Pathologic N

This input is used for staging

Notes

Note 1: Histological examination of a regional lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.(1)

Note 2: If laterality of lymph nodes is not specified, assume nodes are ipsilateral.

Midline nodes are assigned as ipsilateral

Note 3: The description of lymph nodes has been standardized across the head and neck schemas. All lymph node levels and groups listed here are assigned as regional nodes for TNM staging.

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 nodes see M [distant metastasis])

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 nodes, NOS
Lymph nodes, NOS

Note 4: For head and neck schemas, additional information about lymph nodes (size of involved nodes, extracapsular extension, levels involved, and location of involved nodes above or below the lower border of the cricoid cartilage) is coded in Site-Specific Factors 1, 3-9.

Note 5: For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior triangle, inferior to the transverse cervical artery) and code appropriately.

If the specific level cannot be determined, assign them as Level V nodes

NAACCR Item

NAACCR #890

Pathologic N	Pathologic N Display	Description	Registrar Notes
pX	pNX	Regional lymph nodes cannot be assessed	Pathologic classification criteria met, evaluation done: Physician unable to assess N Surgical resection primary tumor, no regional lymph nodes removed Involvement of regional lymph nodes not documented Physician assigns pNX, no other information available to determine N
p0	pN0	No regional lymph nodes metastasis
p1	pN1	Regional lymph node metastasis	Regional lymph nodes, NOS Lymph nodes, NOS Stated as N1
c0	cN0	Clinically: No regional lymph node metastasis	Use only for TNM defined pTis cases where there is a resection of the primary and the nodes are not evaluated pathologically
88	88	Not applicable	In situ case but no pTis is defined by TNM Death certificate only (DCO) case
<BLANK>	BLANK	See Registrar Notes	Pathologic classification criteria not met No surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category Evidence of metastatic disease (pM1), no other workup Only Pathologic Stage Group documented (no T, N, or M information available)

(1) International Union Against Cancer (UICC) TNM Classification of Malignant Tumors, 7th ed., Sobin, LH, Gospodarowicz, M, Wittekind, CH, eds. New York: Wiley, 2009, pg., 52