04-18-2025
- PET: 2.1 cm RUL mass with moderate activity. Malignancy cannot be excluded. Nonspecific 1.2 x 0.7 cm left lower cervical lymph node with mild activity. No hypermetabolic masses are identified in the abdomen or pelvis
- Ultrasound-guided biopsy of left cervical lymph node: metastatic adenocarcinoma, consistent with lung primary
Question: Are mets to the lower cervical lymph nodes reflected in the cN or cM category?
- cN
- cM
Answer: cN- regional lymph node mets
Discussion: Although metastasis to the Ipsilateral or Contralateral Low cervical/Supraclavicular node(s) are considered regional nodes when assigning AJCC Stage and EOD, the Summary Stage manual considers mets to Ipsilateral or Contralateral Low Cervical/Supraclavicular node(s) Distant lymph node mets.
TIP: Be sure to code the field according to the instructions in the appropriate manual for that field. Do not mix and match instructions from various manuals for other fields.
| Field | Code | Definition |
| AJCC clinical N Category | cN3 | AJCC 8th Edition Chapter 36 Lung Refer to Fig. 36.1 & Table 36.1, the same info is also in Version 9 Per IASLC Low cervical nodes are in the Supraclavicular Zone, Lymph node Station 1 |
| EOD Regional Nodes | 600 | EOD Manual IPSILATERAL or CONTRALATERAL Low cervical Proximal root Scalene (inferior deep cervical) Sternal notch Supraclavicular (transverse cervical) |
| EOD Mets | 00 | EOD Manual No distant metastasis |
| Summary Stage | 7 | Summary Stage Manual 2018 Distant lymph node(s), NOS IPSILATERAL or CONTRALATERAL Low cervical |