August 30, 2024
Tumor Tip of the Week 08-30-2024 Regional Node Positive/Examined Document Where They Come From
Scenario#1: Positive FNA of a lymph node in same lymph node chain removed at surgery
- Lung Cancer
- FNA Hilar Node+
- Lobectomy 3 Hilar nodes +, 2/11 Mediastinal Nodes +
| LN Station | Result | Regional LN Positive | Regional LN Examined |
| Hilar | 1 FNA (+) 3 Nodes + | 3 per STORE/SEER Do not count a positive aspiration or core biopsy of a lymph node in the same lymph node chain removed at surgery as an additional node in Regional Nodes Positive when there are positive nodes in the resection. | 3 Per STORE/SEER Do not count an aspiration or core biopsy of a lymph node in the same lymph node chain removed at surgery as an additional node in Regional Nodes Examined |
| Mediastinal | 2/11 Nodes + | 2 | 11 |
| TOTAL | 05 | 14 |
Scenario#2: Positive FNA from a node in a different region
- Right Breast Cancer
- FNA Ipsilateral Supraclavicular Node + {per AJCC this is considered a regional lymph node for breast}
- Right Axillary Dissection 4/9 nodes Positive
| LN Station | Result | Regional LN Positive | Regional LN Examined |
| Supraclavicular | 1 FNA (+) | 1 Per STORE/SEER Include the node in the count of Regional Nodes Positive when the positive aspiration or core biopsy is from a node in a different node region | 1 Per STORE/SEER Include the node in the count of Regional Nodes Examined when the aspiration or core biopsy is from a node in a different node region |
| Axillary | 4/9 Nodes + | 4 | 9 |
| TOTAL | 05 | 10 |
Scenario #3: Positive/Negative FNA’s in Same & Different Lymph Node Regions
- Right Lung Cancer
- FNA Level 4,7, 10R are negative, but FNA level 11R+
- Lobectomy w/ Mediastinal LN Dissection: Level 7 (1 node negative), Level 12 R (6 nodes negative)
| LN Station | Result | Regional LN Positive | Regional LN Examined | Rationale |
| 7 | 1 FNA (-) 1 LN Excised (-) | 00 | 1 Per STORE/SEER Do not count an aspiration or core biopsy of a lymph node in the same lymph node chain removed at surgery as an additional node in Regional Nodes Examined | Per STORE/SEER Include the node in the count of Regional Nodes Examined when the aspiration or core biopsy is from a node in a different node region |
| 4 | 1 FNA (-) | 00 | 1 | |
| 10R | 1 FNA (-) | 00 | 1 | |
| 11R | 1 FNA + | 95 Per STORE/SEER Use code 95 when a positive lymph node is aspirated and surgically resected lymph nodes are negative | 1 | |
| 12R | 6 LN Excised (-) | 00 | 6 | |
| TOTAL | 95 | 10 |
Scenario#4: Positive FNA of a lymph node Unknown if in same lymph node chain removed at surgery
- Lung Cancer
- FNA Regional Node+ at another facility (no further information available)
- Level 7 (1 node+), Level 12R (6 nodes negative)
| LN Station | Result | Regional LN Positive | Regional LN Examined |
| Regional Node NOS | 1 FNA (+) | Assume the lymph node that is core-biopsied or aspirated is part of the lymph node chain surgically removed and do not include it in the count of Regional Nodes Positive when its location is not known | Assume the lymph node that is aspirated or core-biopsied is part of the lymph node chain surgically removed and do not include it in the count of Regional Nodes Examined when its location is not known |
| Level 7 | 1 node + | 1 | 1 |
| 12R | 6 nodes – | 0 | 6 |
| TOTAL | 01 | 07 |
