Extranodal Extension Head and Neck Clinical
Description
Extranodal extension is defined as “the extension of a nodal metastasis through the lymph node capsule into adjacent tissue” and is a prognostic factor for most head and neck tumors. This data item pertains to clinical extension.
The presence of extranodal extension (ENE) from regional lymph nodes is an important prognostic factor in some cancers because these patients are rarely cured without some type of systemic chemotherapy or radiation.
Clinical ENE is described in the AJCC Head and Neck Staging System as "Unambiguous evidence of gross ENE on clinical examination (e.g., invasion of skin, infiltration of musculature, tethering to adjacent structures, or cranial nerve, brachial plexus, sympathetic trunk, or phrenic nerve invasion with dysfunction)"
* The terms 'fixed' or 'matted' are used to describe lymph nodes
This data item for ENE detected clinically.
Rationale
Extranodal Extension Head and Neck Clinical is a Registry Data Collection Variable in AJCC. It was previously collected as Head and Neck SSF #8 (Common SSF).
Additional Info
**Source documents:** pathology report, imaging reports, physical exam report.
**Other names include** ENE, extracapsular extension, ECE, extracapsular extension, ECE, extranodal spread, extracapsular extension, or extracapsular spread
* *Note*: ENE is the preferred terminology
**For further information**, refer to the *Head and Neck* cancer protocols published by the College of American Pathologist for the AJCC Staging Systems for *Head and Neck.*
Notes
**Note 1:** **Physican Statement**
* Physician statement of extranodal extension (ENE) clinically or physician clinical stage indicating the absence or presence of ENE can be used to code this data item when no other information is available
* Physical exam alone is sufficient to determine Clinical ENE
**Note 2:** **Clinical assessment criteria**
* The assessment of ENE must be based on evidence acquired prior to definitive surgery of the primary site, chemotherapy, radiation, or other type of treatment, i.e., the clinical timeframe for staging.
* The assessment for ENE in **addition to physical examination** may include imaging, biopsy of the regional lymph node, and/or biopsy of tissues surrounding the regional lymph node
* Fixed or matted nodes are clinical indications of ENE
* Imaging **alone** is not enough to determine or exclude ENE
* Note that the rules for coding ENE for head and neck sites compared to non-head and neck sites are different.
Coding Guidelines
**1)** **Code 0** when lymph nodes are determined to be **clinically positive** and physical examination does not indicate any signs of extranodal extension.
**2)** **Code 1** when **ENE** is unquestionable as determined by physical examination
**3)** **Code 2** when there are positive nodes clinically, ENE is identified by biopsy (microscopically confirmed)
**4)** **Code 4** when there are positive nodes clinically, ENE is identified, but not known how identified
**5)** **Code 7** when nodes are clinically negative (cN0)
**6)** **Code 9** when
* **a.** No information in the medical record
* **b.** Positive nodes clinically, not evaluated (assessed) for ENE
* **c.** Positive nodes clinically, unknown if evaluated (assessed) for ENE
* **d.** Lymph nodes not evaluated (assessed) clinically
* **e.** Unknown if lymph nodes evaluated (assessed) clinically
* **f.** Lymph node biopsy (e.g., FNA, core, incisional, excisional, sentinel node) performed and is negative for ENE or not stated
Default
8
Metadata
SSDI
| Code |
Description |
| 0 |
Regional lymph node(s) involved, ENE not present/not identified during diagnostic workup |
| 1 |
Regional lymph node(s) involved, ENE present/identified during diagnostic workup,
based on physical exam WITH or WITHOUT imaging |
| 2 |
Regional lymph node(s) involved, ENE present/identified during diagnostic workup,
based on microscopic confirmation |
| 4 |
Regional lymph nodes involved, ENE present/identified, unknown how identified |
| 7 |
No lymph node involvement during diagnostic workup (cN0)
Non-invasive neoplasm (behavior /2) |
| 8 |
Not applicable: Information not collected for this case
(If this information is required by your standard setter, use of code 8 may result in an edit |
| 9 |
Not documented in medical record
ENE not assessed during diagnostic workup, or unknown if assessed
Clinical assessment of lymph node(s) not done, or unknown if done |
