Breast - CS Lymph Nodes

Note 1: Code only regional nodes and nodes, NOS, in this field. Distant nodes such as cervical (excluding supraclavicular) or contralateral axillary are coded in CS Mets at DX.
Note 2: Micrometastases are defined as tumor deposits greater than 0.2 millimeter (mm) but not greater than 2.0 mm in largest dimension. Macrometastases are tumor deposits greater than 2.0 mm. All nodes with at least micrometastases are included in the count of positive lymph nodes, but at least one node must contain a macrometastasis for assignment of a pathologic N category greater than pN1mi.
Note 3: If the pathology report indicates that nodes are positive but size of the metastases is not stated, assume the metastases are greater than 0.2 mm and code the lymph nodes as positive in this field. Use code 600 in the absence of other information about regional nodes.
Note 4: In a physical exam if palpable nodes are not described as fixed or matted, assume that nodes are movable.
Note 5: Codes 130-600 refer to level I and level II ipsilateral axillary lymph nodes and ipsilateral intramammary nodes only. Ipsilateral level III axillary lymph nodes, which are also known as infraclavicular or apical nodes, are coded 750 or higher. Axillary lymph nodes do not include internal mammary or ipsilateral supraclavicular lymph nodes.
Note 6: For the breast schema, the choice of the N category is dependent on the CS Lymph Nodes Eval field. There are certain CS Lymph Nodes codes that can only be used if the nodes are evaluated clinically (CS Lymph Nodes Eval is coded 0, 1, 5, or 9), which will be designated as "Evaluated clinically:" at the beginning of the code description. Similarly, there are certain CS Lymph Nodes codes that can only be used if the nodes are evaluated pathologically (CS Lymph Nodes Eval is coded 2, 3, 6, or 8), and these will be designated as "Evaluated pathologically:". All other codes can be used for clinical or pathologic evaluation.
Note 7: Isolated tumor cells (ITC) are defined as single tumor cells or small clusters not greater than 0.2 mm, usually detected only by immunohistochemical (IHC) or molecular methods but which may be verified on hematoxylin and eosin (H and E) stains. ITCs do not usually show evidence of malignant activity (e.g., proliferation or stromal reaction). Lymph nodes with ITCs only are not considered positive lymph nodes. If the record only states N0(i+), code to 000 and see CS Site-Specific Factor 4.

^ For CS Lymph Nodes code 000 ONLY, the N category is assigned based on the coding of CS Site-Specific Factors 4 and 5 using the IHC MOL Table for this schema.
^^ For CS Lymph Nodes codes 250, 258, 260, 510, 520, 600, 610, 620, 630, 720, and 748 ONLY, the N category is assigned based on the values of CS Lymph Nodes Eval and CS Site-Specific Factor 3 (Number of Positive Ipsilateral Axillary Lymph Nodes). If the CS Lymph Nodes Eval code is 2 (p), 3 (p), 6 (yp), or 8 (a), the N category is determined by reference to the Lymph Nodes Pathologic Evaluation Table. If the CS Lymph Nodes Eval code is 0 (c), 1(c), 5(c), or 9 (c), the N category is determined by reference to the Lymph Nodes Clinical Evaluation Table. If the CS Lymph Nodes Eval field is not coded, the N category is determined by reference to the Lymph Nodes Positive Axillary Node Table.
* For CS Lymph Nodes code 000 ONLY, the N category is assigned based on the coding of CS Site-Specific Factors 4 and 5 using the IHC MOL Table for this schema.
