Biomarkers (Tumor Markers)

In addition to the standard data items found on a pathology report, information on Biomarkers and Genetics can also be found on the pathology report. Some of these may be found on the original pathology report (with or without an addendum), or in a molecular pathology report.

For Lung, there are several Biomarker data items. These are called Site-Specific Data Items (SSDIs), and are collected for each case.

See Schemas | SSDI and Grade Data for the SSDI manual and the schema information or SEER*RSA in the Lung schema for complete coding instructions for these data items.

Note: For the SSDIs, it is very important that you always read the general instructions (see NAACCR link above) first. For example, the general instructions tell you how to code when there is a range, “less than” or “greater than” is used. After the general instructions are reviewed, you move to the data specific instructions.

Biomarkers (tumor markers) can be diagnostic, predictive, and/or prognostic.

• Diagnostic: Aid in making diagnosis
• Predictive: Associated with response to treatment
• Prognostic: Associated with disease outcome (i.e., overall survival)

There are several biomarkers that are collected for Lung. More information for these SSDIs can be found in the SSDI Manual

Separate Tumor Nodules

Separate Tumor Nodules are defined as intrapulmonary metastases, meaning a single primary lung tumor with one or more separate malignant nodules in the same lung.

This data item captures malignant separate tumor nodules in the ipsilateral lung only. Separate tumor nodules in the contralateral lung are not coded in this SSDI and are reflected in stage only.

Information about separate tumor nodules is typically obtained from radiology reports, and may be supported by physician documentation or staging statements.

Separate tumor nodules can be hard to distinguish. Many times there are nodules present, but they are not the same as separate tumor nodules. Just because a radiology report states “nodule,” one cannot assume that it is a separate tumor nodule. Nodules in the lung can appear for many reasons.

If a radiology report states a nodule is present, don’t automatically assume it’s a separate tumor nodule. Look for information such as “nodule consistent with metastatic disease,“ or “nodule concerning for malignancy.” A radiologist must indicate in some way that the nodule is thought to be malignant.

The stage assigned can also indicate that the nodule is thought to be malignant. If a tumor is staged as a localized tumor (with or without lymph nodes), then there are no separate tumor nodules. If a tumor is staged as a regional or distant, separate tumor nodules may be present. Always check the physician staging if you are not clear if there are separate tumor nodules present.

Visceral and Parietal Pleural Invasion

Visceral and Parietal Pleural Invasion (VPI) is defined as tumor extension beyond the elastic layer of the pleura.

The presence of VPI is an adverse prognostic factor and is associated with upstaging, more aggressive tumor behavior, increased complications, and poorer survival outcomes.

Assessment of VPI requires surgical resection, as pleural invasion is determined by surgical resection

If no surgical resection was performed, code 9, per SSDI instructions.

Updated: April 8, 2026