Extranodal Extension Pathological
**Note 1:** Physician statement of Extranodal Extension (ENE) Pathological or physician pathological staging can be used to code this data item when there is no other information available.
**Note 2:** Extranodal extension is defined as "the extension of a nodal metastasis through the lymph node capsule into adjacent tissue." ENE is the preferred terminology. Other names include: extranodal spread, extracapsular extension, or extracapsular spread."
* "A regional node extending into a distant structure or organ is categorized as ENE and is not considered distant metastatic disease."
**Note 3:** Be aware that the rules for coding ENE for head and neck sites compared to non-head and neck sites are different.
**Note 4:** Code the status of extranodal extension assessed on the surgical resection specimen for the most involved regional lymph node(s). Do not code ENE for any distant nodes.