This Review Covers

SEER Lymph Node ✔ EOD Lymph Node Involvement Codes Revisited ✔ Number of Regional Nodes Positive ✔ Number of Regional Nodes Examined ✔ Scope of Regional Lymph Node Surgery SEER Program Training Materials ✔ Number of Regional Lymph Nodes October 2002 Examined ✔ Lymph Node Anatomy of Major Sites 1 SEER Lymph www.seer.cancer.gov Node Codes 2 SEER Lymph www.seer.cancer.gov Node Codes

EOD Lymph Node Involvement Lymph Node Involvement(1) ✔ One digit hierarchical code ✔ Code LN involvement 0 for all in ✔ Describes farthest lymph node situ cases involvement ✔ Code distant lymph nodes if ● regional present ● distant ✔ Read each scheme--know when ✔ Corresponds to AJCC N, M fields size, laterality, number of nodes where name of involved node and location of nodes is important chain is important 3 SEER Lymph www.seer.cancer.gov Node Codes 4 SEER Lymph www.seer.cancer.gov Node Codes

1 Number of Regional LN Lymph Node Involvement (2) Positive and Examined ✔Terms which do NOT indicate LN involvement (except for lymphoma) ✔ Each 2 digit numeric field ● Palpable ✔ ● Enlarged Each cumulative over all first course ● Visible procedures ● Swelling ✔ Number positive corresponds to ● Shotty AJCC N category for sites where ● Lymphadenopathy number of involved nodes is a ✔For lymphomas, any mention of lymph criterion nodes is coded as involvement ✔ Number examined useful to determine extent of regional node dissection 5 SEER Lymph www.seer.cancer.gov Node Codes 6 SEER Lymph www.seer.cancer.gov Node Codes

Number of Reg LN Positive Number of Regional Lymph

and Examined--Guidelines(1) Nodes Positive--Guidelines (2)

✔# Pos = the number pathologically ✔Special codes examined that were positive even after ● 97 Nodes positive but number pre-surgery therapy unknown OR aspirated node positive ✔# Exam = the number pathologically ● 98 No nodes examined; no LN examined (reported in micro description) surgery ✔Always code 9s for ● 99 Not known if nodes are positive ● Bone marrow; leukemia/myeloma or negative or field not applicable ● Lymphoma; mycosis/Sezary's (unknown or ill-defined primary ● Unknown primary; ill-defined sites site) ● Brain tumor 7 SEER Lymph www.seer.cancer.gov Node Codes 8 SEER Lymph www.seer.cancer.gov Node Codes

2 Number of Regional Lymph Scope of Regional

Nodes Examined--Guidelines(2) Lymph Node Surgery ✔Special codes ✔Regional lymph nodes only ● 95 No nodes removed; aspiration ✔ ● 96 Sampling; number not known Procedure based ● 97 Dissection; number not known ✔No minimum number of nodes ● 98 Procedure not described; number not known ✔Neck dissections defined ● 99 Not known if nodes were ✔ examined; not applicable Hierarchical ✔Not the same concept as EOD LN Involvement field 9 SEER Lymph www.seer.cancer.gov Node Codes 10 SEER Lymph www.seer.cancer.gov Codes Node

Scope of Regional Scope of Regional Lymph Node Surgery Lymph Node Surgery Simple NO / YES format Specific procedures and Intrahepatic Bile Ducts Head and Neck 0 No regional LN removed 1 Regional lymph node(s) removed, NOS 1 Regional lymph node(s) removed 2 Neck dissection, NOS 9 Unknown; not stated; death 3 Selective, limited; nodal sampling; certificate only "berry picking" 4 Modified/modified radical 5 Radical 11 SEER Lymph www.seer.cancer.gov Codes Node 12 SEER Lymph www.seer.cancer.gov Codes Node

