Pathologic N

This input is used for staging


**Note 1:** Histological examination of a selective neck dissection specimen will ordinarily include 6 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 10 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. When size is a criterion for pN classification, measurement of made of the metastasis, not of the entire lymph node. (1) **Note 2:** If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are assigned as ipsilateral. **Note 3:** Size of the largest metastasis in a lymph node must be known to assign N. You may use a physician’s statement of the N category if this is the only information in the medical record. * If the size of the metastasis is not documented, determine the size of the largest involved lymph node as documented pathologically * If the size of the lymph node(s) cannot be determined, assign N1 * Do not code the size of any node(s) assigned in M (distant metastasis) **Note 4:** 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 5:** 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 6:** 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


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 node metastasis No regional lymph node involvement
p1 pN1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension Positive ipsilateral lymph node, not stated if single or multiple
Positive lymph node, not stated if ipsilateral, bilateral, or contralateral

Positive lymph node, size not stated

Stated as N1
p2 pN2 Metastasis as described below Note: N2 has subcategories of N2a, N2b and N2c. Assign N2 only when there is no information available to assign one of the subcategories

Stated as N2 [NOS]
p2A pN2a Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension Stated as N2a
p2B pN2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension Multiple lymph nodes, not stated if ipsilateral, bilateral or contralateral

Stated as N2b
p2C pN2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension Bilateral lymph nodes, size not stated

Stated as N2c
p3 pN3 Metastasis in a lymph node more than 6 cm in greatest dimension Stated as N3
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 Primary site/histology not TNM defined
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., 56