Esophagus - CS Lymph Nodes

Note 1: Code only regional nodes and nodes, NOS in this field. Distant nodes are coded in CS Mets at DX.
Note 2: Regional lymph nodes for any part of the esophagus fall in the range from periesophageal/cervical to the celiac region. Contralateral and bilateral cervical, supraclavicular, and mediastinal lymph nodes are included. However, AJCC has clarified that some nodal chains in this large area are partially regional and partially distant because they include both nodes that are close to the esophagus toward the body's midline and nodes that run laterally away from the esophagus or perpendicular to it. Regional nodes are those that lie in the bed of the esophagus. Examples: regional supraclavicular nodes (level 1), regional pulmonary ligament nodes (level 9), regional hilar tracheobronchial nodes (level 10), or regional diaphragmatic nodes (level 15) are only those nodes closest to the esophagus; nodes in these chains that are further from the esophagus are distant. Medical record terminology is unlikely to be so specific in describing involved node locations, so try to correlate involved node information with staging statements that indicate whether the nodes were considered regional or distant by the physicians; lacking such physician guidance, presume regional nodes. If the record just indicates involvement of supraclavicular nodes, for example, and there is no further information available, presume that the involved nodes were close to the esophagus and regional.
Note 3: Over time the celiac and cervical nodes have been coded in both CS Mets at DX and CS Lymph Nodes, depending on the subsite. Code all nodes that are regional per AJCC 7th Ed. staging (see Notes 2 and 4) in CS Lymph Nodes, but be aware that cervical and celiac nodes are in CS Mets at DX for legacy data whose codes were not updated under CSv2.
Note 4: Lymph node stations/groups from AJCC 7th Ed. chapter 10 are listed in parentheses when applicable. For a descriptive list of these nodal groups, see Part I Section 2 or Figure 10.3 from the AJCC Cancer Staging Atlas, 2nd Ed. or errata for AJCC 7th Ed. chapter 10. AJCC has clarified the status of the most distal node chains for the esophagus/esophagogastric junction chapter. The left gastric artery and celiac nodes (levels 17, 20) are regional, but the common hepatic and splenic artery nodes (levels 18, 19) are not regional. See code 15 in CS Mets at DX.
Note 5: Imaging studies often refer to involved nodes in the gastrohepatic ligament or at the gastrohepatic level for esophageal primaries. Code as left gastric nodes if there is no more specific information.
Note 6: The number of positive regional nodes is required to calculate the correct N category for this schema. Use codes 560, 610 or 710 when the pathology report assigns an N1, N2 or N3 category but does not specify the number of nodes involved, or the record identifies an N1, N2 or N3 category but the specific information about number of nodes involved is not available. Use codes (100-255, 265-280 and 305-500) rather than codes 560, 610 or 710 when information about the number of positive nodes is available, or when nodes are clinically positive but not removed for examination.

^ For CS Lymph Nodes codes 100-255, 265-280, and 305-500 ONLY, the N category for AJCC 7 staging is assigned based on the number of positive lymph nodes; when CS Lymph Nodes Eval is 1, 9 and CS Coding System Original is before CS V02.05, the N category is assigned from the Lymph Nodes Clinical Eval Prior to V02.05 AJCC 7 Table, using Regional Nodes Positive and CS Site-Specific Factor 1; when CS Lymph Nodes Eval is 0, 5 OR (CS Lymph Nodes Eval is 1, 9 and CS Coding System Original is at least V02.05), the N category is assigned from Lymph Nodes Clinical Eval V02.05 AJCC 7 Table, using CS Site-Specific Factor 1; when CS Lymph Nodes Eval is 2, 3, 6, 8, or not coded, the N category is determined from the Lymph Nodes Patholologic Evaluation AJCC 7 Table Also Used When CS Lymph Nodes Eval Is Not Coded, using Regional Nodes Positive.

