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J Thorac Oncol. 2014 Sep;9(9 Suppl 2):S88-96. doi: 10.1097/JTO.0000000000000293.

The ITMIG/IASLC Thymic Epithelial Tumors Staging Project: A Proposed Lymph Node Map for Thymic Epithelial Tumors in the Forthcoming 8th Edition of the TNM Classification of Malignant Tumors.

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*Thoracic Surgery, Columbia University, New York, New York; †Thoracic Surgery, Yale University, New Haven, Connecticut; ‡Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan; §Radiation Oncology, Queen's University, Ontario, Canada; ‖Thoracic Surgery, University of Torino, Torino, Italy; ¶Medical Oncology, Georgetown University, Washington, DC; #Thoracic Surgery, Sloan Kettering Cancer Center, NY, New York; **Thoracic Surgery, Samsung Medical Center, Seoul, South Korea; ††Thoracic Surgery, University of Tokushima, Tokushima, Japan; ‡‡Thoracic Surgery, University of Pisa, Pisa, Italy; §§Pathology, Regina Elena National Cancer Institute, Rome, Italy; ‖‖Radiology, MD Anderson Cancer Center, Houston, Texas; ¶¶Pathology, Royal Brompton Hospital, London, UK; ##Thoracic Surgery, Osaka University, Osaka, Japan; ***Thoracic Surgery, Antwerp University Hospital, Antwerp, Belgium.


Although the presence of nodal disease is prognostic in thymic malignancy, the significance of the extent of nodal disease has yet to be defined. Lymph node dissection has not been routinely performed, and there is currently no node map defined for thymic malignancy. To establish a universal language for reporting as well as characterize the staging of this disease more accurately, an empiric node map is proposed here. This was developed using prior classification systems, series reporting specifics of nodal involvement, anatomical studies of lymphatic drainage, and preexisting node maps of the chest as defined by the International Association for the Study of Lung Cancer and the neck as defined by the American Academy of Otolaryngology-Head and Neck Surgery and the American Society for Head and Neck Surgery. The development of this node map was a joint effort by the International Thymic Malignancy Interest Group and the Thymic Domain of the IASLC Staging and Prognostic Factors Committee. It was reviewed and subsequently approved by the members of ITMIG. This map will be used as an adjunct to define node staging as part of a universal stage classification for thymic malignancy. As more data are gathered using definitions set forth by this node map, a revision may be undertaken in the future.

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