An elective neck dissection specimen from a level I–III selective neck dissection for oral cavity cancer is sent for histopathology. The pathologist identifies a single 1.5 cm lymph node at level II with microscopic tumor deposits and no extranodal extension. According to AJCC 8th edition, what is the pathological N classification?
- A pN2a
- B pN1 ✓
- C pN2b
- D pN3a
Correct answer: B. pN1
Explanation
Under AJCC 8th edition oral cavity nodal staging, a single ipsilateral lymph node ≤3 cm without extranodal extension (ENE) is classified as N1 (pN1). N2a is assigned when a single ipsilateral node is >3 cm but ≤6 cm (no ENE) or when any node ≤3 cm has ENE. N2b denotes multiple ipsilateral nodes, none >6 cm, without ENE. N3a is reserved for nodes >6 cm without ENE. Here the node is 1.5 cm with no ENE, so it is pN1.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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