When pure GGNs are greater than 15 mm in diameter with nodularity or have high pixel attenuation (>-472 HU), the nodules are more likely to be invasive adenocarcinomas. Sublobar resection with a secured safety margin and without nodal dissection is performed for HRCT-suggested pure-GGN invasive adenocarcinomas and has a 100% 5-year survival rate.

2621 Background: The IIP, defined by enriched intratumoral tumor-infiltrating lymphocytes (TIL), is a potential tumor-agnostic biomarker of responsiveness to ICI therapy. Here, we validate the IIP, as assessed by Lunit SCOPE IO, an AI-powered spatial TIL analyzer that runs on routine H&E-stained whole-slide images (WSI), for clinical outcome prediction in a large, multi-center international cohort of ICI-treated patients, demonstrating its utility as a practical biomarker to guide ICI treatment planning. Methods: Lunit SCOPE IO was developed using 17,849 H&E WSI of multiple cancer types, annotated by 104 board-certified pathologists (13.5 x 109 µm2 area and 6.2 x 106 TIL). IIP+ tumors were defined as those with ≥ 20% of all 1 mm2 tumor tiles in a WSI classified as having a high intratumoral TIL density. We evaluated the correlation between IIP and ICI treatment outcomes (overall response rate (ORR) and progression-free survival (PFS), assessed by RECIST v1.1) in a real-world dataset of 1,806 patients ( > 16 primary tumor types) retrospectively collected from Stanford University Medical Center, Samsung Medical Center, Chonnam National University Hospital, Seoul National University Bundang Hospital, and Northwestern University. IIP status was sub-analyzed by PD-L1 22C3 tumor proportion score (TPS, n = 798), microsatellite status, and tumor mutational burden (TMB, n = 130). Results: The IIP+ phenotype (35.2%, 636 of 1,806) was highly enriched in nasopharyngeal carcinoma (68.0%), melanoma (56.3%), renal cell carcinoma (52.9%), and non-small cell lung cancer (NSCLC, 33.7%). The IIP+ proportion by PD-L1 TPS ( < 1% / ≥ 1%) was 21.6% and 40.7%, respectively. While 33.3% of microsatellite unstable (MSI-H) or TMB-high (≥ 10/Mb) tumors were IIP+, a substantial proportion (26.1%) of microsatellite stable (MSS), TMB-low tumors were IIP+. The ORR in IIP+ patients was significantly higher (26.0% vs. 15.8% in IIP-, p < 0.001). Median PFS for IIP+ was 5.3 months (95% CI 4.6-6.9 m), significantly longer than that for IIP- (3.1 m, 95% CI 2.8-3.6 m), with a hazard ratio (HR) of 0.68 (95% CI 0.61-0.76, p < 0.001). The association held after excluding NSCLC patients (n = 909) (HR 0.69, 95% CI 0.59-0.81, p < 0.001). On subgroup analysis, IIP+ correlated significantly with prolonged PFS, regardless of ICI regimen (mono / combo therapy) or PD-L1 TPS ( < 1% / ≥ 1%). Of note, IIP+ was predictive of favorable PFS only in the MSS, TMB-low group (n = 88, HR 0.56, 95% CI 0.33-0.96), but not in the MSI-H or TMB-high groups. Conclusions: The IIP, as evaluated by Lunit SCOPE IO, may represent a practical, clinically-actionable biomarker predictive of favorable ICI treatment outcomes across diverse cancer patient populations, including those with PD-L1 negative, MSS/TMB-low tumors, in whom predictive biomarkers are urgently needed.

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haematoxylin and eosin staining nor at immunohistochemical examination. All patients are still alive, except one patient who is dead of another cause, and free of local or distant recurrence after a mean follow-up of 4 years.SLNB is thus far a procedure which remains controversial in patients with melanomas of Breslow thickness less than or equal to 1 mm usually considered as 'good prognosis' lesions. 2,7 However literature reports a rate of positivity of SLN from 0% to 9.5% in melanomas of Breslow thickness less than or equal to 1 mm, with higher rate of positivity in regressive/ulcerative lesions. 3 In our study, we show the absence of microscopic lymph node involvement in regressive and/or ulcerated thin melanomas (Breslow thickness ≤ 1 mm, mean Breslow index = 0.59 mm). We conclude that SLNB was not useful in our series of thin melanomas, but further larger studies should be now focused on melanomas with Breslow index between 0.75 and 1 mm before concluding that SLNB procedure is not useful in thin regressive and/or ulcerated melanoma patients. 8 References1 Lens MB, Dawes M, Newton-Bishop JA, Goodacre T. Tumour thickness as a predictor of occult lymph node metastases in patients with stage I and II melanoma undergoing sentinel lymph node biopsy. Br J Surg 2002; 89: 1223-1227. 2 Kesmodel SB, Karakousis GC, Botbyl JD et al. Mitotic rate as a predictor of sentinel lymph node positivity in patients with thin melanomas. Ann Surg Oncol 2005; 12: 449-458. 3 Nguyen CL, McClay F, Cole DJ et al. Melanoma thickness and histology predict sentinel lymph node status. Am J Surg 2001; 181: 8-11. 4 Guitart J, Lowe L, Piepkorn M et al. Histological characteristics of metastasizing thin melanomas. Arch Dermatol 2002; 138: 603 -608. 5 Cook MG, Spatz A, Bröcker EB, Ruiter DJ. Identification of histological features associated with metastatic potential in thin (< 1.0 mm) cutaneous melanoma with metastases. A study on behalf of the EORTC Melanoma Group. J Pathol 2002; 197: 188 -193. 6 Vereecken P, Laporte M, Petein M, Steels E, Heenen M. Evaluation of extensive initial staging procedure in intermediate/high risk melanoma patients.