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{
"id" : "clin_n_daj",
"algorithm" : "tnm",
"version" : "1.6",
"name" : "Clin N Breast",
"title" : "Clinical N",
"notes" : "**Note 1:** Code only regional nodes and nodes, NOS, in this field. Distant nodes such as cervical (excluding supraclavicular) or contralateral axillary and/or contralateral internal mammary are coded in M (distant metastasis).\n\n**Note 2:** Clinically detected is defined as detected by clinical examination or by imaging studies (excluding lymphoscintigraphy) and having characteristics highly suspicious for malignancy or a presumed pathologic macrometastasis based on fine-needle aspiration biopsy with cytological examination. (1)\n\n**Note 3:** Excisional biopsy of a lymph node or biopsy of a sentinel node, in the absence of assignment of a pT, is classified as a clinical N, e.g., cN1. Pathologic classification (pN) is used for excision or sentinel lymph node biopsy only in conjunction with a pathologic T assignment. (1)\n\n**Note 4:** In a physical exam if palpable nodes are not described as fixed or matted, assume that nodes are movable.\n\n**Note 5:** The breast lymphatics drain by way of three major routes: axillary, transpectoral, and internal mammary. Intramammary lymph nodes reside within breast tissue and are coded as axillary lymph nodes for staging purposes. Supraclavicular lymph nodes are classified as regional lymph nodes for staging purposes. \n\n**Regional lymph nodes**\n\n**Axillary (ipsilateral):** Interpectoral (Rotter) nodes and lymph nodes along the axillary vein and its tributaries, which may be divided into the following levels: \n\n Level I (low-axilla)\n Lymph nodes lateral to the lateral border of pectoralis minor muscle\n Level II (mid-axilla): lymph nodes between: \n Medial lateral borders of the pectoralis minor muscle and interpectoral (Rotter's) lymph nodes\n Level III (apical axilla)\n Lymph nodes medial to the medial margin of the pectoralis minor muscle and inferior to the clavicle\n Infraclavicular (subclavicular) nodes\n The infraclavicular designation may be used for level III nodes to differentiate these nodes from the remaining level I and II axillary nodes\n \n**Internal mammary (ipsilateral)** \n\n Lymph nodes in the intercostal spaces along the end of the sternum in the endothoracic fascia\n\n**Supraclavicular (ipsilateral)** \n\n Lymph nodes in the supraclavicular fossa: A triangle defined by the omohyoid muscle and tendon (lateral and superior border) \n \n**Intramammary** \n\n Lymph nodes within the breast: Intramammary lymph nodes are coded as axillary lymph nodes level I",
"footnotes" : "(1) International Union Against Cancer (UICC) *TNM Classification of Malignant Tumors,* 7th ed., Sobin, LH, Gospodarowicz, M, Wittekind, CH, eds. New York: Wiley, 2009, pg., 186",
"last_modified" : "2018-02-02T14:54:22.488Z",
"definition" : [ {
"key" : "clin_n",
"name" : "Clinical N",
"type" : "INPUT"
}, {
"key" : "clin_n_display",
"name" : "Clinical N Display",
"type" : "DESCRIPTION"
}, {
"key" : "description",
"name" : "Description",
"type" : "DESCRIPTION"
}, {
"key" : "notes",
"name" : "Registrar Notes",
"type" : "DESCRIPTION"
} ],
"rows" : [ [ "cX", "cNX", "Regional lymph nodes cannot be assessed (e.g., previously removed)", "Clinical classification criteria met, evaluation done: \n Physician unable to assess N\n Regional lymph node involvement cannot be determined or findings inconclusive\nPhysician assigns cNX, no other information available to determine N" ], [ "c0", "cN0", "No regional lymph node metastasis", "" ], [ "c1", "cN1", "Metastasis in movable ipsilateral Level I, II axillary lymph node(s)", "Clinically movable axillary lymph node(s), ipsilateral, positive \n\nAxillary/regional lymph nodes, NOS\nLymph nodes, NOS\n\nStated as N1" ], [ "c2", "cN2", "Metastasis in ipsilateral Level I, II axillary lymph node(s) that are clinically fixed or matted; or in clinically detected ipsilateral internal mammary lymph node(s) in the absence of clinically evident axillary lymph node metastatsis", "Note: N2 has subcategories of N2a and N2b. Assign N2 only when there is no information available to assign one of the subcategories\n\nStated as N2 [NOS]" ], [ "c2A", "cN2a", "Metastasis in axillary lymph node(s) fixed to one another (matted) or to other structures", "Metastasis in fixed/matted ipsilateral axillary nodes clinically \n\nNote: Axillary lymph nodes refer only to Level I and II axillary nodes, see N3 (sub)categories for involvement of Level III nodes\n\nStated as N2a" ], [ "c2B", "cN2b", "Metastasis only in clinically detected internal mammary lymph node(s) and in the absence of clinically detected axillary lymph node metastasis", "Note: Axillary lymph nodes refer only to Level I and II axillary nodes, see N3 (sub)categories for involvement of Level III nodes\n\nStated as N2b" ], [ "c3", "cN3", "Metastasis in ipsilateral infraclavicular (Level III axillary) lymph node(s) WITH or WITHOUT Level I, II axillary lymph node involvement; OR \n\nMetastasis In clinically detected ipsilateral internal mammary lymph node(s) with clinically \nevident Level I, II axillary lymph node metastasis; OR \n\nMetastasis in ipsilateral supraclavicular lymph node(s) WITH or WITHOUT \naxillary or internal mammary lymph node involvement", "Note: N3 has subcategories of N3a, N3b and N3c. Assign N3 only when there is no information available to assign one of the subcategories\n\nStated as N3 [NOS]" ], [ "c3A", "cN3a", "Metastasis in infraclavicular lymph nodes", "Level III axillary nodes (apical), ipsilateral\n\nMetastasis in ipsilateral infraclavicular lymph nodes\n\nStated as N3a" ], [ "c3B", "cN3b", "Metastasis in internal mammary and axillary lymph nodes", "Metastasis in ipsilateral and internal mammary and axillary lymph nodes\n\nStated as N3b" ], [ "c3C", "cN3c", "Metastasis in ipsilateral supraclavicular lymph node(s)", "Stated as N3c" ], [ "88", "88", "Not applicable", "Primary site/histology not TNM defined\nDeath certificate only (DCO) case" ], [ "", "BLANK", "See Registrar Notes", "Clinical classification criteria not met\nClinical classification criteria met, evaluation done:\n No information about diagnostic workup\n Results not documented in record\nTumor first detected on surgical resection (no clinical workup)\nEvidence of metastatic disease [(cM1) or (pM1)], no other workup\nOnly Clinical Stage Group documented (no T, N, or M information available)" ] ]
}
