Lymph Nodes Head and Neck Levels VI-VII
Description
Lymph Nodes for Head and Neck, Levels VI-VII records the involvement of Levels VI-VII 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.
**Level VI** contains the lymph nodes of the anterior central compartment from the hyoid bone superiorly to the suprasternal notch inferiorly. On each side, the lateral boundary is formed by the medial border of the carotid sheath. Lymph node chains at this level:
* Laterotracheal, Paralaryngeal, paratracheal (above suprasternal notch), perithyroidal, Precricoid (Delphian), Prelaryngeal, recurrent laryngeal)
**Level VII** contains the lymph nodes inferior to the suprasternal notch in the superior mediastinum. Lymph node chains at this level:
* Esophageal groove, paratracheal (below suprasternal notch), Pretracheal (below suprasternal notch)
Rationale
Level of nodal involvement is a Registry Data Collection Variable in AJCC. This data item was previously collected as Head and Neck SSF #5 (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.
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 VI or VII lymph nodes
Non-invasive neoplasm (behavior /2) |
| 1 |
Level VI lymph node(s) involved |
| 2 |
Level VII lymph node(s) involved |
| 3 |
Levels VI and VII 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 nodes levels VI-VII not assessed, or unknown if assessed |
