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{
"id" : "path_n_dbt",
"algorithm" : "tnm",
"version" : "1.6",
"name" : "Path N Skin",
"title" : "Pathologic N",
"notes" : "**Note 1:** Histological examination of a regional lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. (1)\n\n**Note 2:** Code only regional nodes and nodes, NOS, in this field. Distant nodes are coded in M (distant metastasis).\n\n**Note 3:** Bilateral or contralateral nodes are regional nodes for head, neck, and truncal tumors with bidirectional drainage to primary nodal basins, as shown on lymphoscintigraphy. Truncal tumors may also drain to both cephalad and caudal primary nodal basins as shown on lymphoscintigraphy. \n* Clinical assessment of bilateral/contralateral or cephalad/caudal regional nodal involvement is required for tumors where lymphoscintigraphy is not performed\n\n**Note 4:** Contiguous or secondary nodal basins are the next nodal drainage basins beyond the primary nodal basins. Secondary basins are regional for TNM.\n\n**Note 5:** UICC only defines N2, while AJCC defines N2a, N2b, and N2c. If a record comes in with N2a, N2b, or N2c, reassign it to N2. N2 and the subcategories of N2 all stage the same way.\n\n**Note 6:** Size of the largest metastasis in a lymph node must be known to assign N. You may use a physician’s statement of the N category if this is the only information in the medical record.\n* If the size of the metastasis is not documented, determine the size of the largest involved lymph node as documented pathologically\n* If the size of the lymph node(s) cannot be determined, assign N1\n* Do not code the size of any node(s) assigned in M (distant metastasis)\n\n**Regional lymph nodes by skin primary site**\n* Head and Neck sites include bilateral or contralateral nodes\n\n**Lip (C440)**\n \n Cervical\n Facial, NOS \n Buccinator (buccal) \n Nasolabial \n Mandibular, NOS \n Parotid, NOS \n Infra-auricular \n Preauricular \n Submental \n Submandibular (submaxillary) \n \n**External ear/auditory canal (C442)**\n \n Cervical\n Mastoid (post-/retro-auricular) (occipital) \n Preauricular \n \n**Face, Other (cheek, chin, forehead, jaw, nose and temple) (C443)** \n \n Cervical\n Facial, NOS \n Buccinator (buccal) \n Nasolabial \n Mandibular, NOS \n Parotid, NOS \n Infra-auricular \n Preauricular \n Submental\n Submandibular (submaxillary) \n \n**Scalp (C444)** \n \n Mastoid (post-/retro-auricular) (occipital) \n Parotid, NOS \n Infra-auricular \n Preauricular \n Spinal accessory (posterior cervical)\n \n**Neck (C444)**\n \n Axillary \n Mandibular, NOS \n Mastoid (post-/retro-auricular) (occipital) \n Parotid, NOS \n Infra-auricular \n Preauricular \n Spinal accessory (posterior cervical) \n Submental \n Supraclavicular (transverse cervical) \n \n**Trunk (C445)** \n \n Axillary \n Cervical \n Internal mammary (parasternal)\n Femoral (superficial inguinal) \n Supraclavicular (transverse cervical) \n \n**Arm/Shoulder (C446)**\n \n Axillary \n Epitrochlear for hand/forearm \n Spinal accessory for shoulder \n \n**Leg/Hip (C447)**\n \n Femoral (superficial inguinal) \n Popliteal for heel and calf \n \n **Bidirectional nodal involvement (includes bilateral or contralateral nodes)**\n\n Upper Trunk: Femoral (or cephalad/caudal drainage from primary tumor) \n Lower Trunk: Axillary (or cephalad/caudal drainage from primary tumor)\n \n**Secondary nodal basin involvement (includes bilateral or contralateral nodes)**\n \n Head and Neck: Supraclavicular \n Arm/Shoulder: Supraclavicular \n Leg/Hip: Iliac \n All sites: Regional lymph node(s) in secondary nodal basins, NOS",
"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., 167\n\n\\* For this schema, UICC has only the N2 subcategory. AJCC has subcategories N2a, N2b, or N2c.",
"last_modified" : "2018-02-02T14:54:20.639Z",
"definition" : [ {
"key" : "path_n",
"name" : "Pathologic N",
"type" : "INPUT"
}, {
"key" : "path_n_display",
"name" : "Pathologic N Display",
"type" : "DESCRIPTION"
}, {
"key" : "description",
"name" : "Description",
"type" : "DESCRIPTION"
}, {
"key" : "notes",
"name" : "Registrar Notes",
"type" : "DESCRIPTION"
} ],
"rows" : [ [ "pX", "pNX", "Regional lymph nodes cannot be assessed", "Pathologic classification criteria met, evaluation done:\n Physician unable to assess N\n Surgical resection primary tumor, no regional lymph nodes removed\n Involvement of regional lymph nodes not documented\nPhysician assigns pNX, no other information available to determine N" ], [ "p0", "pN0", "No regional lymph node metastasis", "" ], [ "p1", "pN1", "Metastasis in a single lymph node, 3 cm or less in greatest dimension", "IPSILATERAL positive regional lymph node(s), not stated if single or multiple\n\nPositive lymph nodes, not stated if ipsilateral, contralateral or bilateral\n\nRegional lymph nodes, NOS\nLymph nodes, NOS\n\nStated as N1" ], [ "p2", "pN2", "Metastasis in a single lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or in multiple lymph nodes, none more than 6 cm in greatest dimension*", "Multiple ipsilateral lymph nodes, NOS\nBilateral or contralateral lymph nodes, NOS\n\nStated as N2 (N2a, N2b, N2c, N2 [NOS])" ], [ "p3", "pN3", "Metastasis in a lymph node, more than 6 cm in greatest dimension", "Stated as N3" ], [ "c0", "cN0", "Clinically: No regional lymph node metastasis", "Use only for TNM defined pTis cases where there is a resection of the primary and the nodes are not evaluated pathologically" ], [ "88", "88", "Not applicable", "Primary site/histology not TNM defined\nDeath certificate only (DCO) case" ], [ "", "BLANK", "See Registrar Notes", "Pathologic classification criteria not met \nNo surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category\nEvidence of metastatic disease (pM1), no other workup\nOnly Pathologic Stage Group documented (no T, N, or M information available)" ] ]
}
