Clinical N

This input is used for staging

Notes

**Note 1:** Code only regional nodes and nodes, NOS, in this field. Distant nodes such as cervical (excluding supraclavicular) or contralateral axillary and/or contralateral internal mammary are coded in M (distant metastasis). **Note 2:** Clinically detected is defined as detected by clinical examination or by imaging studies (excluding lymphoscintigraphy) and having characteristics highly suspicious for malignancy or a presumed pathologic macrometastasis based on fine-needle aspiration biopsy with cytological examination. (1) **Note 3:** Excisional biopsy of a lymph node or biopsy of a sentinel node, in the absence of assignment of a pT, is classified as a clinical N, e.g., cN1. Pathologic classification (pN) is used for excision or sentinel lymph node biopsy only in conjunction with a pathologic T assignment. (1) **Note 4:** In a physical exam if palpable nodes are not described as fixed or matted, assume that nodes are movable. **Note 5:** The breast lymphatics drain by way of three major routes: axillary, transpectoral, and internal mammary. Intramammary lymph nodes reside within breast tissue and are coded as axillary lymph nodes for staging purposes. Supraclavicular lymph nodes are classified as regional lymph nodes for staging purposes. **Regional lymph nodes** **Axillary (ipsilateral):** Interpectoral (Rotter) nodes and lymph nodes along the axillary vein and its tributaries, which may be divided into the following levels: Level I (low-axilla) Lymph nodes lateral to the lateral border of pectoralis minor muscle Level II (mid-axilla): lymph nodes between: Medial lateral borders of the pectoralis minor muscle and interpectoral (Rotter's) lymph nodes Level III (apical axilla) Lymph nodes medial to the medial margin of the pectoralis minor muscle and inferior to the clavicle Infraclavicular (subclavicular) nodes The infraclavicular designation may be used for level III nodes to differentiate these nodes from the remaining level I and II axillary nodes **Internal mammary (ipsilateral)** Lymph nodes in the intercostal spaces along the end of the sternum in the endothoracic fascia **Supraclavicular (ipsilateral)** Lymph nodes in the supraclavicular fossa: A triangle defined by the omohyoid muscle and tendon (lateral and superior border) **Intramammary** Lymph nodes within the breast: Intramammary lymph nodes are coded as axillary lymph nodes level I

NAACCR Item

NAACCR #950
Clinical N Clinical N Display Description Registrar Notes
cX cNX Regional lymph nodes cannot be assessed (e.g., previously removed) Clinical classification criteria met, evaluation done:
Physician unable to assess N
Regional lymph node involvement cannot be determined or findings inconclusive
Physician assigns cNX, no other information available to determine N
c0 cN0 No regional lymph node metastasis
c1 cN1 Metastasis in movable ipsilateral Level I, II axillary lymph node(s) Clinically movable axillary lymph node(s), ipsilateral, positive

Axillary/regional lymph nodes, NOS
Lymph nodes, NOS

Stated as N1
c2 cN2 Metastasis in ipsilateral Level I, II axillary lymph node(s) that are clinically fixed or matted; or in clinically detected ipsilateral internal mammary lymph node(s) in the absence of clinically evident axillary lymph node metastatsis Note: N2 has subcategories of N2a and N2b. Assign N2 only when there is no information available to assign one of the subcategories

Stated as N2 [NOS]
c2A cN2a Metastasis in axillary lymph node(s) fixed to one another (matted) or to other structures Metastasis in fixed/matted ipsilateral axillary nodes clinically

Note: Axillary lymph nodes refer only to Level I and II axillary nodes, see N3 (sub)categories for involvement of Level III nodes

Stated as N2a
c2B cN2b Metastasis only in clinically detected internal mammary lymph node(s) and in the absence of clinically detected axillary lymph node metastasis Note: Axillary lymph nodes refer only to Level I and II axillary nodes, see N3 (sub)categories for involvement of Level III nodes

Stated as N2b
c3 cN3 Metastasis in ipsilateral infraclavicular (Level III axillary) lymph node(s) WITH or WITHOUT Level I, II axillary lymph node involvement; OR

Metastasis In clinically detected ipsilateral internal mammary lymph node(s) with clinically
evident Level I, II axillary lymph node metastasis; OR

Metastasis in ipsilateral supraclavicular lymph node(s) WITH or WITHOUT
axillary or internal mammary lymph node involvement
Note: N3 has subcategories of N3a, N3b and N3c. Assign N3 only when there is no information available to assign one of the subcategories

Stated as N3 [NOS]
c3A cN3a Metastasis in infraclavicular lymph nodes Level III axillary nodes (apical), ipsilateral

Metastasis in ipsilateral infraclavicular lymph nodes

Stated as N3a
c3B cN3b Metastasis in internal mammary and axillary lymph nodes Metastasis in ipsilateral and internal mammary and axillary lymph nodes

Stated as N3b
c3C cN3c Metastasis in ipsilateral supraclavicular lymph node(s) Stated as N3c
88 88 Not applicable Primary site/histology not TNM defined
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Clinical classification criteria not met
Clinical classification criteria met, evaluation done:
No information about diagnostic workup
Results not documented in record
Tumor first detected on surgical resection (no clinical workup)
Evidence of metastatic disease [(cM1) or (pM1)], no other workup
Only Clinical 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., 186