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 is 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:** For nasopharynx, unilateral and bilateral retropharyngeal nodes are mapped to N1, and nodes in the supraclavicular fossa are mapped to N3b. The supraclavicular fossa is defined by 3 points: the superior margin of the sterna end of the clavicle, the superior margin of the lateral end of the clavical, and the point where the neck meets the shoulder. **Note 4:** 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 5:** 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 6:** 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 7:** 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 node(s) 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
p1 pN1 Unilateral metastasis, in cervical lymph nodes(s), and/or unilateral or bilateral metastasis in retropharyngeal lymph nodes, 6 cm or less in greatest dimension, above the supraclavicular fossa Positive lymph nodes, not stated if unilateral or bilateral
Positive lymph nodes, size of lymph node metastasis unknown

Stated as N1
p2 pN2 Bilateral metastasis in cervical lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa Positive bilateral nodes, NOS

Stated as N2
p3 pN3 Metastasis in cervical lymph node(s) greater than 6 cm in dimension or in the supraclavicular fossa Note: N3 has subcategories of N3a and N3b. Assign N3 only when there is no information available to assign one of the subcategories.

Stated as N3 [NOS]
p3A pN3a Greater than 6 cm in dimension Stated as N3a
p3B pN3b Extension in the supraclavicular fossa Unilateral or bilateral positive regional node(s):
Level IV - Lower jugular:
Jugulo-omohyoid (supraomohyoid)
Lower deep cervical
Virchow node
Level VB - Transverse cervical, supraclavicular (see Note 4)
Level VII - Superior mediastinal group
Esophageal groove
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch

Stated as N3b
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
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, pgs., 28, 35, 42, 49