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:** Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in M (distant metastasis). **Note 3:** Any finding of melanoma in lymph nodes, regardless of size and including isolated tumor cells (ITCs), are coded as positive lymph nodes. * Assign N1 If only ITCs are present **Note 4:** Bilateral or contralateral nodes are classified as regional nodes for head, neck, and truncal tumors with bidirectional drainage to primary nodal basins, as shown on lymphoscintigraphy. Truncal tumors may also drain to both cephalad and caudal primary nodal basins as shown on lymphoscintigraphy. * Clinical assessment of bilateral/contralateral or cephalad/caudal regional nodal involvement is required for tumors where lymphoscintigraphy is not performed **Note 5:** Contiguous or secondary nodal basins are the next nodal drainage basins beyond the primary nodal basins. Secondary basins are regional for TNM staging. **Note 6:** Assign N2c if there are satellite(s) or in-transit metastasis without regional lymph node involvement. Assign N3 if both satellite nodules/in-transit metastases and regional lymph nodes are present. **Regional lymph nodes by skin primary site** * Head and Neck sites include bilateral or contralateral nodes **Lip (C440)** Cervical Facial, NOS Buccinator (buccal) Nasolabial Mandibular, NOS Parotid, NOS Infra-auricular Preauricular Submental Submandibular (submaxillary) **External ear/auditory canal (C442)** Cervical Mastoid (post-/retro-auricular) (occipital) Preauricular **Face, Other (cheek, chin, forehead, jaw, nose and temple) (C443)** Cervical Facial, NOS Buccinator (buccal) Nasolabial Mandibular, NOS Parotid, NOS Infra-auricular Preauricular Submental Submandibular (submaxillary) **Scalp (C444)** Mastoid (post-/retro-auricular) (occipital) Parotid, NOS Infra-auricular Preauricular Spinal accessory (posterior cervical) **Neck (C444)** Axillary Mandibular, NOS Mastoid (post-/retro-auricular) (occipital) Parotid, NOS Infra-auricular Preauricular Spinal accessory (posterior cervical) Submental Supraclavicular (transverse cervical) **Trunk (C445)** Axillary Cervical Internal mammary (parasternal) Femoral (superficial inguinal) Supraclavicular (transverse cervical) **Arm/Shoulder (C446)** Axillary Epitrochlear for hand/forearm Spinal accessory for shoulder **Leg/Hip (C447)** Femoral (superficial inguinal) Popliteal for heel and calf **Bidirectional nodal involvement (includes bilateral or contralateral nodes)** Upper Trunk: Femoral (or cephalad/caudal drainage from primary tumor) Lower Trunk: Axillary (or cephalad/caudal drainage from primary tumor) **Secondary nodal basin involvement (includes bilateral or contralateral nodes)** Head and Neck: Supraclavicular Arm/Shoulder: Supraclavicular Leg/Hip: Iliac All sites: Regional lymph node(s) in secondary nodal basins, NOS

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 node metastasis No regional lymph node involvement
p1 pN1 Metastasis in one regional lymph node Note: N1 has subcategories of N1a and N1b. Assign N1 only when there is no information available to assign one of the subcategories

Regional lymph nodes, NOS
Lymph nodes, NOS

Stated as N1 [NOS]
p1A pN1a Only microscopic metastasis (clinically occult) One positive node identified by sentinel lymph node OR after completion of lymphadenectomy

Stated as N1a
p1B pN1b Macroscopic metastasis (clinically apparent) One positive node clinically detected and confirmed by lymphadenectomy OR when there is gross extracapsular extension

Stated as N1b
p2 pN2 Metastasis in two or three regional lymph nodes or satellite(s) or in-transit metastasis 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 Only microscopic nodal metastasis Two to three nodes identified by sentinel lymph node OR after completion of lymphadenectomy

Stated as N2a
p2B pN2b Macroscopic nodal metastasis Two to three nodes clinically detected and confirmed by lymphadenectomy OR when there is gross extracapsular extension

Stated as N2b
p2C pN2c Satellite(s) or in-transit metastasis WITHOUT regional nodal metastasis Satellite nodule(s) or in transit metastasis, distance from primary tumor less than or equal to 2 cm or distance not stated WITHOUT regional lymph node involvement.

Described as tumor with satellite nodule(s) or in transit metastasis, NOS WITHOUT regional lymph node involvement

Stated as N2c
p3 pN3 Metastasis in four or more regional lymph nodes, or matted metastatic regional lymph nodes, or satellite(s) or in-transit metastasis with metastasis in regional lymph node(s) Matted lymph nodes

Satellite nodule(s) or in-transit metastases WITH regional lymph nodes

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 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., 174