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By histological definition, in-situ adenocarcinoma is defined only for GGOs with a diameter of http://www.selleckchem.com/products/OSI-906.html tumour is coded for the invasive component only. The concept that overall burden of lymph nodal disease (nN) might be more important than the anatomical location of the involved nodes comes from similar observations in oesophageal cancer. In a large retrospective series of resected Japanese patients, it was observed that the number of lymph nodes involved was a more precise prognostic determinant than their location and could be considered for the nodal stage classification as is done in other organs [62]. However, it is difficult buy MLN0128 to assess the exact number of the metastatic lymph nodes pre-operatively, and a uniform definition for pre- and post-operative assessment is preferable to avoid confusion. Besides, fragmentation of lymph nodes produced during the operation might result in an overestimation of the survival risk. Pleural lavage cytology (PLC) is performed by some surgeons as the initial step after performing thoracotomy. In patients without overt effusion or pleural dissemination, a recent meta-analysis confirmed that PLC shown to be positive for cancer cells has an adverse and independent prognostic impact after complete resection [63]. CGK 733 When PLC is positive, the resection should be classified as R1(cy+). Sophisticated immunohistochemical and genetic techniques permit the detection of very small tumour deposits. A micrometastasis as defined by the UICC and AJCC usually is detected by routine haematoxylin and eosin staining, and typically mitoses and invasion are seen [64]. Such micrometastases in nodes or distant sites are counted as positive and denoted by the symbol (mi): for example, cN1(mi) or pN2(mi). However, the prognostic impact was not evaluated in the IASLC staging analysis. Isolated tumour cells (ITCs) are small clumps of tumour cells typically without mitoses or vascular or lymphatic invasion. ITCs within nodes (or distant sites) are not counted in the stage classification and should be coded as N0 (or M0), regardless of node level harbouring the ITC, for example, pN0(i 1) or pN0(mol 1). The prognostic value of ITCs has been inconsistent. The same applies for circulating tumour cells [65]. A staging classification describes the anatomical extent of a tumour, disregarding its biological behaviour.