VI.2.3.1 Regional Lymph Nodes Positive

NOTE: Effective with cases diagnosed January 1, 2016 and forward, the AJCC definition takes precedence if the definition of regional nodes differs between the AJCC Cancer Staging Manual and the SEER Program Coding and Staging Manual.  

Coding Instructions:

• This field is based on pathologic information only.  

• Record information only about regional lymph nodes in this field.

• This field is to be recorded regardless of whether the patient received preoperative treatment.

• This field collects the cumulative count of lymph nodes found to be positive by pathologic examination.

• From all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment.

• If the location of the lymph node that is core-biopsied or aspirated is not known, assume it is part of the lymph node chain surgically removed, and do not include it in the count of Regional Nodes Positive.

• If there is a discrepancy regarding the number of positive lymph nodes, use information in the following priority:  

• final diagnosis

• synoptic report (also known as CAP protocol or pathology report checklist)

• microscopic

• gross

• If there are multiple primary cancers with different histologic types in the same organ and the pathology report just states the number of nodes positive.

• First try to determine the histology of the metastases in the nodes and code the nodes as positive for the primary with that histology.  

• If no further information is available, code the nodes as positive for all primaries.

• For all primary sites except cutaneous melanoma and Merkel cell carcinoma of skin, count only lymph nodes that contain micrometastases or larger (metastases greater than 0.2 millimeters in size).  

• Do not include in the count of lymph nodes positive any nodes that are identified as containing isolated tumor cells (ITCs).

• If the path report indicates that nodes are positive but the size of metastasis is not stated, assume the metastases are larger than 0.2 mm and count the lymph node(s) as positive.

• For cutaneous melanoma and Merkel cell carcinoma, count nodes with ITCs as positive lymph nodes.

• Code 95 is used when the only procedure for regional lymph nodes is a needle aspiration (cytology) or core biopsy (tissue).

• Use code 95 when a positive lymph node is aspirated and there are no surgically resected lymph nodes.

• Use code 95 when a positive lymph node is aspirated and surgically resected lymph nodes are negative.

• Code 97 for any combination of positive aspirated, biopsied, sampled or dissected lymph nodes if the number of involved nodes cannot be determined on the basis of cytology or histology.  

• Code 97 includes positive lymph nodes diagnosed by either cytology or histology.

• Avoid using Regional Nodes Positive code 97 if possible, even if this means slightly undercounting the number of nodes positive.

• Code 98 may be used in several situations.

• When the assessment of lymph nodes is clinical only.

• When no lymph nodes are removed and examined.   

• When a “dissection” of a lymph node drainage area is found to contain no lymph nodes at the time of pathologic examination.

• If Regional Nodes Positive is coded as 98, Regional Nodes Examined is usually coded 00.

• Code 99 is used if it is unknown whether regional lymph nodes are positive.

• For the following primary sites and histologies, the Regional Nodes Positive field is always coded as 99:

• Placenta

• Brain and Cerebral Meninges

• Other Parts of Central Nervous System

• Intracranial Gland

• Hodgkin and non-Hodgkin Lymphoma

• Hematopoietic, Reticuloendothelial, Immunoproliferative and Myeloproliferative Neoplasms

• Myeloma and Plasma Cell Disorders

• Other and Ill-Defined Primary Sites

• Unknown Primary Site

Codes:

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