Lymph Nodes Head and Neck Levels IV-V
Description
Lymph Nodes for Head and Neck, Levels IV-V records the involvement of Levels IV-V lymph nodes.
This data item is used to code the presence or absence of lymph node involvement in head and neck levels I-III. The definitions of the levels are the same for all applicable head and neck sites.
* Note: This data item was previously collected for all head and neck sites. It is now only clinically relevant for unknown head and neck primaries with positive cervical (head and neck) lymph nodes and mucosal melanomas of the head and neck.
**Level IV** contains the lower jugular lymph nodes from the level of the cricoid cartilage superiorly to the clavicle inferiorly. Lymph node chains at this level:
* Jugulo-omohyoid (supraomohyoid), lower deep cervical, lower jugular
**Level V** is subdivided into levels VA and VB, which contain the lymph nodes in the posterior triangle bounded by the anterior border of the trapezius muscle posteriorly, the posterior border of the sternocleidomastoid muscle anteriorly, and the clavicle inferiorly. For descriptive purposes, Level V may be further subdivided into upper (VA) and lower (VB) levels corresponding to a plane defined by the inferior border of the cricoid cartilage. Lymph node chains at this level:
* Posterior cervical, posterior triangle (spinal accessory, transverse cervical [upper, middle, and lower, corresponding to the levels that define upper, middle, and lower jugular nodes]), supraclavicular
Rationale
Level of nodal involvement is a Registry Data Collection Variable in AJCC. This data item was previously collected as Head and Neck SSF #4 (common SSF).
Additional Info
**Source documents:** pathology report, imaging
For more information on **Head and Neck levels**, see AJCC 8th edition, Chapter 5: Staging Head and Neck Cancers, Table 5.1
Notes
**Note 1:** **Physician Statement**
* Physician statement of Levels IV-V lymph node involvement can be used to code this data item when no other information is available.
**Note 2:** **Related data items**
* 3876: LN Head and Neck Levels I-III
* 3877: LN Head and Neck Levels IV-V
* 3878: LN Head and Neck Levels VI-VII
* 3879: LN Head and Neck Other
**Note 3:** **Priority order**
* Pathological information takes priority over clinical.
**Note 4:** **Supraclavicular nodes**
* If lymph nodes are described only as “supraclavicular,” try to determine if they are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior triangle, inferior to the transverse cervical artery) and code appropriately.
* If the specific level cannot be determined, or is documented as supraclavicular with no further information, code them as Level V nodes
**Note 5:** **Priority order**
* Pathological information takes priority over clinical.
Coding Guidelines
**1)** Code all applicable levels that are involved
* ***Example:*** A carcinoma of the base of tongue involves bilateral submandibular nodes and left upper, mid-, and lower jugular nodes, the largest measuring 4 cm. There is no extracapsular extension. These are level I, II, III, and IV lymph nodes according to AJCC definitions.
* **i.** Levels I-III: Code 7 (Levels I, II and III lymph nodes involved) to show that levels I, II, and III are involved
* **ii.** Levels IV-V: Code 1 to show that level IV is involved
* **iii.** Levels VI-VII: Code 0 for no other nodes involved
* **iv.** Head and Neck, Other: Code 0 for no other nodes involved
**2)** If information is available on some nodes, but the others are unknown, code what is known.
* ***Example:*** Multiple lymph nodes involved, level II documented, but the other levels not mentioned. Code 2 to indicate level II involvement.
**3)** If a lymph node is described as involving two levels, or documented as a range, code both levels.
* ***Example:*** Physical examination for a floor of mouth cancer describes a large lymph node mass low in level II stretching into Level III. Code 6 for Levels II-III because both Level II and Level III are mentioned.
**4)** **Code 9** when the only information available is “Regional nodes, NOS” or “Cervical nodes, NOS” or “Internal jugular nodes, NOS” or “Lymph nodes, NOS. In other words, if regional nodes are known to be positive but the level(s) of nodes involved is unknown, code 9.
* ***Example:*** Patient diagnosed elsewhere with carcinoma of oropharynx with cervical lymph node involvement. No other information available. All Head and Neck Level data items are coded to 9 since there is no specific information about the levels.
* **i.** Levels I-III: Code 9
* **ii.** Levels IV-V: Code 9
* **iii.** Levels VI-VII: Code 9
* **iv.** Head and Neck, Other: Code 9
Default
8
Metadata
SSDI
| Code |
Description |
| 0 |
No involvement in Levels IV or V lymph nodes |
| 1 |
Level IV lymph node(s) involved |
| 2 |
Level V lymph node(s) involved |
| 3 |
Levels IV and V lymph node(s) involved |
| 8 |
Not applicable: Information not collected for this case
(If this item is required by your standard setter, use of code 8 will result in an edit error) |
| 9 |
Not documented in medical record
Positive nodes, but level of positive node(s) unknown
Lymph node levels IV-V not assessed, or unknown if assessed |
