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 (300, 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 (500) 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:** **Regional lymph nodes for Head and Neck tumors**
* **Note:** For codes 300, 400, or 500, 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
- Regional lymph node(s), NOS
- Lymph node(s), NOS
**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 involvement |
NONE |
| 300 |
**CLINICAL assessment only**
Ipsilateral regional lymph node(s) |
RN |
| 400 |
**CLINICAL assessment only**
Bilateral or contralateral regional lymph node(s) |
RN |
| 500 |
**PATHOLOGICAL assessment only**
Regional lymph node(s) involved |
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) O'Sullivan, B., Lydiatt, W.M., Shah, J.P., et al. **HPV-Mediated (p16+) Oropharyngeal Cancer**. In: Amin, M.B., Edge, S.B., Greene, F.L., et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017
