Collaborative Stage

Note 1: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS [extracapsular spread] can be diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence of cranial nerve invasion. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and stranding of the perinodal soft tissue in previously untreated patients."
Note 2: Code the status of extracapsular extension assessed clinically for any involved regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension for any nodes coded in CS Mets at DX in this field.
Note 3: If nodes are involved clinically, and documentation of physical examination or imaging is available without a statement of extracapsular extension, use code 010.
Note 4: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular extension, use code 030.
Note 5: If there is no information about clinical assessment of nodes, use code 999.

Code	Description
000	No regional lymph nodes involved clinically
010	Regional lymph node(s) involved clinically, no extracapsular extension clinically
020	Regional lymph node(s) involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030	Regional lymph node(s) involved clinically, unknown if extracapsular extension
988	Not applicable: Information not collected for this case (If this information is required by your standard setter, use of code 988 may result in an edit error.)
997	Clinical examination of regional lymph nodes performed, unknown results
998	No clinical examination of regional lymph nodes
999	Unknown if regional lymph nodes involved clinically, not stated Regional lymph nodes cannot be assessed Not documented in patient record

CS Site-Specific Factor 8
Extracapsular Extension Clinically, Lymph Nodes for Head and Neck