Pathologic N
This input is used for staging
Notes
**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 nodesNAACCR 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 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) |