Code	Description	TNM 7 Map	TNM 6 Map	SS77 Map	SS2000 Map
000	No regional lymph node involvement	N0	N0	NONE	NONE
100	Regional lymph nodes (including contralateral or bilateral): For all subsites: Peri-/paraesophageal (8L, 8M) Cervical esophagus only: Cervical, NOS: Anterior deep cervical (laterotracheal) (recurrent laryngeal) Internal jugular, NOS Deep cervical, NOS: Upper, NOS: Jugulodigastric (subdigastric) Intrathoracic esophagus, upper or middle, only: Internal jugular, NOS: Deep cervical, NOS: Lower, NOS: Jugulo-omohyoid (supraomohyoid) Middle Upper cervical, NOS: Jugulodigastric (subdigastric) Intrabronchial: Carinal (tracheobronchial) (10R, 10L) (tracheal bifurcation) Hilar (bronchopulmonary) (proximal lobar) (pulmonary root) Peritracheal Left gastric (superior gastric) (17): Cardiac (cardial) Lesser curvature Perigastric, NOS Posterior mediastinal (tracheoesophageal) Intrathoracic esophagus, lower (abdominal) only: Left gastric (superior gastric) (17): Cardiac (cardial) Lesser curvature Perigastric, NOS Posterior mediastinal (3P) (tracheoesophageal)	^	N1	RN	RN
200	Cervical esophagus only: Scalene (inferior deep cervical) (1) Supraclavicular (transverse cervical) (1)	^	N1	D	RN
220	Intrathoracic, upper thoracic or middle, only: Superior mediastinal	^	N1	D	RN
250	Upper thoracic esophagus only: Cervical lymph nodes Lower thoracic (abdominal) esophagus only: Celiac lymph nodes (20)	^	N0	D	D
255	250 + any of (100, 200, 220)	^	N1	D	D
260	OBSOLETE DATA REVIEWED AND CHANGED V0203 See codes 000 - 255 and 265 - 280, and CS Mets at DX codes 15 and 50 Cervical esophagus only: Common hepatic (regional) (18) Diaphragmatic (15) Pulmonary ligament (9) Splenic (19) Intrathoracic esophagus, upper or middle, only: Common hepatic (18) (regional) Diaphragmatic (15) Splenic (19) Lower thoracic (abdominal) esophagus only: Aortopulmonary (5) Pulmonary ligament (9)	ERROR	ERROR	ERROR	ERROR
265	For cervical esophagus: Diaphragmatic (15) Pulmonary ligament (9) For intrathoracic esophagus, upper or middle,: Diaphragmatic (15) For lower thoracic (abdominal) esophagus: Aortopulmonary:(5): Para-aortic (ascending aorta or phrenic) Subaortic Pulmonary ligament (9)	^	N0	D	D
270	265 + any of (100, 200, 220)	^	N1	D	D
275	265 + 250	^	N0	D	D
280	275 + any of (100, 200, 220)	^	N1	D	D
300	OBSOLETE DATA REVIEWED AND CHANGED V0203 See codes 000-255, 265-280, and 305-330 and CS Mets at DX codes 15 and 50 All esophagus subsites: Anterior mediastinal (6) Mediastinal, NOS Cervical esophagus only: Aortopulmonary (5) Paratracheal (2R,2L, 4R, 4L) Posterior mediastinal (3P) Superior mediastinal Intrathoracic esophagus,upper or middle, only: Aortopulmonary (5) Pulmonary ligament (9) Intrathoracic esophagus, lower (abdominal) only: Common hepatic (18) Diaphragmatic (15) Paratracheal (2R,2L, 4R,4L) Splenic (19) Superior mediastinal	ERROR	ERROR	ERROR	ERROR
305	For all esophagus subsites: Anterior mediastinal (6) Mediastinal, NOS For cervical esophagus only: Aortopulmonary (5): Para-aortic (ascending aorta or phrenic) Subaortic Paratracheal (2R, 2L, 4R, 4L) Posterior mediastinal (3P) Superior mediastinal For intrathoracic esophagus, upper or middle, only: Aortopulmonary (5): Para-aortic (ascending aorta or phrenic) Pulmonary ligament (9) For intrathoracic esophagus, lower (abdominal) only: Diaphragmatic (15) Paratracheal (2R, 2L, 4R, 4L) Superior mediastinal	^	N1	D	D
310	305 + (250 or 255)	^	N1	D	D
320	305 + (265 or 275)	^	N1	D	D
330	305 + (270 or 280)	^	N1	D	D
500	Regional lymph node(s), NOS	^	N1	RN	RN
560	Stated as pathologic N1 with no other pathologic information on regional lymph nodes	N1	N1	RN	RN
600	OBSOLETE DATA CONVERTED V0203 See code 500 Stated as clinical N2 (clinical assessment; no lymph nodes removed)	ERROR	ERROR	ERROR	ERROR
610	Stated as pathologic N2 with no other pathologic information on regional lymph nodes	N2	N1	RN	RN
700	OBSOLETE DATA CONVERTED V0203 See code 500 Stated as clinical N3a (clinical assessment; no lymph nodes removed)	ERROR	ERROR	ERROR	ERROR
710	Stated as pathologic N3 with no other pathologic information on regional lymph nodes	N3	N1	RN	RN
800	Lymph nodes, NOS	N1	N1	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