Regional lymph nodes are listed for each site in the
summary staging manual.
1. Consider the highest specific lymph node chain that is
involved by tumor.
2. For lymphomas, any mention of lymph nodes is indicative
of involvement and is used to determine the number and location
of lymph node chains involved (see lymphoma scheme).
3. For solid tumors, the terms "fixed" or "matted" and "mass
in the mediastinum, retroperitoneum, and/or mesentery" (with
no specific information as to tissue involved) are considered
involvement of lymph nodes.
4. Terms, such as "palpable," "enlarged," "visible swelling,"
"shotty," or "lymphadenopathy" should be ignored (except for
lung primaries); look for a statement of involvement, either
clinically or pathologically. For lung primaries, these terms
are interpreted as regional lymph node involvement.
5. The terms "homolateral" and "ipsilateral"
are used interchangeably. Any unidentified nodes included
with the resected primary site specimen are to be considered
as "Regional Lymph Nodes, NOS."
6. If the only indication of lymph node involvement in the
record is the physician' statement of an N category from the
TNM
staging system or a stage from a site-specific
staging system, such as "Duke's C," consider that information
in determining regional lymph node involvement.
7. If there is a discrepancy between documentation in the
medical record and the physician's assignment of a TNM stage,
the documentation takes precedence. Cases of this type should
be discussed with the physician who assigned the TNM stage
(see General Guideline 9).
8. If a specific chain of lymph nodes is named, but not listed
as regional, first determine if the name is synonymous for
a listed lymph node. Otherwise, assume distant lymph node(s)
are involved.
Note: Regional lymph nodes are not palpable for inaccessible
sites such as bladder, kidney, prostate, esophagus, stomach,
lung, liver, corpus uteri, and ovary. The best description
concerning regional lymph nodes will be the surgeon's evaluation
at the time of exploratory surgery or definitive surgery.
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