SITE SPECIFIC DATA ITEMS (SSDI)/ GRADE

Description

Lymph Nodes for Head and Neck, Levels IV-V records the involvement of Levels IV-V lymph nodes. This data item is used to code the presence or absence of lymph node involvement in head and neck levels I-III. The definitions of the levels are the same for all applicable head and neck sites. * Note: This data item was previously collected for all head and neck sites. It is now only clinically relevant for unknown head and neck primaries with positive cervical (head and neck) lymph nodes and mucosal melanomas of the head and neck. **Level IV** contains the lower jugular lymph nodes from the level of the cricoid cartilage superiorly to the clavicle inferiorly. Lymph node chains at this level: * Jugulo-omohyoid (supraomohyoid), lower deep cervical, lower jugular **Level V** is subdivided into levels VA and VB, which contain the lymph nodes in the posterior triangle bounded by the anterior border of the trapezius muscle posteriorly, the posterior border of the sternocleidomastoid muscle anteriorly, and the clavicle inferiorly. For descriptive purposes, Level V may be further subdivided into upper (VA) and lower (VB) levels corresponding to a plane defined by the inferior border of the cricoid cartilage. Lymph node chains at this level: * Posterior cervical, posterior triangle (spinal accessory, transverse cervical [upper, middle, and lower, corresponding to the levels that define upper, middle, and lower jugular nodes]), supraclavicular

Notes

**Note 1:** **Physician Statement** * Physician statement of Levels IV-V lymph node involvement can be used to code this data item when no other information is available. **Note 2:** **Related data items** * 3876: LN Head and Neck Levels I-III * 3877: LN Head and Neck Levels IV-V * 3878: LN Head and Neck Levels VI-VII * 3879: LN Head and Neck Other **Note 3:** **Priority order** * Pathological information takes priority over clinical. **Note 4:** **Supraclavicular nodes** * If lymph nodes are described only as “supraclavicular,” try to determine if they are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior triangle, inferior to the transverse cervical artery) and code appropriately. * If the specific level cannot be determined, or is documented as supraclavicular with no further information, code them as Level V nodes **Note 5:** **Priority order** * Pathological information takes priority over clinical.