Extranodal Extension Head and Neck Pathological
Description
Extranodal extension (ENE) 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 pathological staging 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. Extranodal extension is defined as metastatic tumor growing from within the lymph node outward through the lymph node capsule and into surrounding connective tissues.
* “A regional node extending into a distant structure or organ is categorized as ENE and is not recorded as distant metastatic disease.”
This data item for ENE that is detected pathologically for head and neck primaries.
Rationale
Extranodal Extension Head and Neck Clinical is a Registry Data Collection Variable in AJCC. It was previously collected as Head and Neck SSF #9 (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:** **Physician Statement**
* 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:** **Pathological assessment criteria**
* 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, or the absence of ENE from a sentinel)
* Do not code ENE for any distant lymph nodes
Coding Guidelines
**1)** **Code 0.0** when there are positive nodes pathologically, but ENE not identified/not present.
* **a.** **Absence of ENE**, positive lymph nodes assessed by lymph node dissection (1292: Scope of Regional Lymph Node Surgery must be 3-7)
**2)** **Code the actual size of the ENE in the range 0.1-9.9 mm**
* **a.** **Code X.1** when actual size of the ENE is 10 mm or greater
* **b.** **Code X.2** when stated to be microscopic [ENE (mi)]
* **c.** **Code X.3** when stated to be major [ENE (ma)]
* **d.** **Code X.4** when size not documented, unknown whether microscopic (mi) or major (ma)
**3)** **Codes 0.1-9.9, X.1, X.2, X.3, X.4** as appropriate for
* **a.** Presence of ENE assessed by Sentinel Lymph Node biopsy
* **b.** Presence of ENE assessed by lymph node biopsy
* **c.** If codes 0.1-0.9, 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
**4)** **Code X.7** when nodes are surgically resected, and they are negative (pN0)
* **a.** Lymph nodes negative for cancer assessed by Sentinel lymph node biopsy or lymph node dissection
* **b.** 1292: Scope of Regional Lymph Node Surgery must be 2-7
**5)** **Code X.9** when
* **a.** Absence of ENE, positive lymph nodes assessed by Sentinel Lymph Nodes Biopsy
* **i.** 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
* **b.** Positive nodes pathologically, not evaluated (assessed) for ENE
* **c.** Positive nodes pathologically, unknown if evaluated (assessed) for ENE
* **d.** Lymph nodes not evaluated (assessed) pathologically (no surgical resection of lymph nodes)
* **e.** Unknown if lymph nodes evaluated pathologically (assessed)
Default
X.8
Metadata
SSDI
| 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)
Non-invasive neoplasm (behavior /2)
ENE not assessed pathologically, or unknown if assessed
Pathological assessment of lymph node(s) not done, or unknown if done |
