V.4.2.5 Mets at Diagnosis – Distant Lymph Node(s)

Coding Instructions:

• Use AJCC TNM to determine regional verses distant lymph nodes.

NOTE: Regional lymph nodes are NOT coded in this field.

• Code information about distant lymph node(s) metastasis only (discontinuous or distant) to distant lymph node(s) identified at the time of diagnosis.

• Metastatic involvement may be single (one focus of metastatic disease) or multiple (multiple foci of metastatic disease in the same site or multiple sites).

• Information regarding distant lymph node involvement may be clinical or pathologic.

• Code this field for distant lymph node metastasis even if the patient had neoadjuvant (preoperative) systemic therapy, unless it is determined to be disease progression.

• Code distant lymph node involvement in this field for all solid tumors, Kaposi’s sarcoma, Lymphomas, Unknown primary site and Other and Ill-defined primary sites.  

• Code this field for Lymphomas of all sites for the histologies (9590-9699, 9702-9727, 9735, 9737-9738, 9811-9818, 9823, 8927, and 9737).

• Assign the code that best describes whether the case has distant lymph node metastasis at diagnosis.

• Use code 0 when the medical record:

• Indicates no distant (discontinuous) metastases to distant lymph nodes. Including:

• A negative clinical or pathologic statement

• Negative imaging reports

• States lymph nodes are involved, but there is no indication whether they are regional or distant.

• Mentions (discontinuous) metastasis but distant lymph nodes are not stated as the involved site.

• The patient is diagnosed with an unknown primary (C80.9), unless involved lymph nodes are mentioned to be distant lymph nodes.

NOTE: For all Lymphomas. Lymph node involvement is captured/recorded in the stage group and is based on involvement above and below the diaphragm. The distinction between regional and distant lymph nodes is not relevant.

• Use code 1 when the medical record confirms:

• The patient has distant (discontinuous) metastasis and distant lymph node(s) are mentioned as involved.

NOTE: Placental lymph node involvement for placental primaries is classified as distant lymph node involvement (M1) and are to be recorded in this field.

• Use code 8 (Not applicable) for the following site/histology combinations for which a code for distant metastasis is not clinically relevant:

• Use code 9 when the patient is known to have distant metastasis but it cannot be determined whether the distant metastasis include distant lymph node(s).

Codes:

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