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. 2020 Oct 20;12:10361–10374. doi: 10.2147/CMAR.S268081

Table 1.

Three Common Diagnostic Criteria for Multiple Primary Lung Cancers

Martini Melamed criteria10 ACCP guidelines11 TNM staging system (8th edition)12
sMPLCs:
1. Tumors physically distinct and separate
2. Histology:
A. Different histological types
B. Same histological type, but in different segments, lobes, if origin from carcinoma in situ
And no carcinoma in lymphatics common to both
And no extrapulmonary metastases		 sMPLCs:
1. Different histology
2. Different molecular genetic characteristics
3. Arising from a separate focus of carcinoma in situ
4. Same histology, if:
Tumors in different lobes
And no N2, N3 involvement
And no systemic metastases		 Clinical Criteria for sMPLCs:
1. Different histological types on biopsy
2. Arguments favoring sMPLCs:
Different radiographic appearance or metabolic uptake
Different growth rates
Different biomarker pattern
Absence of lymphatic or systemic metastases
mMPLCs:
1. Different histological types
2. Same histological type, if:
Free interval between cancers ≥2 years
Or origin from carcinoma in situ
Or second cancer in different lobes and no carcinoma in common lymphatics and extrapulmonary sites		 mMPLCs:
1. Different histology
2. Different molecular genetic characteristics
3. Arising from a separate focus of carcinoma in situ
4. Same histology, temporarily separated, if:
Free interval between cancers ≥4 years
And no systemic metastases		 Pathologic criteria for sMPLCs (e.g., after resection):
1. Different histological types
2. Clearly different comprehensive histologic assessment
3. Squamous carcinomas arising from carcinoma in situ.
4. Arguments favoring sMPLCs:
Different biomarker pattern
Free of lymphatic or systemic metastases.

Abbreviations: ACCP, American College of Chest Physicians; sMPLCs, synchronous multiple primary lung cancers; mMPLCs, metachronous multiple primary lung cancers.