Extranodal Extension Head and Neck Pathological


**Note 1:** Physician statement of extranodal extension (ENE) pathologically during a lymph node dissection or physician pathological stage indicating the absence or presence of ENE can be used to code this data item when no other information is 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 recorded as distant metastatic disease.” **Note 3:** Code the status of ENE assessed on histopathologic examination of **surgically resected** involved regional lymph node(s). Do not code ENE from a lymph node biopsy (FNA, core, incisional, excisional, sentinel). Do not code ENE for any distant lymph nodes. Code the status of ENE based on the following criteria * Code 0.0 * Absence of ENE, positive lymph nodes assessed by lymph node dissection * Codes 0.1-9.9, X.1, X.2, X.3, X.4 as appropriate for * Presence of ENE assessed by Sentinel Lymph Node biopsy * Presence of ENE assessed by lymph node biopsy * Code X.9 * Absence of ENE, positive lymph nodes assessed by Sentinel Lymph Node biopsy * A positive Sentinel Lymph Node biopsy cannot assess the absence of ENE, only the presence of it. This is because there is not enough surrounding tissue in a Sentinel Lymph node biopsy to accurately assess ENE * If codes 0.0-0.9, X.1-X.7 are used, this indicates that the lymph nodes were surgically resected or a Sentinel Lymph Node biopsy was done and Scope of Regional Lymph Node Surgery [NAACCR Data Item: 1292] must be 2-7 **Note 4:** Be aware that the rules for coding ENE for head and neck sites compared to non-head and neck sites are different. **Note 5:** Definitions of ENE subtypes and rules: * Microscopic ENE [ENE (mi)] is defined as less than or equal to 2 mm. * Major ENE [ENE (ma)] is defined as greater than 2 mm. * Both ENE (mi) and ENE (ma) qualify as ENE (+) for definition of pN. **Note 6:** The measurement of ENE is the distance from the lymph node capsule in millimeters (mm).




NAACCR #3832


Code Description
0.0 Lymph nodes positive for cancer but ENE not identified or negative
0.1-9.9 ENE 0.1 to 9.9 mm
X.1 ENE 10 mm or greater
X.2 ENE microscopic, size unknown Stated as ENE (mi)
X.3 ENE major, size unknown Stated as ENE (ma)
X.4 ENE present, microscopic or major unknown, size unknown
X.7 Surgically resected regional lymph node(s) negative for cancer (pN0)
X.8 Not applicable: Information not collected for this case (If this information is required by your standard setter, use of code X.8 may result in an edit error)
X.9 Not documented in medical record No surgical resection of regional lymph node(s) ENE not assessed pathologically, or unknown if assessed Pathological assessment of lymph node(s) not done, or unknown if done