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**
* Includes imaging or 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
**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
