EOD Regional Nodes
**Note 1:** Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in EOD Mets.
**Note 2:** This schema has lymph node codes that are defined as **CLINICAL** assessment only or **PATHOLOGICAL** assessment only.
+ **CLINICAL** assessment only codes (000, 150, 350, 400) 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 (030, 050, 070, 200, 250, 300) 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 the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2 mm and code the lymph nodes as positive in this field.
**Note 4:** If regional nodes are removed and there is no mention of the level or another specific type, assume these are Level I-II and code appropriately.
**Note 5:** Isolated tumor cells (ITCs) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected by immunohistochemical (IHC) or molecular methods. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). Lymph nodes with ITCs only are not counted as positive nodes. RT-PCR is a molecular method designed to find evidence of unique tumor or epithelial cell markers.
+ Codes 030, 050, and 070 are for nodes that are **pathologically negative** but are **positive** for ITCs or RT-PCR
- Code 030: Negative nodes pathologically with positive ITCs OR positive ITCs AND positive RT-PCR
- Code 050: Negative nodes pathologically with positive RT-PCR, negative ITCs
- Code 070: Negative nodes pathologically, unknown if ITCs or RT-PCR
**Note 6:** Internal mammary nodes (codes 250, 300, 400, 600) are not routinely removed unless there was an uptake during a sentinel lymph node biopsy, or they were clinically apparent on imaging. Before assigning one of these codes, make sure that the documentation clearly states that internal mammary nodes are involved.
+ Do not confuse **internal mammary** nodes with **intramammary nodes**, which are routinely evaluated
**Note 7:** Codes 100-200 and 350 only apply to involved axillary level I and II lymph nodes. If internal mammary, infraclavicular (subclavicular, level III axillary, apical), or supraclavicular lymph nodes are involved, codes 100-200 and 350 may not be used.
**Note 8:** **Regional lymph nodes include**
- Axillary, NOS (ipsilateral)
- Level I (low-axilla) (low) (superficial), NOS [adjacent to tail of breast]
+ Anterior (pectoral)
+ Lateral (brachial)
+ Posterior (subscapular)
- Level II (mid-axilla) (central), NOS
+ Interpectoral (Rotter's)
- Level III (high) (deep), NOS
+ Apical (subclavian)
+ Axillary vein
- Fixed/matted axillary (level I and II) (ipsilateral)
- Infraclavicular (subclavicular) (ipsilateral)
- Internal mammary (parasternal) (ipsilateral)
- Intramammary (ipsilateral)
- Supraclavicular (transverse cervical) (ipsilateral)
**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) Hortobagyi, G.N., Giuliano, A., et al. **Breast**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017