EOD Regional Nodes
**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 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
+ 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:** Bilateral or contralateral nodes are classified as regional nodes for head, neck, and truncal tumors with bidirectional drainage to primary nodal basins, as shown on lymphoscintigraphy. Truncal tumors may also drain to both cephalad and caudal primary nodal basins as shown on lymphoscintigraphy.
* Clinical assessment of bilateral/contralateral or cephalad/caudal regional nodal involvement is required for tumors where lymphoscintigraphy is not performed
**Note 6:** Contiguous or secondary nodal basins are the next nodal drainage basins beyond the primary nodal basins and are coded as regional nodes.
**Note 7:** 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 8:** 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 (includes bilateral or contralateral nodes)**
Level IA - Submental
Level IB - Submandibular (submaxillary), sublingual
**Level II - Upper jugular**
Upper deep cervical
Level IIA - Anterior
Level IIB - Posterior
**Level III - Middle jugular**
Middle deep cervical
**Level IV - Lower jugular**
Lower deep cervical
**Level V - Posterior triangle group**
Level VA - Spinal accessory
Level VB - Transverse cervical, supraclavicular
**Level VI - Anterior compartment group**
Paratracheal - above suprasternal notch
Pretracheal - above suprasternal notch
**Level VII - Superior mediastinal group (for other mediastinal node(s) see EOD Mets)**
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch
Deep cervical, NOS
- Buccinator (buccal)
Internal jugular, NOS
**Note 9:** Code 800 if regional lymph nodes are involved, but there is no indication which ones are involved.
(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) Califano, J.A., Lydiatt, W.M., Shah, J.P., et al. **Cutaneous Carcinoma of the Head and Neck**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017