Note 1 Physician statement of Levels IV-V lymph node involvement can be used to code this data item when no other information is available.

Note 2 Head and Neck Lymph Node Involvement is coded in the following data items

• LN Head and Neck Levels I-III (NAACCR Data Item #3876)
• LN Head and Neck Levels IV-V (NAACCR Data Item #3877)
• LN Head and Neck Levels VI-VII (NAACCR Data Item #3878)
• LN Head and Neck Other (NAACCR Data Item #3879)

Note 3 Code the presence or absence of lymph node involvement for Levels IV-V

• For more information on Levels IV-V lymph nodes, see AJCC 8th edition, Chapter 5 Staging Head and Neck Cancers, Table 5.1

Note 4 If lymph nodes are described only as “supraclavicular,” try to determine if they are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior triangle, inferior to the transverse cervical artery) and code appropriately.

• If the specific level cannot be determined, or is documented as supraclavicular with no further information, code them as Level V nodes

Note 5 Pathological information takes priority over clinical.

Note 6 If involved regional node levels are documented as a range, and/or if the involved nodes overlap multiple levels, code all levels specified.

Note 7 If information is available on some nodes, but the others are unknown, code what is known.

• *Example* Multiple lymph nodes involved, level V documented, but the other levels not mentioned. Code 2 to indicate level V involvement.