Lymph Nodes Head and Neck Levels I-III
Description
Lymph Nodes for Head and Neck, Levels I-III records the involvement of Levels I-III 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 I** is subdivided into levels IA and IB, which contain the submental and submandibular triangles bounded by the anterior and posterior bellies of the digastric muscle, the hyoid bone inferiorly, and the body of the mandible superiorly. Lymph node chains at this level:
* Submental (Level IA), submandibular (Level IB), submaxillary (Level IB)
**Level II** is subdivided into levels IIA and IIB, which contain the upper jugular lymph nodes and extend from the level of the skull base superiorly to the hyoid bone inferiorly. A vertical plane defined by the spinal accessory nerve is the boundary between level IIA (anterior to spinal accessory nerve) and IIB (posterior to spinal accessory nerve). Lymph node chains at this level:
* Jugulodigastric (subdigastric), upper deep cervical, upper jugular
**Level III** contains the middle jugular lymph nodes from the hyoid bone superiorly to the level of the lower border of the cricoid cartilage inferiorly. Lymph node chains at this level:
* Middle deep cervical, mid-jugular
Rationale
Level of nodal involvement is a Registry Data Collection Variable in AJCC for several head and neck chapters. This data item was previously collected as Head and Neck SSF #3 (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 I-III 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.
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 I, II, or III lymph nodes
Non-invasive neoplasm (behavior /2) |
| 1 |
Level I lymph node(s) involved |
| 2 |
Level II lymph node(s) involved |
| 3 |
Level III lymph node(s) involved |
| 4 |
Levels I and II lymph nodes involved |
| 5 |
Levels I and III lymph nodes involved |
| 6 |
Levels II and III lymph nodes involved |
| 7 |
Levels I, II and III lymph nodes 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 I-III not assessed, or unknown if assessed |
