EOD Regional Nodes

Notes

**Note 1:** For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by TNM. **Note 2:** This schema has lymph node codes that are defined as **CLINICAL** assessment only or **PATHOLOGICAL** assessment only. + **CLINICAL** assessment only codes (450) are used when there is a clinical work up only and there is no surgical resection of the primary tumor or site. This includes FNA, core biopsy, sentinel node biopsy, or lymph node excision - *Exception:* If patient has neoadjuvant therapy, and the clinical assessment is greater than the pathological assessment, then the clinical assessment code would take priority + **PATHOLOGICAL** assessment only codes (150, 500, 600, 700) are used for Larynx when - Primary tumor or site surgically resected with + Any microscopic examination of regional lymph nodes. Includes - FNA, core biopsy, sentinel node biopsy or lymph node excision done during the clinical work up and/or - Lymph node dissection performed - Primary tumor or site NOT surgically resected, but - Lymph node dissection performed + Remaining codes (no designation of **CLINICAL** or **PATHOLOGICAL** only assessment) can be used based on clinical and/or pathological information **Note 3:** If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are ipsilateral. **Note 4:** Supraclavicular lymph nodes can be either Level IV or Level V * Level IV: deep to the sternocleidomastoid muscle, in the lower jugular chain * Level V: in the posterior triangle, inferior to the transverse cervical artery, supraclavicular lymph nodes, NOS **Note 5:** Extranodal extension (ENE) is defined as the extension of a nodal metastasis through the lymph node capsule into adjacent tissue. The following codes record the status of the lymph nodes with positive ENE * Code 150: Pathological only: single ipsilateral node, less than or equal to 3 cm * Code 450: Clinical only: overt ENE * Code 500: Pathological only: single ipsilateral node, greater than 3 cm * Code 600: Pathological only: multiple ipsilateral, bilateral or contralateral nodes * Code 700: Pathological only: Single contralateral node **Note 6:** For codes 100-700, use the list below for named regional lymph nodes. If the only information available is "regional lymph nodes, NOS" or "lymph nodes," code 800. **The following lymph nodes are regional for Head and Neck tumors** **Level I** Level IA - Submental Level IB - Submandibular (submaxillary), sublingual **Level II - Upper jugular** Jugulodigastric (subdigastric) Upper deep cervical Level IIA - Anterior Level IIB - Posterior **Level III - Middle jugular** Middle deep cervical **Level IV - Lower jugular** Jugulo-omohyoid (supraomohyoid) Lower deep cervical Virchow node **Level V - Posterior triangle group** Posterior cervical Level VA - Spinal accessory Level VB - Transverse cervical, supraclavicular **Level VI - Anterior compartment group** Laterotracheal Paralaryngeal Paratracheal - above suprasternal notch Perithyroidal Precricoid (Delphian) Prelaryngeal Pretracheal - above suprasternal notch Recurrent laryngeal **Level VII - Superior mediastinal group (for other mediastinal node(s) see EOD Mets)** Esophageal groove Paratracheal - below suprasternal notch Pretracheal - below suprasternal notch **Other groups** Cervical, NOS Deep cervical, NOS Facial - Buccinator (buccal) - Mandibular - Nasolabial Internal jugular, NOS Parapharyngeal Parotid - Infraauricular - Intraparotid - Periparotid - Preauricular Retroauricular (mastoid) Retropharyngeal Suboccipital **Note 7:** Code 800 if regional lymph nodes are involved, but there is no indication which ones are involved.
Code Description SS2018 N
000 No regional lymph node involvement NONE
100 Metastasis in a SINGLE ipsilateral lymph node 3 cm or smaller in greatest dimension Extranodal extension (ENE) negative or unknown RN
150 PATHOLOGICAL assessment only Metastasis in SINGLE ipsilateral node 3 cm or smaller in greatest dimension Extranodal extension (ENE) positive RN
200 Metastasis in SINGLE ipsilateral node Larger than 3 cm but not larger than 6 cm in greatest dimension Extranodal extension (ENE) negative OR unknown RN
250 Metastasis in MULTIPLE ipsilateral nodes No nodes larger than 6 cm in greatest dimension Extranodal extension (ENE) negative or unknown RN
300 Metastasis in bilateral or contralateral lymph node(s) No nodes larger than 6 cm in greatest dimension Extranodal extension (ENE) negative OR unknown RN
400 Metastasis in a lymph node larger than 6 cm in greatest dimension Extranodal extension (ENE) negative OR unknown RN
450 CLINICAL assessment only Metastasis in any lymph node(s) with clinically overt ENE RN
500 PATHOLOGICAL assessment only Metastasis in a SINGLE ipsilateral node Larger than 3 cm in greatest dimension Extranodal extension (ENE) positive RN
600 PATHOLOGICAL assessment only Metastasis in MULTIPLE ipsilateral, contralateral, or bilateral nodes Extranodal extension (ENE) positive for any node RN
700 PATHOLOGICAL assessment only Single contralateral node (any size) Extranodal extension (ENE) positive RN
800 Regional lymph node(s), NOS Lymph node(s), NOS RN
999 Unknown; regional lymph node(s) not stated Regional lymph node(s) cannot be assessed Not documented in medical record Death Certificate Only U
(1) Fritz AG, Ries LAG (eds). **SEER Extent of Disease 1988: Codes and Coding Instructions (3rd Edition, 1998)**, National Cancer Institute, NIH Pub. No. 98-2313, Bethesda, MD, 1998 (2) Young JL Jr, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (eds.). **SEER Summary Staging Manual-2000: Codes and Coding Instructions**, National Cancer Institute, NIH Pub. No. 01-4969, Bethesda, MD, 2001. (3) Collaborative Stage Work Group of the American Joint Committee on Cancer. **Collaborative Stage Data Collection System User Documentation and Coding Instructions, version 02.05**. American Joint Committee on Cancer (Chicago, IL) (4) Gress, D.M., Edge, S.B., Gershenwald, J.E., et al. **Principles of Cancer Staging**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017 (5) Lydiatt, W.M., Patel, S.G., Shah, J.P., et al. **Staging Head and Neck Cancers**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017 (6) Patel, S.G., Lydiatt, W.M., Shah, J.P., et al. **Larynx**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017