Extranodal Extension Head and Neck Clinical
ENE, Extracapsular extension (ECE)
Description
Extranodal extension is defined as “the extension of a nodal metastasis through the lymph node capsule into adjacent tissue” and is a prognostic factor for most head and neck tumors. This data item pertains to clinical extension. The presence of extranodal extension (ENE) from regional lymph nodes is an important prognostic factor in some cancers because these patients are rarely cured without some type of systemic chemotherapy or radiation. Extranodal extension is defined as metastatic tumor growing from within the lymph node outward through the lymph node capsule and into surrounding connective tissues. This data item for ENE detected clinically.Notes
**Note 1:** **Physican Statement** * Physician statement of extranodal extension (ENE) clinically or physician clinical stage indicating the absence or presence of ENE can be used to code this data item when no other information is available * Physical exam alone is sufficient to determine Clinical ENE **Note 2:** **Clinical assessment criteria** * The assessment of ENE must be based on evidence acquired prior to definitive surgery of the primary site, chemotherapy, radiation, or other type of treatment, i.e., the clinical timeframe for staging. * The assessment for ENE in **addition to physical examination** may include imaging, biopsy of the regional lymph node, and/or biopsy of tissues surrounding the regional lymph node * Fixed or matted nodes are clinical indications of ENE * Imaging **alone** is not enough to determine or exclude ENE * Note that the rules for coding ENE for head and neck sites compared to non-head and neck sites are different.| Code | Description |
|---|---|
| 0 | Regional lymph node(s) involved, ENE not present/not identified during diagnostic workup |
| 1 | Regional lymph node(s) involved, ENE present/identified during diagnostic workup, based on physical exam WITH or WITHOUT imaging |
| 2 | Regional lymph node(s) involved, ENE present/identified during diagnostic workup, based on microscopic confirmation |
| 4 | Regional lymph nodes involved, ENE present/identified, unknown how identified |
| 7 | No lymph node involvement during diagnostic workup (cN0) |
| 8 | Not applicable: Information not collected for this case (If this information is required by your standard setter, use of code 8 may result in an edit |
| 9 | Not documented in medical record ENE not assessed during diagnostic workup, or unknown if assessed Clinical assessment of lymph node(s) not done, or unknown if done |