Cases of this type should be discussed with the physician who assigned the TNM. If there is a discrepancy between documentation in the medical record and the physician's assignment of TNM, the documentation takes precedence.If the only indication of lymph node involvement in the record is the physician's statement of an N category from the TNM staging system or a stage from a site-specific staging system, such as Dukes' C, record the numerically lowest equivalent CS lymph node code for that category.The size of the metastasis within the lymph node can be inferred if the size for the entire node falls within one of the codes for example a single involved node 1.5 cm in size can be coded to "single lymph node less than 2 cm" because the metastasis cannot be larger than 1.5 cm. Code the size of the metastasis, not the entire node, except as noted in site-specific instructions.When size of involved regional lymph nodes is required, code from pathology report, if given.Where more specific categories are provided, the codes for "regional lymph node(s), NOS" and "lymph nodes, NOS" should be used only after an exhaustive search for more specific information. Any unidentified nodes included with the resected primary site specimen are to be coded as regional lymph nodes, NOS.The terms "homolateral," "ipsilateral," and "same side" are used interchangeably.If regional lymph nodes for these inaccessible sites are not mentioned on imaging or exploratory surgery, they are presumed to be clinically negative. The best description concerning regional lymph nodes will be on imaging studies or the surgeon's evaluation at the time of exploratory surgery or definitive surgery. Regional lymph nodes are not palpable for inaccessible sites such as bladder, kidney, prostate, esophagus, stomach, lung, liver, corpus uteri and ovary.For lymphomas, any mention of lymph nodes is indicative of involvement.Any other terms, such as "palpable," "enlarged," "visible swelling," "shotty," or "lymphadenopathy" should be ignored (except for adenopathy, enlargement, and mass in the hilum or mediastinum for lung primaries) unless there is a statement of involvement by the clinician.
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