3 Scope of Regional Scope of Regional Lymph Lymph Node Surgery Node Surgery--Guidelines Colon--general terms ✔Code farthest nodes removed, ● Colic nodes even if negative ● Mesenteric nodes ● Peri-\epi-\para-\ colic ✔Code node aspiration to NOS Colon--specific node chains Examples: ✔Nodes not in regional list are ● Anterior cecal coded as distant ● Ileocolic ● Posterior cecal ● Right colic 13 SEER Lymph www.seer.cancer.gov Codes Node 14 SEER Lymph www.seer.cancer.gov Codes Node

Number of Regional Number of Regional Lymph Lymph Nodes Removed Nodes Removed--Guidelines ✔ Not cumulative ✔00 if no nodes in specimen ✔01 - 90 nodes examined Special Codes 90 Ninety or more regional nodes... ✔Code "sampling," "dissection" 95 Aspiration ✔Code aspiration if no nodes 96 Sampling, number not stated 97 Dissections, number not stated removed 98 Nodes removed, number unknown, procedure not defined 15 SEER Lymph www.seer.cancer.gov Codes Node 16 SEER Lymph www.seer.cancer.gov Codes Node

4 Major Lymph Node Chains of Head 1. submental Lymph Node Anatomy 2. submandibular 3. jugular (deep cervical) for Selected Sites 8 4. superficial cervical 10 9 5. supraclavicular 3, 4 6. prelaryngeal* and 7 1 paratracheal* 2 7. retropharyngeal 8. parotid 5 9. buccal 10. retroauricular and * not shown occipital 17 SEER Lymph www.seer.cancer.gov Codes Node 18 SEER Lymph www.seer.cancer.gov Codes Node

Lymph Nodes of Esophagus Lymph Nodes of Stomach LN1, 2, 3 Cervical/supraclavicular M1 N1 LN6, 7 Cervical Intrathoracic esophagus LN7 LN1, 3 esophagus primary M1 N1 primary

Mediastinal

Perigastric

LN1, 5 LN1, 5

Source: TNM-interactive, UICC, 1998 LN# = EOD LN code

19 SEER Lymph www.seer.cancer.gov Codes Node 20 SEER Lymph www.seer.cancer.gov Codes Node Source: TNM-interactive, UICC, 1998 LN# = EOD LN code

5 Lymph Nodes of Stomach Regional Nodes -- Colon Terms that apply to all segments: Colic LN1 peri- epi- para- LN1 LN1 Mesenteric LN3 LN4 LN4 LN7

LN# = EOD LN code

Source: TNM-interactive, UICC, 1998 LN# = EOD LN code 21 SEER Lymph www.seer.cancer.gov Codes Node 22 SEER Lymph www.seer.cancer.gov Codes Node

Regional Nodes -- Colon Gallbladder and Extrahepatic "Named" nodes are Bile Ducts Lymph Nodes EOD LN code 2 Regional nodes specific to each Regional Lymph Nodes Cystic duct node segment of colon Pericholedochal LN1 Hilar Cecum Peripancreatic (head Ascending only) LN2 Periduodenal Hepatic flexure Periportal Celiac LN5 Transverse Superior Splenic flexure Mesenteric LN6 Descending Sigmoid Source: TNM-interactive, UICC, 1998 LN# = EOD LN code 23 SEER Lymph www.seer.cancer.gov Codes Node 24 SEER Lymph www.seer.cancer.gov Codes Node

6 Lymph Nodes of Pancreas Lymph Nodes of Pancreas EOD LN Codes Body, Head Tail Peripan- 11 creatic Hepatic 1 1

Celiac 1 7

Infra/sub- 17 pyloric Prox. 11 mesenteric Common 17 bile duct Splenic 7 1 Pancreati- Source: TNM-interactive, UICC, 1998 71 Source: TNM-interactive, UICC, 1998 colienal 25 SEER Lymph www.seer.cancer.gov Codes Node 26 SEER Lymph www.seer.cancer.gov Codes Node

