margins (i.

e., positive or negative margins), and do molecular diagnostic studies to determine whether certain gene mutations are present. A new lung cancer TNM staging system was developed by the International Association of the Study of Lung Cancer (IASLC) and adopted by the American Joint Commission for Cancer (AJCC) (8th edition, 2017). This new staging system is applicable to both NSCLC and SCLC based on studies by the IASLC which demonstrated the prognostic significance of the various stage designations in both diseases… application of the TNM system will not change how patients are treated; however, clinical research studies should begin to utilize the TNM system, because it will allow for more precise assessments of prognosis and specific therapy in the future.

Therefore, the SCLC algorithm was revised in 2011 to include the TNM staging information.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. Only one quality data code (QDC) per date of service for a patient is required.