EOD Regional Nodes

Notes

**Note 1:** **Regional nodes and nodes, NOS** * Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in EOD Mets. **Note 2:** **CLINICAL AND PATHOLOGICAL codes** * This schema has lymph node codes that are defined as **CLINICAL** assessment only or **PATHOLOGICAL** assessment only. + **CLINICAL** assessment only codes (100, 200, 600, 650) 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 (300, 350, 400, 500, 700, 750) 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 * **Code 000** is used when there is no evidence of regional lymph nodes clinically **OR** lymph nodes are negative pathologically (*Regional Nodes Positive = 00, 98*) * **Code 800** is used when there are positive nodes (clinical or pathological), but the specific lymph nodes or number of positive nodes is unknown (*Regional Nodes Positive = 97*) * **Code 999** is used when the lymph node status is unknown and *Regional Nodes Positive = 99* **Note 3:** **Isolated tumor cells** * 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 isolated tumor cells (ITCs) are counted as positive lymph nodes **Note 4:** **In transit metastasis** * In transit metastasis is defined as a tumor distinct from the primary lesion and located either between the primary lesion and the draining regional lymph node(s) or distal to the primary lesion. * In transit metastasis with positive lymph node(s) are coded under regional lymph nodes. * Code 600 if there are **clinically** in-transit metastasis WITHOUT regional lymph node involvement * Code 650 if there are **clinically** in-transit metastasis WITH regional lymph node involvement * Code 700 if there are **pathologically** in-transit metastasis WITHOUT regional lymph node involvement * Code 750 if there are **pathologically** in-transit metastasis WITH regional lymph node involvement **Note 5:** **Regional lymph nodes for skin** * Single, Multiple, Ipsilateral, Bilateral or Contralateral lymph nodes **Skin of head and neck (C000-C006, C008-C009, C440-C444)** - Levels I-VII - Axillary (neck only, C444) - Cervical, NOS - Deep cervical, NOS - Facial (buccinator, buccal, nasolabial) - Internal jugular, NOS - Parapharyngeal - Parotid (infraauricular, intraparotid, periparotid, preauricular) - Retroauricular (mastoid) - Retropharyngeal - Suboccipital **Skin of trunk (C445)** - Upper trunk + Axillary + Cervical + Internal mammary + Supraclavicular - Lower trunk + Superficial inguinal (femoral) **Skin of upper limb and shoulder (C446)** - Axillary - Cervical - Epitrochlear for hand/forearm - Internal mammary (parasternal) - Spinal accessory for shoulder - Supraclavicular (transverse cervical) **Skin of lower limb and hip (C447)** - Femoral (superficial inguinal) - Inguinal - Popliteal for heel and calf **Vulva (C510-C512, C518-C519)** - Deep inguinal, NOS - Femoral - Inguinal, NOS - Inguinofemoral (groin) - Node of Cloquet or Rosenmuller (highest deep inguinal) - Superficial inguinal (femoral) **Penis (C600-C602, C608-C609)** - Iliac, NOS + External + Internal (hypogastric, obturator) - Inguinal, NOS + Node of Cloquet or Rosenmuller (highest deep inguinal) + Superficial [femoral] - Pelvic, NOS **Scrotum (C632)** - Iliac, NOS + External + Internal (hypogastric), NOS * Obturator - Inguinal, NOS + Deep inguinal, NOS * Node of Cloquet or Rosenmuller (highest deep inguinal) + Superficial inguinal (femoral) **Note 6:** **Lymph nodes, NOS** * 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 metastasis detected * On clinical AND/OR radiologic examination * Sentinel node biopsy or lymph node dissection NONE
100 **CLINICAL assessment only** Clinical and/or radiologic exam positive nodes - WITHOUT biopsy or resection of lymph nodes RN
200 **CLINICAL assessment only** Clinically positive nodes on core biopsy/FNA - WITHOUT sentinel lymph node biopsy or resection of lymph nodes RN
300 **PATHOLOGICAL assessment only** Clinically occult nodes - WITH positive nodes from sentinel node biopsy RN
350 **PATHOLOGICAL assessment only** Clinically occult nodes - WITH positive nodes on lymph node resection RN
400 **PATHOLOGICAL assessment only** Clinically and/or radiologically positive nodes - WITH positive nodes on biopsy or lymph node resection RN
500 **PATHOLOGICAL assessment only** Clinically unknown if positive or negative - WITH positive nodes on biopsy or lymph node resection RN
600 **CLINICAL assessment only** In-transit metastasis present - WITHOUT lymph node metastasis or UNKNOWN Discontinuous from primary tumor Located between primary tumor and draining regional nodal basin OR distal to the primary tumor RN
650 **CLINICAL assessment only** Code 600 WITH lymph node metastasis RN
700 **PATHOLOGICAL assessment only** In-transit metastasis present - WITHOUT lymph node metastasis or UNKNOWN Discontinuous from primary tumor Located between primary tumor and draining regional nodal basin OR distal to the primary tumor RN
750 **PATHOLOGICAL assessment only** Code 700 WITH lymph node metastasis 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
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