Lymph Nodes of Lung Lymph Node Stations -- Lung LN6 N3 Pulmonary (N1, LN1) Lymph Nodes LN2 10 Hilar N2 LN6 N1 11-14 Lobar and segmental N3 Same side Peribronchial LN1 Hilar Mediastinal (N2-3, LN 2, 6) N1 N2 1 Superior mediastinal Same side 2 Paratracheal (upper) LN6 Subcarinal N3 Mediastinal 3 Pretracheal, retrotracheal 4 Lower paratracheal, azygos N3 LN2 Contralateral 5-6 Aortic (not shown) N2 Primary Mediastinal 7 Carinal, subcarinal (N2) tumor Hilar Any 8 Paraesophageal (below carina) scalene Lymph Node LN# = EOD LN code supraclavicular 9 Pulmonary ligament Stations LN# = EOD LN code

Adapted from R S Snell: Clinical Anatomy for Medical Students, 5th ed. 1995. 27 SEER Lymph www.seer.cancer.gov Codes Node 28 SEER Lymph www.seer.cancer.gov Codes Node

7 Scope of Regional Lymph Node Surgery-- Lymph Nodes of Cervix

Level I (N1, LN 1-4, 6; N2, LN5) 5. Common iliac Superficial axillary nodes 6. Presacral (low axillary, intramammary) 4. External iliac 3. Hypogastric Level II (N1, LN 1-4, 6; N2, LN5) III Interpectoral axillary lymph (obturator) nodes (Rotter’s nodes) S II Int Mam 3. Internal iliac 2. Parametrial Level III (N1, LN 1-4, 6; N2, LN5) I 1. Paracervical Deep (high axillary, apical) All are EOD LN code 1 Internal mammary (N3, LN 7) LN# = EOD LN code (parasternal lymph nodes) 1-4 based on size of metastasis Source: TNM Atlas, 3rd ed. 2nd rev., by B. Spiessl et al. Springer Verlag 1992. 29 SEER Lymph www.seer.cancer.gov Codes Node 30 SEER Lymph www.seer.cancer.gov Codes Node

Lymph Nodes of Corpus, Lymph Nodes of Prostate Ovary, and Fallopian Tube below the bifurcation of EOD LN Codes the common iliac arteries Ovary, Corpus Tube LN7

Hypo- 11 gastric LN6 Common 11 iliac External 11 iliac LN1-3, 5 Lateral 11 sacral LN6, 7 Para- 22 aortic LN# = EOD LN code 1-3 based on size of Inguinal 6, 7 3 metastasis Source: TNM-interactive, UICC, 1998 Source: TNM-interactive, UICC, 1998 31 SEER Lymph www.seer.cancer.gov Codes Node 32 SEER Lymph www.seer.cancer.gov Codes Node

8 Lymph Nodes of Testis Lymph Nodes for Kidney, Abdominal paraaortic (periaortic) 1 Interaortocaval Renal Pelvis and Ureter 2 Paracaval Kidney and Renal Pelvis 3 Precaval 4 EOD LN code 1-3 or 5 4 Retrocaval 1 1-3 based on size of metastasis 3 Hilar 5 Preaortic C 5 6 Retroaortic 2 A 6 Abdominal para-aortic Paracaval Under certain conditions: Ureter Intrapelvic EOD LN code 1-3 or 5 External iliac except as noted 1-3 based on size of metastasis Inguinal LN6 Hilar All are EOD LN Paracaval code 1-3 or 5 Intrapelvic (Pelvic, NOS) except as noted 1-3 based on size of Source: Cancer: PPO, DeVita et al Abdominal para-aortic LN7 Source: TNM-interactive, UICC, 1998

33 SEER Lymph www.seer.cancer.gov Codes Node metastasis 34 SEER Lymph www.seer.cancer.gov Codes Node

Lymph Nodes of Bladder Malignant Lymphoma Anatomic below the bifurcation of Lymph Node the common iliac arteries Regions for Ann Arbor LN7 Staging

For lymphomas, lymph node regions LN6 are counted in the LN1-3, 5 EOD Extension field.

Graphic: LN7 Clinical Oncology-- LN# = EOD LN code a multidisciplinary approach, 1-3 based on size of 7th ed. P. Rubin) metastasis Source: TNM-interactive, UICC, 1998 35 SEER Lymph www.seer.cancer.gov Codes Node 36 SEER Lymph www.seer.cancer.gov Codes Node

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