CS Lymph Nodes

Notes

**Note 1**: Code only regional nodes and nodes, NOS, in this field. Distant nodes such as cervical (excluding supraclavicular) or contralateral axillary are coded in CS Mets at DX. **Note 2**: Micrometastases are defined as tumor deposits greater than 0.2 millimeter (mm) but not greater than 2.0 mm in largest dimension. Macrometastases are tumor deposits greater than 2.0 mm. All nodes with at least micrometastases are included in the count of positive lymph nodes, but at least one node must contain a macrometastasis for assignment of a pathologic N category greater than pN1mi. **Note 3**: If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2 mm and code the lymph nodes as positive in this field. Use code 600 in the absence of other information about regional nodes. **Note 4**: In a physical exam if palpable nodes are not described as fixed or matted, assume that nodes are movable. **Note 5**: Codes 130-600 refer to level I and level II ipsilateral axillary lymph nodes and ipsilateral intramammary nodes only. Ipsilateral level III axillary lymph nodes, which are also known as infraclavicular or apical nodes, are coded 750 or higher. Axillary lymph nodes do not include internal mammary or ipsilateral supraclavicular lymph nodes. **Note 6**: For the breast schema, the choice of the N category is dependent on the CS Lymph Nodes Eval field. There are certain CS Lymph Nodes codes that can only be used if the nodes are evaluated clinically (CS Lymph Nodes Eval is coded 0, 1, 5, or 9), which will be designated as "Evaluated clinically:" at the beginning of the code description. Similarly, there are certain CS Lymph Nodes codes that can only be used if the nodes are evaluated pathologically (CS Lymph Nodes Eval is coded 2, 3, 6, or 8), and these will be designated as "Evaluated pathologically:". All other codes can be used for clinical or pathologic evaluation. **Note 7**: Isolated tumor cells (ITC) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected only by immunohistochemical (IHC) or molecular methods but which may be verified on hematoxylin and eosin (H and E) stains. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). Lymph nodes with ITCs only are not considered positive lymph nodes. If the record only states N0(i+), code to 000 and see CS Site-Specific Factor 4.
Code Description AJCC 7 N TNM 6 N Summary Stage 1977 N Summary Stage 2000 N
000 No regional lymph node involvement
OR isolated tumor cells (ITCs) detected by immunohistochemistry/immunohistochemical (IHC) methods or molecular methods ONLY.
(See Note 7 and CS Site-Specific Factors 4 and 5)		 IHC MOL IHC MOL NONE NONE
050 Evaluated pathologically:

None; no regional lymph node involvement
BUT ITCs detected on routine hematoxylin and eosin (H and E) stains.
(See Note 7)		 N0(i+) N0(i+) NONE NONE
130 Evaluated pathologically:

Axillary lymph node(s), ipsilateral, micrometastasis ONLY detected by IHC ONLY
(At least one micrometastasis greater than 0.2 mm or more than 200 cells
AND all micrometastases less than or equal to 2 mm)		 N1mi N1mi RN RN
150 Evaluated pathologically:

Axillary lymph node(s), ipsilateral, micrometastasis ONLY detected or verified on H&E
(At least one micrometastasis greater than 0.2 mm or more than 200 cells
AND all micrometastases less than or equal to 2 mm)

Micrometastasis, NOS		 N1mi N1mi RN RN
155 Evaluated pathologically:

Stated as N1mi with no other information on regional lymph nodes		 N1mi N1mi RN RN
250 Evaluated pathologically:

Movable axillary lymph node(s), ipsilateral, positive with more than micrometastasis
(At least one metastasis greater than 2 mm)
(See Note 4)		 Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
255 Evaluated clinically:

Clinically movable axillary lymph node(s), ipsilateral, positive
(Clinical assessment because of neoadjuvant therapy or no pathology)
(See Note 4)		 N1 N1 RN RN
257 Evaluated clinically:

Clinically stated only as N1
(Clinical assessment because of neoadjuvant therapy or no pathology)		 N1 N1 RN RN
258 Evaluated pathologically:

