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.
**No surgical resection**
* Use **CLINICAL** assessment only codes (000, 150, 350, 400) 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 (030, 050, 070, 200, 250, 300) 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:** **Size of metastasis not stated**
* 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:** **Level of lymph nodes not specified**
* 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 (ITC)**
* 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:** **Code 000** is only for clinical evaluation of lymph nodes (physical exam, imaging)*
**Note 6:** **Internal mammary nodes**
* 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:** **Axillary Level I and II lymph nodes**
* 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:** **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 |
**CLINICAL assessment only**
No clinical regional lymph node involvement (**based on physical exam, imaging ONLY**) |
NONE |
| 030 |
**PATHOLOGICAL assessment only**
ITCs only (malignant cell clusters no larger than 0.2 mm) in regional lymph node(s) |
NONE |
| 050 |
**PATHOLOGICAL assessment only**
Positive molecular findings by reverse transcriptase polymerase chain reaction (RT-PCR), no ITCs detected |
NONE |
| 070 |
**PATHOLOGICAL assessment only**
No regional lymph node involvement pathologically
(lymph nodes removed and pathologically negative)
WITHOUT ITCs or ITC testing unknown |
NONE |
| 100 |
Micrometastasis, less than or equal to 2 mm
Axillary (level I and II) lymph node(s), ipsilateral
Detected by IHC or H&E (At least one micrometastasis greater than 0.2 mm or more than 200 cells)
Micrometastasis, NOS |
RN |
| 150 |
**CLINICAL assessment only**
Clinically positive movable axillary (level I and II) lymph node(s), ipsilateral
Positive needle core biopsy/FNA |
RN |
| 200 |
**PATHOLOGICAL assessment only**
Positive axillary (level I and II) lymph node(s), ipsilateral
WITH more than micrometastasis
(At least one metastasis greater than 2 mm, or size of metastasis not stated)
WITHOUT internal mammary lymph node(s) or not stated |
RN |
| 250 |
**PATHOLOGICAL assessment only**
Internal mammary node(s), ipsilateral, positive on sentinel node biopsy but not clinically apparent
(No positive imaging or clinical exam)
WITHOUT axillary lymph node(s), ipsilateral |
RN |
| 300 |
**PATHOLOGICAL assessment only**
Internal mammary node(s), ipsilateral, positive on sentinel node biopsy but not clinically apparent
(No positive imaging or clinical exam)
WITH axillary lymph node(s), ipsilateral |
RN |
| 350 |
**CLINICAL assessment only**
Fixed/matted axillary (level I and II) (ipsilateral) |
RN |
| 400 |
**CLINICAL assessment only**
Internal mammary node(s), ipsilateral
WITHOUT axillary (level I and II) lymph node(s), ipsilateral |
RN |
| 500 |
Infraclavicular lymph node(s) (subclavicular) (level III axillary node(s)) (apical), ipsilateral
WITH or WITHOUT axillary (level I and II) nodes(s)
WITHOUT internal mammary node |
RN |
| 600 |
Internal mammary node(s), ipsilateral, clinically apparent
(On imaging or clinical exam)
WITH axillary (level I, II, or III) lymph node(s), ipsilateral including infraclavicular |
RN |
| 700 |
Supraclavicular node(s), ipsilateral |
D |
| 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)
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