** For CS Lymph Nodes codes 250,258, 260, 280, 500, 510, 520, 600, 610, 620, 630, 720, and 748 ONLY, the N category is assigned based on the values of CS Lymph Nodes Eval and CS Site-Specific Factor 3 (Number of Positive Ipsilateral Axillary Lymph Nodes). If the CS Lymph Nodes Eval code is 2 (p), 3 (p), 6 (yp), or 8 (a), the N category is determined by reference to the Lymph Nodes Pathologic Evaluation Table. If the CS Lymph Nodes Eval code is 0 (c), 1(c), 5(c), or 9 (c), the N category is determined by reference to the Lymph Nodes Clinical Evaluation Table. If the CS Lymph Nodes Eval field is not coded, the N category is determined by reference to the Lymph Nodes Positive Axillary Node Table.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
000	No regional lymph node involvement OR isolated tumor cells (ITCs) detected by immunohistochemistry/immunohistochemical (IHC) methods or molecular methods ONLY. (See Note 7 and CS Site-Specific Factors 4 and 5)	^	*	NONE	NONE
050	Evaluated pathologically: None; no regional lymph node involvement BUT ITCs detected on routine hematoxylin and eosin (H and E) stains. (See Note 7)	N0(i+)	N0(i+)	NONE	NONE
130	Evaluated pathologically: Axillary lymph node(s), ipsilateral, micrometastasis ONLY detected by IHC ONLY (At least one micrometastasis greater than 0.2 mm or more than 200 cells AND all micrometastases less than or equal to 2 mm)	N1mi	N1mi	RN	RN
150	Evaluated pathologically: Axillary lymph node(s), ipsilateral, micrometastasis ONLY detected or verified on H&E (At least one micrometastasis greater than 0.2 mm or more than 200 cells AND all micrometastases less than or equal to 2 mm) Micrometastasis, NOS	N1mi	N1mi	RN	RN
155	Evaluated pathologically: Stated as N1mi with no other information on regional lymph nodes	N1mi	N1mi	RN	RN
250	Evaluated pathologically: Movable axillary lymph node(s), ipsilateral, positive with more than micrometastasis (At least one metastasis greater than 2 mm) (See Note 4)	^^	**	RN	RN
255	Evaluated clinically: Clinically movable axillary lymph node(s), ipsilateral, positive (Clinical assessment because of neoadjuvant therapy or no pathology) (See Note 4)	N1	N1	RN	RN
257	Evaluated clinically: Clinically stated only as N1 (Clinical assessment because of neoadjuvant therapy or no pathology)	N1	N1	RN	RN
258	Evaluated pathologically: Pathologically stated only as N1 [NOS], no information on which nodes were involved	^^	**	RN	RN
260	Stated as N1 [NOS] with no other information on regional lymph nodes	^^	**	RN	RN
280	OBSOLETE DATA RETAINED V0104 Stated as N2, NOS	ERROR	**	RN	RN
290	OBSOLETE DATA CONVERTED V0203 See code 610 Clinically stated only as N2, NOS (clinical assessment because of neoadjuvant therapy or no pathology)	ERROR	ERROR	ERROR	ERROR
300	OBSOLETE DATA CONVERTED V0203 See code 620 Pathologically stated only as N2 NOS; no information on which nodes were involved	ERROR	ERROR	ERROR	ERROR
500	OBSOLETE DATA RETAINED V0104 Fixed/matted ipsilateral axillary nodes, positive with more than micrometastasis (i.e., at least one metastasis greater than 2 mm) Fixed/matted ipsilateral axillary nodes, NOS	ERROR	**	RN	RN
510	Evaluated clinically: Fixed/matted ipsilateral axillary nodes clinically (Clinical assessment because of neoadjuvant therapy or no pathology) Stated clinically as N2a (Clinical assessment because of neoadjuvant therapy or no pathology)	^^	**	RN	RN
520	Evaluated pathologically: Fixed/matted ipsilateral axillary nodes clinically with pathologic involvement of lymph nodes WITH at least one metastasis greater than 2 mm	^^	**	RN	RN
600	Axillary/regional lymph node(s), NOS Lymph nodes, NOS	^^	**	RN	RN
610	Evaluated clinically: Clinically stated only as N2 [NOS] (Clinical assessment because of neoadjuvant therapy or no pathology)	^^	**	RN	RN
