VI.2.3 Regional Lymph Nodes Examined

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:

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

• This field is based on pathologic information only.

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

• Record the total number of regional lymph nodes removed and examined by the pathologist.

• The number of regional lymph nodes examined is cumulative from all procedures that removed lymph nodes through the completion of surgeries in the first course of treatment

• Do not count a positive aspiration or core biopsy of a lymph node in the same lymph node chain removed at surgery as an additional node in Regional Nodes Examined.

• If the positive aspiration or core biopsy is from a node in a different node region, include the node in the count of Regional Nodes Examined.

• If the location of the lymph node that is aspirated or core-biopsied 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 Examined.

• When neither the type of lymph node removal procedure nor the number of lymph nodes examined is known, use code 98.

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

• final diagnosis

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

• microscopic

• gross

• Code 00 may be used in several situations.

• When the assessment of lymph nodes is clinical.

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

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

• Code 96 is used if the number of nodes removed by biopsy is not known.

• Use code 96 when a limited number of nodes are removed but the number is unknown. A lymph node “sampling” is removal of a limited number of lymph nodes.  Other terms for removal of a limited number of nodes include lymph node biopsy, berry picking, sentinel lymph node procedure, sentinel node biopsy, selective dissection.   

• Code 97 is used when:

• More than a limited number of lymph nodes are removed and the number is unknown.  A lymph node “dissection” is the removal of most or all of the nodes in the lymph node chain(s) that drain the area around the primary tumor. Other terms include lymphadenectomy, radical node dissection, or lymph node stripping.

• If both a lymph node sampling and a lymph node dissection are performed and the total number of lymph nodes examined is unknown.

• Code 99 is used if it is unknown whether nodes were removed or examined.

• For the following schemas, the Regional Nodes Examined 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

NOTE: Effective with cases diagnosed on or after January 1, 2003, the fields for Rx Summ-Reg LN Examined and Rx Hosp-Reg LN Examined are no longer required by the CCR and the CoC. Information regarding the number of lymph nodes has been incorporated into the scope fields.

Codes:

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