EOD Regional Nodes
Notes
**Note 1:** **Definition of Head and Neck Lymph Nodes**
* For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by TNM.
**Note 2:** **CLINICAL AND PATHOLOGICAL codes**
* This schema has lymph node codes that are defined as **CLINICAL** assessment only or **PATHOLOGICAL** assessment only.
**No surgical resection**
* Use **CLINICAL** assessment only codes (450) when there is a clinical work up only and there is **NO surgical resection of the primary tumor or site** WITH
* Any microscopic examination of regional lymph nodes, which includes FNA, core biopsy, sentinel node biopsy, lymph node excision, or lymph node dissection done during the clinical work up.
**Surgical resection without neoadjuvant therapy**
* Use **PATHOLOGICAL** assessment only codes (150, 500, 600, 700) when there is a **surgical resection of the primary tumor or site** WITH
* Any microscopic examination of regional lymph nodes, which includes FNA, core biopsy, sentinel node biopsy, lymph node excision done or lymph node dissection performed.
**Surgical resection after neoadjuvant therapy**
* If patient has neoadjuvant therapy, and the clinical assessment is equal to or greater than the pathological assessment, then the clinical assessment codes take priority. Otherwise, code the pathologic assessment.
* See ***EOD 2018 General Instructions*** for further instructions on coding cases with neoadjuvant therapy, https://seer.cancer.gov/tools/staging/eod/.
**Note 3:** **Laterality**
* If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are ipsilateral.
**Note 4:** **Supraclavicular lymph nodes**
* 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**
* 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:** **Regional lymph nodes for Head and Neck tumors**
* **Note:** 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.
**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
| 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) Ridge, J.A., Lydiatt, W.M., Shah, J.P., et al. **Oral Cavity**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017
