EOD Primary Tumor
**Note 1:** Bronchopneumonia is not the same thing as obstructive pneumonitis and should not be coded as such.
* Bronchopneumonia is an acute inflammation of the walls of the bronchioles, usually a result of spread of infection from the upper to the lower respiratory tract
* Obstructive pneumonitis is a combination of atelectasis, bronchiectasis with mucous plugging, and parenchymal inflammation that develops distal to an obstructing endobronchial lesion
**Note 2:** Ground glass opacities (GGO), ground glass nodules (GGN), and ground/glass lepidic (GG/L) are frequently observed on CT and are increasingly detected with the advancements in imaging and are described as an area of hazy increased lung opacity. GGO, GGN, and GG/L can be observed in both benign and malignant lung conditions along with pre-invasive lesions (adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic carcinoma). They are often associated with early stage lung cancer but not necessarily malignancies themselves.
* For staging purposes, these are not to be counted as separate tumor nodules
**Note 3:** Code 100 is to be used only when the following criteria are met
* Minimally invasive adenocarcinoma (less than or equal to 3 cm)
* **WITH** predominantly **lepidic pattern** **AND**
* less than or equal to 5 mm invasion in greatest dimension
* If predominantly **lepidic pattern** is present and the size of the invasive component is unknown, see code 300
**Note 4:** Code 200 is to be used for **superficial spreading tumors** only. The pathology report must state that it is superficially spreading.
* These types of tumor are uncommon, and this code should be used very sparingly. If in doubt, do not use this code
**Note 5:** Code 300 is to be used for a localized cancer where size defines the extent of the primary tumor. It is not a predominantly lepidic pattern (code 100), or a superficial spreading tumor (code 200), and there is no involvement of adjacent structures or invasion of the pleural (codes 400 and above).
**Note 6:** Atelectasis is the failure of the lung to expand (inflate) completely. This may be caused by a blocked airway, a tumor, general anesthesia, pneumonia or other lung infections, lung disease, or long-term bed rest with shallow breathing. Sometimes called a collapsed lung.
* For staging purposes, atelectasis must present with an obstructing tumor
**Note 7:** Specific information about visceral pleura invasion is captured in codes 450 (PL1, PL2, or NOS) and 500 (PL3). Elastic layer involvement has prognostic significance for lung cancer.
**Note 8:** Penetration of the visceral pleura indicates a progression of invasion, even in small (≤ 3cm) tumors, and indicates a less favorable prognosis. Visceral pleural invasion is determined to be present both in tumors that extend to the visceral pleural surface (type PL2 invasion), and in tumors that penetrate beyond the elastic layer of the visceral pleura (type PL1 invasion). Further invasion, which extends to the parietal pleura, is also described as type PL3 invasion.
**Note 9:** "Vocal cord paralysis," "superior vena cava syndrome," and "compression of the trachea or the esophagus" are classified as either direct extension from the primary tumor or mediastinal lymph node involvement
* If these manifestations are caused by direct extension of the primary tumor, code as primary tumor involvement (EOD Primary Tumor, code 650)
* If the primary tumor is peripheral and clearly unrelated to vocal cord paralysis, SVC obstruction, or compression of the trachea, or the esophagus, these manifestations are secondary to lymph node involvement; code as mediastinal lymph node involvement (EOD Lymph Nodes, code 400)
* If unable to determine if these manifestations are due to direct extension or mediastinal lymph node involvement, record as mediastinal lymph node involvement (EOD Lymph Nodes, code 400)
**Note 10:** Separate ipsilateral tumor nodules of the same histopathological type (intrapulmonary metastases) are coded either 500 (same lobe) or 700 (different ipsilateral lobe). Separate tumor nodules in the contralateral lung are assigned in EOD Mets.
**Note 11:** Occult carcinoma occurs when tumor is proven by the presence of malignant cells in sputum or bronchial washings, but there is no other evidence of the tumor. In these cases, assign EOD Primary Tumor 980, EOD Regional Nodes 000, and EOD Mets 00.
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