Pathologically stated only as N1 [NOS], no information on which nodes were involved 		Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
260 Stated as N1 [NOS] with no other information on regional lymph nodes Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
280 OBSOLETE DATA RETAINED V0104

Stated as N2, NOS		 ERROR: Determine Correct Table for AJCC N RN RN
290 OBSOLETE DATA CONVERTED V0203
See code 610

Clinically stated only as N2, NOS (clinical assessment because of neoadjuvant therapy or no pathology)		 ERROR: ERROR: ERROR: ERROR:
300 OBSOLETE DATA CONVERTED V0203
See code 620

Pathologically stated only as N2 NOS; no information on which nodes were involved		 ERROR: ERROR: ERROR: ERROR:
500 OBSOLETE DATA RETAINED V0104

Fixed/matted ipsilateral axillary nodes, positive with more than micrometastasis (i.e., at least one metastasis greater than 2 mm)

Fixed/matted ipsilateral axillary nodes, NOS		 ERROR: Determine Correct Table for AJCC N RN RN
510 Evaluated clinically:

Fixed/matted ipsilateral axillary nodes clinically
(Clinical assessment because of neoadjuvant therapy or no pathology)

Stated clinically as N2a (Clinical assessment because of neoadjuvant therapy or no pathology)		 Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
520 Evaluated pathologically:

Fixed/matted ipsilateral axillary nodes clinically with pathologic involvement of lymph nodes
WITH at least one metastasis greater than 2 mm		 Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
600 Axillary/regional lymph node(s), NOS
Lymph nodes, NOS		 Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
610 Evaluated clinically:

Clinically stated only as N2 [NOS]
(Clinical assessment because of neoadjuvant therapy or no pathology)		 Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
620 Evaluated pathologically:

Pathologically stated only as N2 [NOS]; no information on which nodes were involved		 Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
630 Stated as N2 [NOS] with no other information on regional lymph nodes Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
710 Evaluated pathologically:

Internal mammary node(s), ipsilateral, positive on sentinel nodes but not clinically apparent
(No positive imaging or clinical exam)
WITHOUT axillary lymph node(s), ipsilateral		 N1b N1b RN RN
720 Evaluated pathologically:

Internal mammary node(s), ipsilateral, positive on sentinel nodes but not clinically apparent
(No positive imaging or clinical exam)
WITH axillary lymph node(s), ipsilateral		 Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
730 Evaluated pathologically:

Internal mammary node(s), ipsilateral, positive on sentinel nodes but not clinically apparent
(No positive imaging or clinical exam)
UNKNOWN if positive axillary lymph node(s), ipsilateral		 N1b N1b RN RN
735 Evaluated clinically:

Internal mammary node(s), ipsilateral, positive on sentinel nodes but primary not resected
WITHOUT axillary lymph node(s), ipsilateral OR UNKNOWN if positive axillary lymph node(s),		 N2b N2b RN RN
740 Internal mammary node(s), ipsilateral, clinically apparent
(On imaging or clinical exam)
WITHOUT axillary lymph node(s), ipsilateral		 N2b N2b RN RN
745 Internal mammary node(s), ipsilateral, clinically apparent
(On imaging or clinical exam)
UNKNOWN if positive axillary lymph node(s), ipsilateral		 N2b N2b RN RN
748 Stated as N2b with no other information on regional lymph nodes Determine Correct Table for AJCC N Determine Correct Table for AJCC N RN RN
750 Infraclavicular lymph node(s)(subclavicular) (level III axillary nodes) (apical), ipsilateral
WITH or WITHOUT axillary nodes(s)
WITHOUT internal mammary node(s)		 N3a N3a D RN
755 Stated as N3a with no other information on regional lymph nodes N3a N3a D RN
760 OBSOLETE DATA RETAINED AND REVIEWED V0203
See codes 763 and765

