Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas The official version of this document is online at www.cancerstaging.org/cstage/manuals. 29 April 2010 Part II - Salivary Glands - 1 Version 02.02.00 Parotid Gland C07.9 C07.9 Parotid gland Note: Laterality must be coded for C07.9. CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and Neck CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular Lymph Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and Neck CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head and Neck CS Site-Specific Factor 10 CS Site-Specific Factor 11 CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25 The following tables are available at the collaborative staging website: Histology Inclusion Table AJCC 7th ed. Histology Exclusion Table AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage Extension Size Table Lymph Nodes Size Table Parotid Gland CS Tumor Size (Revised: 07/29/2009) Note 1: Code the specific tumor size as stated in the medical record. Use code 992 or 994 if the physician's statement about T value is the ONLY information available about the size of the tumor. (Refer to the CS Extension table for instructions on coding extension.) Code Description 000 No mass/tumor found 001-988 001 - 988 millimeters (code exact size in millimeters)
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Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 1 Version 02.02.00
210 Multiple positive ipsilateral nodes, any listed in code
110 (WITH or WITHOUT nodes listed in code
100)
^ * D RN
220 Multiple positive ipsilateral nodes, any listed in code
120 (WITH or WITHOUT nodes listed in code 100
or 110)
^ * D D
290 Stated as N2b, no other information N2b N2b RN RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 8 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
300 Regional lymph nodes listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
^ * RN RN
310 Regional lymph nodes listed in code 110:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D RN
320 Regional lymph nodes listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D D
400 Regional lymph nodes listed in code 100:
Positive bilateral or contralateral nodes
^ * RN RN
410 Regional lymph nodes, any listed in code 110:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100)
^ * D RN
420 Regional lymph nodes, any listed in code 120:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100 or 110)
^ * D D
490 Stated as N2c, no other information N2c N2c RN RN
500 Regional lymph nodes listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * RN RN
510 Regional lymph nodes as listed in code 110:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D RN
520 Regional lymph nodes listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D D
600 Stated as N2, NOS N2NOS N2NOS RN RN
700 Stated as N3, no other information N3 N3 RN RN
800 Lymph nodes, NOS, no other information ^ * RN RN
999 Unknown; not stated
Regional lymph node(s) cannot be assessed
Not documented in patient record
NX NX U U
^ For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 7th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
* For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 6th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 9 Version 02.02.00
Parotid Gland
CS Lymph Nodes Eval (Revised: 10/26/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on physical
examination, imaging examination, or other non-invasive clinical evidence. No
autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging based on at least one of the following
criteria:
No regional lymph nodes removed for examination. Evidence based on endoscopic
examination, or other invasive techniques including surgical observation, without
biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of regional
lymph nodes or sentinel nodes as part of the diagnostic workup, WITHOUT removal
of the primary site adequate for pathologic T classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from autopsy
(tumor was suspected or diagnosed prior to autopsy).
p
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 10 Version 02.02.00
Code Description Staging
Basis
3 Meets criteria for AJCC pathologic staging based on at least one of the following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core needle bx,
excisional bx, sentinel node bx or node resection), WITH removal of the primary site
adequate for pathologic T classification (treatment) or biopsy assessment of the highest
T category.
OR
Any microscopic assessment of a regional node in the highest N category, regardless of the
T category information.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on clinical evidence, unless the pathologic evidence at surgery
(AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on pathologic evidence, because the pathologic evidence at
surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Parotid Gland
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
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Parotid Gland
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Parotid Gland
CS Mets at DX (Revised: 07/23/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
Distant lymph node(s) plus other distant metastases
M1 M1 D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 M1 D D
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 MX U U
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 12 Version 02.02.00
Parotid Gland
CS Mets Eval (Revised: 08/10/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging examination,
and/or other non-invasive clinical evidence. No pathologic examination of metastatic
tissue performed or pathologic examination was negative.
c
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other invasive
technique, including surgical observation without biopsy. No pathologic examination
of metastatic tissue performed or pathologic examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but positive
metastatic evidence derived from autopsy (tumor was suspected or diagnosed prior to
autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical systemic
treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-surgical
systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant treatment.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on clinical evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on pathologic evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND tumor was
unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 13 Version 02.02.00
Parotid Gland
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 14 Version 02.02.00
Parotid Gland
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 15 Version 02.02.00
Parotid Gland
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Parotid Gland
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 16 Version 02.02.00
Code Description
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Parotid Gland
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 17 Version 02.02.00
Parotid Gland
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Salivary Glands - 18 Version 02.02.00
Parotid Gland
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
Parotid Gland
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Salivary Glands - 19 Version 02.02.00
Code Description
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Parotid Gland
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
010 Nodes involved pathologically, no extracapsular extension pathologically
220 Multiple positive ipsilateral nodes, any listed in code
120 (WITH or WITHOUT nodes listed in code
100)
^ * D D
290 Stated as N2b, no other information N2b N2b RN RN
300 Regional lymph nodes listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
^ * RN RN
320 Regional lymph nodes listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D D
400 Regional lymph nodes listed in code 100:
Positive bilateral or contralateral nodes
^ * RN RN
420 Regional lymph nodes, any listed in code 120:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100)
^ * D D
490 Stated as N2c, no other information N2c N2c RN RN
500 Regional lymph nodes listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * RN RN
520 Regional lymph nodes listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D D
600 Stated as N2, NOS N2NOS N2NOS RN RN
700 Stated as N3, no other information N3 N3 RN RN
800 Lymph nodes, NOS ^ * RN RN
999 Unknown; not stated
Regional lymph node(s) cannot be assessed
Not documented in patient record
NX NX U U
^ For codes 100-120, 200-220, 300-320, 400-420, 500-520 and 800 ONLY, the N category for AJCC 7th Edition
Staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
* For codes 100-120, 200-220, 300-320, 400-420, 500-520 and 800 ONLY, the N category for AJCC 6th Edition
Staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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Submandibular Gland
CS Lymph Nodes Eval (Revised: 10/26/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on physical
examination, imaging examination, or other non-invasive clinical evidence. No
autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging based on at least one of the following
criteria:
No regional lymph nodes removed for examination. Evidence based on endoscopic
examination, or other invasive techniques including surgical observation, without
biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of regional
lymph nodes or sentinel nodes as part of the diagnostic workup, WITHOUT removal
of the primary site adequate for pathologic T classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from autopsy
(tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core needle bx,
excisional bx, sentinel node bx or node resection), WITH removal of the primary site
adequate for pathologic T classification (treatment) or biopsy assessment of the highest
T category.