620	Evaluated pathologically: Pathologically stated only as N2 [NOS]; no information on which nodes were involved	^^	**	RN	RN
630	Stated as N2 [NOS] with no other information on regional lymph nodes	^^	**	RN	RN
710	Evaluated pathologically: Internal mammary node(s), ipsilateral, positive on sentinel nodes but not clinically apparent (No positive imaging or clinical exam) WITHOUT axillary lymph node(s), ipsilateral	N1b	N1b	RN	RN
720	Evaluated pathologically: Internal mammary node(s), ipsilateral, positive on sentinel nodes but not clinically apparent (No positive imaging or clinical exam) WITH axillary lymph node(s), ipsilateral	^^	**	RN	RN
730	Evaluated pathologically: Internal mammary node(s), ipsilateral, positive on sentinel nodes but not clinically apparent (No positive imaging or clinical exam) UNKNOWN if positive axillary lymph node(s), ipsilateral	N1b	N1b	RN	RN
735	Evaluated clinically: Internal mammary node(s), ipsilateral, positive on sentinel nodes but primary not resected WITHOUT axillary lymph node(s), ipsilateral OR UNKNOWN if positive axillary lymph node(s),	N2b	N2b	RN	RN
740	Internal mammary node(s), ipsilateral, clinically apparent (On imaging or clinical exam) WITHOUT axillary lymph node(s), ipsilateral	N2b	N2b	RN	RN
745	Internal mammary node(s), ipsilateral, clinically apparent (On imaging or clinical exam) UNKNOWN if positive axillary lymph node(s), ipsilateral	N2b	N2b	RN	RN
748	Stated as N2b with no other information on regional lymph nodes	^^	**	RN	RN
750	Infraclavicular lymph node(s)(subclavicular) (level III axillary nodes) (apical), ipsilateral WITH or WITHOUT axillary nodes(s) WITHOUT internal mammary node(s)	N3a	N3a	D	RN
755	Stated as N3a with no other information on regional lymph nodes	N3a	N3a	D	RN
760	OBSOLETE DATA RETAINED AND REVIEWED V0203 See codes 763 and765 Internal mammary node(s), ipsilateral, clinically apparent (on imaging or clinical exam) WITH axillary lymph node(s), ipsilateral, codes 150 to 600 WITH or WITHOUT infraclavicular (level III axillary nodes) (apical) lymph nodes	N3b	N3b	RN	RN
763	Internal mammary node(s), ipsilateral, clinically apparent (On imaging or clinical exam) WITH axillary lymph node(s), ipsilateral, codes 150 to 600 WITHOUT infraclavicular (level III axillary nodes) (apical) lymph nodes or unknown if infraclavicular (level III axillary nodes) (apical) lymph nodes involved	N3b	N3b	RN	RN
764	Internal mammary node(s), ipsilateral, clinically apparent (On imaging or clinical exam) WITHOUT axillary lymph node(s), ipsilateral WITH infraclavicular (level III axillary nodes) (apical) lymph nodes involved	N3b	N3b	D	RN
765	Internal mammary node(s), ipsilateral, clinically apparent (On imaging or clinical exam) WITH axillary lymph node(s), ipsilateral WITH infraclavicular (level III axillary nodes) (apical) lymph nodes involved	N3b	N3b	D	RN
768	Stated as N3b with no other information on regional lymph nodes	N3b	N3b	RN	RN
770	OBSOLETE DATA RETAINED V0200 Internal mammary node(s), ipsilateral, clinically apparent (on imaging or clinical exam) UNKNOWN if positive axillary lymph node(s), ipsilateral	ERROR	N2b	RN	RN
780	OBSOLETE DATA RETAINED V0200 (750) + (770)	ERROR	N3a	D	RN
790	OBSOLETE DATA CONVERTED V0203 See code 820 Stated as N3, NOS	ERROR	ERROR	ERROR	ERROR
800	Supraclavicular node(s), ipsilateral	N3c	N3c	D	D
805	Stated as N3c with no other information on regional lymph nodes	N3c	N3c	D	D
810	Evaluated clinically: Clinically stated only as N3 [NOS] (Clinical assessment because of neoadjuvant therapy or no pathology)	N3NOS	N3NOS	RN	RN
815	Evaluated pathologically: Pathologically stated only as N3 [NOS]; no information on which nodes were involved	N3NOS	N3NOS	RN	RN
820	Stated as N3, NOS with no other information on regional lymph nodes	N3NOS	N3NOS	RN	RN
999	Unknown; regional lymph nodes not stated Regional lymph node(s) cannot be assessed Not documented in patient record	NX	NX	U	U