Internal mammary node(s), ipsilateral, clinically apparent (on imaging or clinical exam)
WITH axillary lymph node(s), ipsilateral, codes 150 to 600
WITH or WITHOUT infraclavicular (level III axillary nodes) (apical) lymph nodes		 N3b N3b RN RN
763 Internal mammary node(s), ipsilateral, clinically apparent
(On imaging or clinical exam)
WITH axillary lymph node(s), ipsilateral, codes 150 to 600
WITHOUT infraclavicular (level III axillary nodes) (apical) lymph nodes or unknown if infraclavicular (level III axillary nodes) (apical) lymph nodes involved		 N3b N3b RN RN
764 Internal mammary node(s), ipsilateral, clinically apparent
(On imaging or clinical exam)
WITHOUT axillary lymph node(s), ipsilateral
WITH infraclavicular (level III axillary nodes) (apical) lymph nodes involved		 N3b N3b D RN
765 Internal mammary node(s), ipsilateral, clinically apparent
(On imaging or clinical exam)
WITH axillary lymph node(s), ipsilateral
WITH infraclavicular (level III axillary nodes) (apical) lymph nodes involved
 N3b N3b D RN
768 Stated as N3b with no other information on regional lymph nodes N3b N3b RN RN
770 OBSOLETE DATA RETAINED V0200

Internal mammary node(s), ipsilateral, clinically apparent (on imaging or clinical exam)
UNKNOWN if positive axillary lymph node(s), ipsilateral		 ERROR: N2b RN RN
780 OBSOLETE DATA RETAINED V0200

(750) + (770)		 ERROR: N3a D RN
790 OBSOLETE DATA CONVERTED V0203
See code 820

Stated as N3, NOS		 ERROR: ERROR: ERROR: ERROR:
800 Supraclavicular node(s), ipsilateral N3c N3c D D
805 Stated as N3c with no other information on regional lymph nodes N3c N3c D D
810 Evaluated clinically:

Clinically stated only as N3 [NOS]
(Clinical assessment because of neoadjuvant therapy or no pathology)		 N3NOS N3NOS RN RN
815 Evaluated pathologically:

Pathologically stated only as N3 [NOS]; no information on which nodes were involved		 N3NOS N3NOS RN RN
820 Stated as N3, NOS with no other information on regional lymph nodes N3NOS N3NOS RN RN
999 Unknown; regional lymph nodes not stated
Regional lymph node(s) cannot be assessed
Not documented in patient record		 NX NX U U
- For CS Lymph Nodes code 000 ONLY, the N category is assigned based on the coding of CS Site-Specific Factors 4 and 5 using the IHC MOL Table for this schema. - For CS Lymph Nodes codes 250, 258, 260, 510, 520, 600, 610, 620, 630, 720, and 748 ONLY, the N category is assigned based on the values of CS Lymph Nodes Eval and CS Site-Specific Factor 3 (Number of Positive Ipsilateral Axillary Lymph Nodes). If the CS Lymph Nodes Eval code is 2 (p), 3 (p), 6 (yp), or 8 (a), the N category is determined by reference to the Lymph Nodes Pathologic Evaluation Table. If the CS Lymph Nodes Eval code is 0 (c), 1(c), 5(c), or 9 (c), the N category is determined by reference to the Lymph Nodes Clinical Evaluation Table. If the CS Lymph Nodes Eval field is not coded, the N category is determined by reference to the Lymph Nodes Positive Axillary Node Table. - For CS Lymph Nodes code 000 ONLY, the N category is assigned based on the coding of CS Site-Specific Factors 4 and 5 using the IHC MOL Table for this schema. - For CS Lymph Nodes codes 250,258, 260, 280, 500, 510, 520, 600, 610, 620, 630, 720, and 748 ONLY, the N category is assigned based on the values of CS Lymph Nodes Eval and CS Site-Specific Factor 3 (Number of Positive Ipsilateral Axillary Lymph Nodes). If the CS Lymph Nodes Eval code is 2 (p), 3 (p), 6 (yp), or 8 (a), the N category is determined by reference to the Lymph Nodes Pathologic Evaluation Table. If the CS Lymph Nodes Eval code is 0 (c), 1(c), 5(c), or 9 (c), the N category is determined by reference to the Lymph Nodes Clinical Evaluation Table. If the CS Lymph Nodes Eval field is not coded, the N category is determined by reference to the Lymph Nodes Positive Axillary Node Table.