OR
Any microscopic assessment of a regional node in the highest N category, regardless of the
T category information.
p
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Code Description Staging
Basis
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on clinical evidence, unless the pathologic evidence at surgery
(AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on pathologic evidence, because the pathologic evidence at
surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Submandibular Gland
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Submandibular Gland
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
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Code Description
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Submandibular Gland
CS Mets at DX (Revised: 03/30/2009) Note: Supraclavicular and transverse cervical lymph nodes are now coded in the CS Lymph Nodes table because
they are categorized as N rather than M in AJCC TNM.
CS Mets Eval (Revised: 08/10/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging examination,
and/or other non-invasive clinical evidence. No pathologic examination of metastatic
tissue performed or pathologic examination was negative.
c
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Code Description Staging
Basis
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other invasive
technique, including surgical observation without biopsy. No pathologic examination
of metastatic tissue performed or pathologic examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but positive
metastatic evidence derived from autopsy (tumor was suspected or diagnosed prior to
autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical systemic
treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-surgical
systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant treatment.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on clinical evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on pathologic evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND tumor was
unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Submandibular Gland
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
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Code Description
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Submandibular Gland
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
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Code Description
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Submandibular Gland
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
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Code Description
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Submandibular Gland
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Submandibular Gland
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
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Code Description
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Submandibular Gland
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Submandibular Gland
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
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Submandibular Gland
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Submandibular Gland
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
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Code Description
010 Nodes involved pathologically, no extracapsular extension pathologically
220 Multiple positive ipsilateral nodes, any listed in code
120 (WITH or WITHOUT nodes listed in code
100)
^ * D D
290 Stated as N2b, no other information N2b N2b RN RN
300 Regional lymph nodes listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
^ * RN RN
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Code Description TNM 7 TNM 6 SS77 SS2000
320 Regional lymph nodes listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D D
400 Regional lymph nodes listed in code 100:
Positive bilateral or contralateral nodes
^ * RN RN
420 Regional lymph nodes, any listed in code 120:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100)
^ * D D
490 Stated as N2c, no other information N2c N2c RN RN
500 Regional lymph nodes listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * RN RN
520 Regional lymph nodes listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D D
600 Stated as N2, NOS N2NOS N2NOS RN RN
700 Stated as N3, no other information N3 N3 RN RN
800 Lymph nodes, NOS ^ * RN RN
999 Unknown; not stated
Regional lymph node(s) cannot be assessed
Not documented in patient record
NX NX U U
^ For codes 100-120, 200-220, 300-320, 400-420, 500-520 and 800 ONLY, the N category for AJCC 7th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table for this site.
* For codes 100-120, 200-220, 300-320, 400-420, 500-520 and 800 ONLY, the N category for AJCC 6th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table for this site.
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Other and Unspecified Major Salivary Glands
CS Lymph Nodes Eval (Revised: 10/26/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on physical
examination, imaging examination, or other non-invasive clinical evidence. No
autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging based on at least one of the following
criteria:
No regional lymph nodes removed for examination. Evidence based on endoscopic
examination, or other invasive techniques including surgical observation, without
biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of regional
lymph nodes or sentinel nodes as part of the diagnostic workup, WITHOUT removal
of the primary site adequate for pathologic T classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from autopsy
(tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core needle bx,
excisional bx, sentinel node bx or node resection), WITH removal of the primary site
adequate for pathologic T classification (treatment) or biopsy assessment of the highest
T category.
OR
Any microscopic assessment of a regional node in the highest N category, regardless of the
T category information.
p
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Code Description Staging
Basis
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on clinical evidence, unless the pathologic evidence at surgery
(AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on pathologic evidence, because the pathologic evidence at
surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Other and Unspecified Major Salivary Glands
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Other and Unspecified Major Salivary Glands
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
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Code Description
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Mets at DX (Revised: 07/23/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
Distant lymph node(s) plus other distant metastases
M1 M1 D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 M1 D D
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 MX U U
Other and Unspecified Major Salivary Glands
CS Mets Eval (Revised: 08/10/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging examination,
and/or other non-invasive clinical evidence. No pathologic examination of metastatic
tissue performed or pathologic examination was negative.
c
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Code Description Staging
Basis
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other invasive
technique, including surgical observation without biopsy. No pathologic examination
of metastatic tissue performed or pathologic examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but positive
metastatic evidence derived from autopsy (tumor was suspected or diagnosed prior to
autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical systemic
treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-surgical
systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant treatment.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on clinical evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on pathologic evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND tumor was
unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
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Code Description
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
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Code Description
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
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Code Description
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
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Code Description
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
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Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Other and Unspecified Major Salivary Glands
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
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Code Description
010 Nodes involved pathologically, no extracapsular extension pathologically