Extranodal Extension Head and Neck Pathological
Notes
**Note 1:** Physician statement of extranodal extension (ENE) pathologically during a lymph node dissection or physician pathological stage indicating the absence or presence of ENE can be used to code this data item when no other information is available. **Note 2:** Extranodal extension is defined as “the extension of a nodal metastasis through the lymph node capsule into adjacent tissue.” ENE is the preferred terminology. Other names include: extranodal spread, extracapsular extension, or extracapsular spread. * “A regional node extending into a distant structure or organ is categorized as ENE and is not recorded as distant metastatic disease.” **Note 3:** Code the status of ENE assessed on histopathologic examination of **surgically resected** involved regional lymph node(s). Do not code ENE from a lymph node biopsy (FNA, core, incisional, or the absence of ENE from a sentinel). Do not code ENE for any distant lymph nodes. Code the status of ENE based on the following criteria * Code 0.0 * Absence of ENE, positive lymph nodes assessed by lymph node dissection * 1292: Scope of Regional Lymph Node Surgery must be 3-7 * Codes 0.1-9.9, X.1, X.2, X.3, X.4 as appropriate for * Presence of ENE assessed by Sentinel Lymph Node biopsy * Presence of ENE assessed by lymph node biopsy * 1292: Scope of Regional Lymph Node Surgery must be 2-7 * Code X.7 as appropriate for * Lymph nodes negative for cancer assessed by Sentinel lymph node biopsy or lymph node dissection * 1292: Scope of Regional Lymph Node Surgery must be 2-7 * Code X.9 * Absence of ENE, positive lymph nodes assessed by Sentinel Lymph Node biopsy * A positive Sentinel Lymph Node biopsy cannot assess the absence of ENE, only the presence of it. This is because there is not enough surrounding tissue in a Sentinel Lymph node biopsy to accurately assess ENE * If codes 0.1-0.9, X.1-X.7 are used, this indicates that the lymph nodes were surgically resected or a Sentinel Lymph Node biopsy was done and Scope of Regional Lymph Node Surgery [NAACCR Data Item: 1292] must be 2-7 **Note 4:** Be aware that the rules for coding ENE for head and neck sites compared to non-head and neck sites are different. **Note 5:** Definitions of ENE subtypes and rules: * Microscopic ENE [ENE (mi)] is defined as less than or equal to 2 mm. * Major ENE [ENE (ma)] is defined as greater than 2 mm. * Both ENE (mi) and ENE (ma) qualify as ENE (+) for definition of pN. **Note 6:** The measurement of ENE is the distance from the lymph node capsule in millimeters (mm).| Code | Description |
|---|---|
| 0.0 | Lymph nodes positive for cancer but ENE not identified or negative |
| 0.1-9.9 | ENE 0.1 to 9.9 mm |
| X.1 | ENE 10 mm or greater |
| X.2 | ENE microscopic, size unknown Stated as ENE (mi) |
| X.3 | ENE major, size unknown Stated as ENE (ma) |
| X.4 | ENE present, microscopic or major unknown, size unknown |
| X.7 | Surgically resected regional lymph node(s) negative for cancer (pN0) |
| X.8 | Not applicable: Information not collected for this case (If this information is required by your standard setter, use of code X.8 may result in an edit error) |
| X.9 | Not documented in medical record No surgical resection of regional lymph node(s) Non-invasive neoplasm (behavior /2) ENE not assessed pathologically, or unknown if assessed Pathological assessment of lymph node(s) not done, or unknown if done |