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:** For this schema, code 000 (no regional lymph node involvement) is not applicable. This code was removed effective Version 2.0 and later in an effort to stop this schema being used when it is not applicable. To get into this schema, there **must** be lymph node involvement (clinically or pathologically)
- If you are in this schema and there are negative nodes clinically, please review the response to Schema Discriminator 1: Occult Head and Neck Lymph Nodes and reassign appropriately (Code 1is for primary site C760 with negative lymph node involvement)
- This schema may be used for nodes that are clinically positive (FNA, core biopsy, lymph node biopsy, lymph node excision or sentinel lymph node biopsy), but are confirmed to be pathologically negative on a lymph node dissection. In these cases, the clinical lymph node involvement has priority and should be coded in this field
* ***Example 1:*** Excision of a single cervical node was positive, subsequent cervical lymph node dissection was negative
* ***Example 2:*** Biopsy of a cervical was positive, the patient underwent neoadjuvant treatment, followed by a negative lymph node dissection
- This schema may **not** be used when nodes are positive on imaging only (not microscopically confirmed clinically) and the same nodes are removed and negative. In this situation, the pathological lymph node involvement would take priority and the lymph nodes would be coded as not involved (see first bullet about reviewing the schema discriminator)
**Note 3:** 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. 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 this schema when
- FNA, core biopsy, sentinel node biopsy or lymph node excision done during the clinical work up and
- Lymph node dissection performed
+ Remaining codes (no designation of **CLINICAL** or **PATHOLOGICAL** only assessment) can be used based on clinical and/or pathological
**Note 4:** If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are ipsilateral.
**Note 5:** 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 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 |
| 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. **Cervical Lymph Nodes and Unknown Primary Tumors 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
